Small Bowel Disease

Question 1

What are some luminal causes of small bowel obstruction?

Answer 1

Gallstone ileus
Food
Bezoar (lump of hair)

Question 2

What is a gallstone ileus?

Answer 2

Large gallstone migrates via fistulas into the small intestine and become lodged

Question 3

What is the most common fistula associated with the gall bladder and small intestine?

Answer 3

Cholecystoduodenal

Question 4

What are some bowel wall causes of small bowel obstruction?

Answer 4

Tumours
Crohn’s disease
Radiation enteritis

Question 5

List some symptoms of small bowel obstruction

Answer 5

Colicky abdo pain
Absolute constipation (no flatus/burping)
Abdominal distention
Faeculent vomiting

Question 6

What investigations are done for small bowel obstruction?

Answer 6

FBC, urinalysis, blood gases
AXR, contrast CT abdomen
Enema XR if necessary

Question 7

Is surgery common for small bowel obstruction?

Answer 7

Not really as most settle with management

Question 8

Outline general treatment of small bowel obstruction

Answer 8

Analgesia
Fluids + potassium (lose K in vomit)
NG tube draining
Anti-embolism measures

Question 9

When would surgery be done early for small bowel obstruction?

Answer 9

Strangulation
Perforation
Ischaemia
PREVENT DEAD GUTS

Question 10

In mesenteric/small bowel ischaemia, the colon is usually unaffected. True/False?

Answer 10

True

Marginal artery of Drummond provides collateral supply

Question 11

What is the typical symptom of mesenteric ischaemia?

Answer 11

Cramping pain

Essentially “angina of the gut”

Question 12

What is the first-line treatment for mesenteric ischaemia?

Answer 12

Surgery! No faffing around

PREVENT DEAD GUTS

Question 13

Upon surgery, if part of the intestine is necrotised, what is done?

Answer 13

Resected (up to a limit)

Question 14

Where does Meckel’s diverticulum occur?

How does it arise?

Answer 14

60cm from ileocaecal valve

Remnant of vitello-intestinal duct from development

Question 15

When does Meckel’s diverticulum present?

Answer 15

Usually before 2yrs of age

Question 16

What is the most common cause of small bowel ischaemia?

Answer 16

Mesenteric atherosclerosis, thromboembolism

Question 17

Which layer of the bowel is most sensitive to hypoxia? Why?

Answer 17

Mucosa

It is the most metabolically active part

Question 18

Increasing the time of ischaemia increases the depth of small bowel infarction. True/False?

Answer 18

True

Question 19

List some complications of small bowel ischaemia

Answer 19

Resolution (if short-term ischaemia)
Scarring, fibrosis -> stricture
Gangrene
Perforation

Question 20

Primary tumours of small bowel are commoner than secondary tumours. True/False?

Answer 20

False
Secondary tumours (metastases) are more common

Question 21

List 3 primary tumours of small bowel

Answer 21

Lymphoma
Carcinoid tumours
Carcinoma

Question 22

Which cells are lymphomas derived from?

Answer 22

B cells

T cells

Question 23

What is coeliac disease?

Answer 23

Abnormal reaction to gluten + wheat products resulting in enterocyte damage + reduced absorption

Question 24

What is the characteristic histological appearance of coeliac disease?

Answer 24

Villous atrophy

Flat mucosal biopsy

Question 25

Which serology is used to investigate coeliac disease?

Answer 25

Anti-TTG, anti-endomesial, anti-gliadin antibodies