Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

GI and General Surgery > Small Bowel > Flashcards

Small Bowel Flashcards

1
Q

What is a hernia?

A

an abnormal protrusion of a viscus outwith its normal body cavity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are predisposing factors for hernias?

A 
coughing 
constipation 
pregnancy 
obesity 
heavy lifting
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the different types of hernia?

A 
hiatus 
incisional 
epigastric 
obturator 
paraumbilical 
umbilical 
femoral 
inguinal (direct or indirect)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is an incisional hernia?

A

protrusion of contents of cavity through an incision (after operation) - usually abdo surgery
structurally weakened anterior abdo wall

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is a paraumbilical hernia?

A

through linea alba (around umbilical region - not umbilicus itself)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is an umbilical hernia?

A

congenital

  • omphalocele
  • gastroschisis

operate if not resolved by 3 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is an obturator hernia?

A

hernia of pelvic floor through obturator foramen into obturator canal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How does an obturator hernia present?

A

mass in medial upper thigh, symptoms of bowel obstruction?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the differences between a direct and an indirect inguinal hernia?

A

indirect - bowel enters canal via deep inguinal ring, lateral to inferior epigastric vessels, controlled by digital pressure over internal/deep inguinal ring when patient coughs

direct - weakness in posterior wall of canal (transversalis fascia), medial to inferior epigastric vessels, poorly controlled by digital pressure over deep ring

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Where is the deep inguinal ring?

A

midpoint of inguinal ligament

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How would a hernia present?

A

non pulsatile, reducible, soft and non tender swelling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is a strangulated hernia? How would it present?

A

comprimised blood supply - ischaemia
pain ++
irreducible and tender tense lump

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is an incarcerated hernia?

A

contents unable to return to original cavity

irreducible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How would an obstructed hernia present?

A

distension, vomiting, constipation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How can you tell the difference between an inguinal and a femoral hernia?

A

location

superomedial to pubic tubercle - inguinal
inferolateral to pubic tubercle - femoral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How are hernias diagnosed?

A

clinical diagnosis

USS if unclear diagnosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the indications for surgery for hernias?

A

symptomatic
risk of complications (e.g. femoral hernias)
strangulation (urgent surgery)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the conservative management of hernias?

A

discuss symptoms of hernia emergencies (strangulation) and tell to go to A+E if they have them

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the surgical management of hernias?

A

open or laparascopic mesh repair

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the complications of hernia surgery?

A

chronic pain
recurrence
damage to structures e.g. vas deferens

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What hernia has a high risk of strangulation?

A

femoral

due to narrow neck of canal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Who is more likely to get femoral hernias?

A

elderly women

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What can cause a bowel obstruction?

A

intraluminal

  • faecal impaction
  • gallstone ileus
  • foreign object

mural (wall)

  • carcinoma
  • inflammatory strictures
  • diverticular strictures
  • radiotherapy strictures

extramural

  • hernias
  • peritoneal mets
  • adhesions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What causes a large bowel obstruction until proven otherwise?

A

cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is a functional obstruction or paralytic ileus?

A

bowel not mechanically blocked but still not working

causes - inflammation, post surgery, electrolyte derangement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Why is urgent fluid resuscitation needed in bowel obstruction?

A

when bowel segment occluded
gross dilatation of proximal limb results in increased peristalsis
secretion of large volumes of electrolyte rich fluid

27
Q

What is a closed loop obstruction?

A

when a second obstruction occurs proximally to first obstruction

28
Q

What can cause a closed loop obstruction?

A

e. g. large bowel obstruction and competent ileocaecal valve

e. g. volvulus

29
Q

What happens in a closed loop obstruction?

A

bowel continues to dilate and dilate, stretches wall until ischaemia or perforation

30
Q

What are the clinical features of a bowel obstruction?

A

crampy abdo pain (secondary to increased peristalsis)

  • should not have guarding or rebound tenderness
  • unless ischaemia developing

vomiting
- if large bowel, ?no vomiting - due to ileocaecal valve

absolute constipation
- develops later on in proximal obstruction

distension
- tympanic percussion

31
Q

When might you get bilious vomit in bowel obstruction?

A

if obstruction is distal to duodenal papilla

32
Q

What are the investigations for suspected obstruction?

A 
urgent bloods 
- electrolyte changes 
venous blood gas
- ischaemia - increased lactate 
- metabolic derangement (vomiting, dehydration) 
CT scan with IV contrast 
- more sensitive than AXR 
- can show site and cause 
AXR
33
Q

How can you tell if it is small bowel or large bowel obstruction on AXR?

A
  • small bowel: central abdo, >3cm, valvulae conniventes visible
  • large bowel: peripheral location, >6cm, haustral lines visible
34
Q

What is the conservative management of bowel obstruction?

A

NBM
analgesia
IV fluids, catheter and fluid balance
NG tube - decompress bowel

35
Q

What is the surgical management of bowel obstruction?

A

laparotomy (?bowel resection)

36
Q

What are the indications for surgery in bowel obstruction?

A

failure to improve 48 hrs conservative
signs of ischaemia or closed loop obstruction
small bowel obstruction in abdo with no previous surgery
cause that needs correcting (tumour, hernia)

37
Q

What would signs of ischaemia be in bowel obstruction?

A

pain worse with movement
focal tenderness
pyrexia
guarding, rebound tenderness

38
Q

What is a volvulus?

A

twisting of a loop of intestine around its mesenteric attachment
leads to closed loop obstruction

39
Q

Wherecan a volvulus occur?

A

sigmoid

caecum

40
Q

Why do volvulus most often occur in the sigmoid colon?

A

long mesentry

41
Q

What sign is seen on AXR in sigmoid volvulus?

A

coffee bean sign

42
Q

What is a caecal volvulus?

A

colonic obstruction + competent ileocaecal valve

43
Q

What is the management of a volvulus?

A

sigmoidoscope decompression and flatus tube

surgery if: ischaemia or performation, failed decompression, necrotic bowel

44
Q

What are risk factors for volvulus?

A

male
neuropsychiatric conditions
previous abdo surgery

45
Q

What is Meckel’s diverticulum?

A

congenital outpouching of terminal ileum - embryonic remnant
- gastric mucosa (secretes stomach acid)

46
Q

How does Meckel’s diverticulum present?

A

acute abdo pain
usually children
usually asymptomatic

47
Q

How is Meckel’s diverticulum diagnosed and treated?

A

radionucleide scan - absorbed differently by stomach cells in diverticulum
surgical excision

48
Q

What is angiodysplasia of the colon?

A

formation of AVMs between previously healthy blood vessels in the bowel

49
Q

What are the clinical features of angiodysplasia?

A

fresh, intermittent rectal bleeding
painless
anaemia

50
Q

What is the management of angiodysplasia?

A

endoscopy coagulation

if more severe: embolisation or surgical resection

51
Q

How does GI malabsorption present?

A 
weight loss, malnutrition 
abdo bloating
steatorrhoea 
diarrhoea 
flatulence
52
Q

What are the causes of GI malabsorption?

A

infection - giardiasis
pancreatic insufficiency - CF, cancer
bowel causes - Crohn’s, coeliac, lactose intolerance, Whipples, tropical sprue

53
Q

How would you investigate malabsorption?

A

bloods: FBC, B12, anti TTG, calcium, folate
stool sample (microscopy)
hydrogen breath test
OGD and biopsy

54
Q

What is coeliac disease?

A

autoimmune hypersensitivity to gluten

T cell mediated response leading to villous atrophy

55
Q

How is coeliac disease diagnosed?

A

serum anti-TTG

confirmed with OGD + duodenal biopsy (villous atrophy)

56
Q

How is coeliac managed?

A

life long gluten free diet

57
Q

How does coeliac disease present?

A 
chronic, intermittent diarrhoea 
failure to thrive 
fatigue 
persistent GI symptoms 
anaemia 
weight loss
58
Q

What is lactose intolerance?

A

deficiency of lactase enzyme, causing intolerance of lactose
symptoms on eating dairy

59
Q

What causes lactose intolerance?

A

congenital - rare

usually secondary to infection, insult to bowel

60
Q

What is Whipples disease?

A

rare bacterial infection caused by Tropheryma whipplei
causes multisystem disorder
middle aged men

61
Q

How does Whipples disease present?

A

symptoms of malabsorption
arthritis
hyperpigmentation

62
Q

How is Whipples diagnosed and managed?

A

OGD and biopsy
PAS +ve macrophages, saggy mucosa

long term antibiotics

63
Q

How is bacterial overgrowth diagnosed?

A

hydrogen breath test

GI and General Surgery (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions