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 are some bowel wall causes of small bowel obstruction?

Answer 3

Tumours
Hernia
Volvulus
Crohn's disease
Radiation enteritis

Question 4

List some symptoms of small bowel obstruction

Answer 4

Colicky abdo pain
Absolute constipation (no flatus/burping)
Abdominal distention
Faeculent vomiting (ESP. SMALL BOWEL)

Question 5

What investigations are done for small bowel obstruction?

Answer 5

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

Question 6

Is surgery common for small bowel obstruction?

Answer 6

Not really as most settle with management

Question 7

Outline general treatment of small bowel obstruction

Answer 7

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

Question 8

When would surgery be done early for small bowel obstruction?

Answer 8

Strangulation
Perforation
Ischaemia
PREVENT DEAD GUTS

Question 9

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

Answer 9

True

Marginal artery of Drummond provides collateral supply

Question 10

What is the typical symptom of mesenteric ischaemia?

Answer 10

Cramping pain

Essentially “angina of the gut”

Question 11

What is the first-line treatment for mesenteric ischaemia?

Answer 11

Surgery!
No faffing around
PREVENT DEAD GUTS

Question 12

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

Answer 12

Resected (up to a limit)

Question 13

Where does Meckel’s diverticulum occur?

How does it arise?

Answer 13

60cm from ileocaecal valve

Remnant of vitello-intestinal duct from development

Question 14

When does Meckel’s diverticulum present?

Answer 14

Usually before 2yrs of age

Question 15

What is the most common cause of small bowel ischaemia?

Answer 15

Mesenteric atherosclerosis, thromboembolism

Question 16

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

Answer 16

Mucosa

It is the most metabolically active part

Question 17

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

Answer 17

True

Question 18

List some complications of small bowel ischaemia

Answer 18

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

Question 19

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

Answer 19

False
Secondary tumours (metastases) are more common

Question 20

List 3 primary tumours of small bowel

Answer 20

Lymphoma
Carcinoid tumours
Carcinoma

Question 21

Which cells are lymphomas derived from?

Answer 21

B cells

T cells

Question 22

What is coeliac disease?

Answer 22

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

Question 23

What is the characteristic histological appearance of coeliac disease?

Answer 23

Villous atrophy

Flat mucosal biopsy

Question 24

Which serology is used to investigate coeliac disease?

Answer 24

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

Question 25

What is adynamic bowel obstruction?

Answer 25

Bowel doesn’t peristalise (no obstruction)
Paralytic ileus - usually from surgery
Pseudoobstruction - in acutely unwell patients

Question 26

What are the symptoms of coeliac disease?

Answer 26

Weight loss and reduced appetitie
Mouth ulcers
Abdominal pain and bloating
Dermatitis herpetiforms
Steatorrhoea (malabsorption)
Anaemia
Vitamin deficiences

Question 27

What are the complications of coeliac disease?

Answer 27

Malignancy
Malabsorption
Osteoporosis