Small Bowel Flashcards
Small bowel obstruction symptoms
Pain, colicky unless strangulated loop of bowel Vomiting -food-> gastric outlet -bile stained-> upper small bowel -faeculant-> distal Constipation Distension
Dehydration
Abdomen non tender
Tinkling bowel sounds
Succession splash
Small bowel obstruction causes
Extramural:
- adhesions-> previous surgery, chronic, radiotherapy, diverticulitis
- hernias
Mural:
- inflammatory stricture
- tumours
- lymphoma
Intra luminal:
- gall stone ileus
- phytobezoar
- trichobezoar
Small bowel obstruction investigations
Urine dip Bloods: -FBC -U+E -creatinine -CRP -cross match group and save
Radiological:
- supine ABX-> distended bowel loops
- CT scan to confirm
Small bowel obstruction management
Non operative:-> if not threat to bowel viability
- fluid and electrolyte replacement
- decompression with NG tube
- 4-6 hourly review
- repeated imaging
Operative:-> imminent perforation
- resus-> O2, fluids, analgesia
- laparoscopy
Upper GI haemorrhage causes
Peptic ulcer >50% Oesophageal varies Gastro duodenal erosions Zollinger Ellison Gastric cancer Malory Weiss tear
Upper GI bleed symptoms
Haematemesis
- fresh-> lower oesophagus to duodenal jejune like flexure
- digested-> coffee grounds-> oesophagus, stomach, duodenum
Melaena-> loose, reddish black tarry stools, foul smell
-upper GI bleed
If proximal to duodenal-jejunal flexure-> get both
Upper GI bleed risk factors
>60 Aspirin NSAIDs Alcohol Previous ulcer Gastric surgery Cirrhosis
Upper GI bleed investigations
Bloods:
- FBC
- U+E
- prothrombin
- INR
- LFTs
- cross match group and save
*test vomit for Hb
Asses for shock
Upper GI bleed management
Resuscitation Rockall risk score -age >60 -shock -co morbidity -diagnosis -evidence of bleeding >1=admit and endoscopy Maintain Hb greater than 10 Surgery if large blood loss/re bleed
Appendicitis pathophysiology
1) obstruction by impacts faeces/faecolith
2) mucosal inflammation
3) serousal inflammation-> localised pain via peritonitis
4) oedema-> compromises blood supply
5) necrosis
6) infarction
7) gangrene 12-24h
Appendicitis symptoms
Poorly localise Central abdo pain that moves to RIF
Appendicitis signs
RIF tenderness Guarding Rebound tenderness Tender Mc Burneys point Anterior tenderness in DRE
Appendicitis investigations
Often clinical Urinalysis Bloods Pregnancy test Plasma amylase Laparoscopy Ct scan USS females
Appendicitis complications
16-30% perforation Wound infection Appendix mass/abcess Paralytic ileus Sepsis Adhesions Haematoma
Chrons pathology
Granulomatous inflammation- full thickness of wall- transmural
Anywhere in the bowel- terminal ileum
Early disease-> oedema in the walls and superficial ulceration-> fissures and fibrous scaring
Established disease-> transmural inflammation-> cobble stones
-> adhesions and fistulas
Skip lesions-> areas of normal bowel
Chrons symptoms
80% diarrhoea Colicky abdo pain Weight loss Malaise and lethargy Nausea and vomiting Low fever Small bowel obstruction Anal fissures, skin tags and abscesses
Chrons investigations
Bloods:
- FBC anaemia and inflammation
- culture
- pANCA, should be negative
Stools:
- c diff toxin
- parasites
- increased calprotectin and lactoferrin
Colonoscopy:
- variable between early and advanced disease
- biopsy
Imaging:
- CT with contrast
- USS
- MRI
Chrons medical treatment
Aminosalicylates
Steroids
Cytotoxic drugs
Biologics
Chrons surgical management
Required by 80%
- > fix acute complications
- > persistent local ileal disease
- > intolerable long term obstructive
- > failure of medical
Strictoscopy
Resection and anastomoses
Pan protocolectomy and ileostomy
UC pathology
Chronic inflammation of rectal and colonic mucosa
Mucosa only
Terminal ileum may become involved if backwash
No skip lesions
Active disease-> rectal and colonic mucosal ulceration-> become con fluent
Chronic quiescent/treated-> red and thinned mucosa
Ruminant active disease-> extensive confluent ulceration
-> dilation-> toxic mega colon
UC symptoms
Diarrhoea with blood and mucous
Lower abdo discomfort
Systemic symptoms in more severe
Relapsing remitting
Truelove and Witts Classification of UC
>6 stools per day Temp >37.8 HR >90 Hb 30 -> severe disease
UC investigations
Bloods:
- FBC, iron deficiency anaemia, inflammation
- pANCA positive
Stools:
- infective causes
- amoebiasis
- increased calprotectin and lactoferrin
Colonoscopy:
- gold standard for assessment of disease severity
- biopsy
- NOT in severe attacks
Imaging:
-plain ABX, toxic mega colon
UC medical management
5-aminosalicyclates Prednislone Sulfesalazine Immunosuppression Biologics
