Small bowel disease Flashcards
who is more likely to get appendicitis
children
men, up to age 25 then equally males and females affected
cause of appendicitis
faecolith bacterial viral parasites tumour obstruction
describe the disease process of appendicitis
trigger factor inflammation and obstruction build up of mucus and exudate ischaemia and perforation peritonitis
who is more likely to have peritonitis as a result of appendicitis
immunosuppressed
older people
diabetics
those wit habsent omentum
what is rosvings sign?
pressing on the left cause pain on the right
what is psoas sign
patient keeps right him flexed to lift appendix off psoas
what is obturators sign
hip flexion will cause pain as inflamed appendix is touching obturator infernus
What is MANTRELS score
Migration of pain to RLQ -1 Anorexia -1 Nausea and vomiting -1 Tenderness to RLQ -2 Rebound pain -1 Elevated temp -1 Leukocytosis -2 WCC left shift -1
would an appendix mass be treated with surgery first line?
no, antibiotics
complications of appendicectomy
pelvic abscess infection intra-abdominal abscess DVT/PE right sided inguinal hernia faecal fistula portal pyaemia ileus respiratory issues post op
what is carcinoid of the appendix
tumour of crypts of leiberkuhn
causes of small bowel obstruction
gallstones food tumour chrons radiation adhesions herniation
causes of mesenteric ischaemia
embolus from AF vasoconstricting drugs compression hypercoagulable state dehydration
complications of meckel’s diverticulum
bleed
ulceration
obstruction
malignancy
where can the tip of the appendix be found?
convergence of tenia coli, sometimes further away
what is malabsorption
defective mucosal absorption
what is coeliac disease
mucosal lesion due to exposure to wheat, barley or rye
describe the disease process of coeliac disease
HLA-DQ8/HLA-DQ2 causes antigen presenting cells to bind to gluten and activate a T cell response
causes mucosal damage
what is lactose malabsorption
deficiency of lactase
what is tropical sprue
colonisation of intestine by infection or altered intestinal flora
how is tropical sprue diagnosed
biopsy
what causes whipple’s disease and how is it diagnosed
tropheryma whipplei
biopsy
how can chron’s disease cause malabsorption
extensive ileal involvement
extensive bowel resection
stricure
enterocolic fistulas
how is it possible to catch giardia lamblia
swimming/travel to areas of contaminated water
what is easy bruising a sign of
vitamin C/K deficiency
what is dermatitis herpetiformis a sign of
coeliac disease
acrodermatitis enteropathica is a sign of
impaired zinc uptake
nail spooning is a sign of
iron deficiency
glossitis and angular stomatitis are signs of
B vitamins and iron deficiency
what is malnutrition
nutrition that in excess or deficiency
cause of malnutrition
decreased food intake
impaired digestion/absorption
increased nutrition requirement
increased nutrient loss
consequence of malnutrition
infection poor wound healing GI dysfunction slow fat loss decreased hormone levels water retention prolonged recovery impaired immune system cardio-respiratory weakness
what vitamins are lower in the elderly
A, C, D, E and zinc
__ and ___ are best ways of identifying malnutrition
BMI
% weight loss
what biochemical tests may indicate malnutrition
albumin
transferrin
to who are oral nutrition supplements given to
intractable malabsorption dysphagia IBD post total gastrectomy SBS bowel fistulae
2 types of ETF
NG
NJ
indication of ETF
inadequate oral intake unconsciousness swallow disorder Upper GI obstruction GI dysfunction increased nutrient requirement
contraindication of ETF
lower GI obstruction
prolonged ileus
severe vomiting/diarrhoea
ischaemia
complications of ETF
nasal damage pharyngeal pouch rupture bronchial placement bleeding/perf tube falls out oesophagitis aspiration nausea pain refeeding syndrome fluid overload
what is parenteral nutrition
administration of nutrients via central/peripheral vein
what is the most likely cause of refeeding syndrome
ETF or PNF
metabolic features refeeding syndrome
hypokalaemia hypomagnesaemia altered glucose metabolism fluid overload hypophosphataemia
physiological features refeeding syndrome
arrhythmia altered consciousness level seizure respiratory failure cardiovascular collapse death
what is intestinal failure
inability to maintain adequate nutrition or fluid status via intestines
causes of Type 1 IF
ileus vomiting dysphagia pancreatitis GI obstruction diarrhoea malignancy/treatment
causes of Type 2 IF
chron's SMA radiation adhesions fistulae
causes of type 3 IF
SBS +/- Chron’s/radiation
dysmotility
malabsorption
inoperable obstruction
treating type 1 IF
replace fluid and electrolyte PNF if cannot tolerate oral >7 days PPI Octreotide some enteral feeding
treating type 2 IF
PNF and some enteral
treating type 3 IF
parenteral nutrition from home
transplant
Glucaon like peptide-2
complications of PNF
sepsis SVC thrombosis line fracture/leak nutrient toxicity liver disturbance
causes of SBS
Small recurrent resection
massive resection
gastric bypass
in IBD how many are affected by malnutrition
85%
most common nutritional deficiencies in IBD
iron vit D Weight loss anaemia folic acid B12
why should you minimise steroid use
factor leading to osteoporosis
what is EEN
withdrawl of all food and drink except water
replaced by enteral nutrition
oral/NG
what is FODMAP
fermentable oligosaccharides disaccharides monosaccharides and polyols
