Small bowel disease Flashcards by Jamie Craig

who is more likely to get appendicitis

children

men, up to age 25 then equally males and females affected

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cause of appendicitis

faecolith 
bacterial
viral 
parasites 
tumour obstruction

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describe the disease process of appendicitis

trigger factor 
inflammation and obstruction 
build up of mucus and exudate 
ischaemia and perforation
peritonitis

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who is more likely to have peritonitis as a result of appendicitis

immunosuppressed
older people
diabetics
those wit habsent omentum

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what is rosvings sign?

pressing on the left cause pain on the right

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what is psoas sign

patient keeps right him flexed to lift appendix off psoas

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what is obturators sign

hip flexion will cause pain as inflamed appendix is touching obturator infernus

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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

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would an appendix mass be treated with surgery first line?

no, antibiotics

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complications of appendicectomy

pelvic abscess 
infection 
intra-abdominal abscess
DVT/PE
right sided inguinal hernia 
faecal fistula 
portal pyaemia 
ileus 
respiratory issues post op

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what is carcinoid of the appendix

tumour of crypts of leiberkuhn

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causes of small bowel obstruction

gallstones 
food 
tumour 
chrons 
radiation 
adhesions 
herniation

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causes of mesenteric ischaemia

embolus from AF
vasoconstricting drugs 
compression 
hypercoagulable state 
dehydration

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complications of meckel’s diverticulum

bleed
ulceration
obstruction
malignancy

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where can the tip of the appendix be found?

convergence of tenia coli, sometimes further away

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what is malabsorption

defective mucosal absorption

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what is coeliac disease

mucosal lesion due to exposure to wheat, barley or rye

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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

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what is lactose malabsorption

deficiency of lactase

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what is tropical sprue

colonisation of intestine by infection or altered intestinal flora

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how is tropical sprue diagnosed

biopsy

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what causes whipple’s disease and how is it diagnosed

tropheryma whipplei

biopsy

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how can chron’s disease cause malabsorption

extensive ileal involvement
extensive bowel resection
stricure
enterocolic fistulas

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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 ```