Small Bowel Disease Flashcards
describe the pathology of appendicitis
- lumen may or may not be occluded
- mucosal inflammation
- lymphoid hyperplasia
- obstruction
- build up of mucus and exudate
- venous obstruction
- perforation
describe the clinical diagnosis of appendicitis
- central pain that migrates to RIF
- anorexia
- nausea
- vomiting
- may not have bowel movement
- pelvic/rectal pain
signs of appendicitis
- mild pyrexia
- mild tachycardia
- localised pain in RIF
- guarding
- rebound
specific signs and tests of appendicitis
- Rosvings: pressing on left causes pain to the right
- Psoas: patients keep the right hip flexed as this lifts an inflammed appendix off the psoas
- Obturator: if appendix is touching obtrurator interus, flexing the hip and internally rotating will cause pain
give some examples of differential diagnosis of appendicitis in children
- gastoenteritis
- mesenteric adentis
give some examples of differential diagnosis of appendicitis in adults
- Terminal ileitis
- Ureteric colic
- Acute pyelonephritis
- Perforated ulcer
- Pancreatitis
- Rectus sheath haemotoma
- ovarian cyst
give some examples of differential diagnosis of appendicitis in elderly
Sigmoid diverticulitis
Intestinal obstruction
Carcinoma of the caecum
explain what investigations would be done for appendicitis
- Blood (CRP, WCC)
- urinalysis
explain the management of appendicitis
- analgesia
- antipyretics
- theatre
- antibiotics
- appendectomy
what would you do in the case of an appendix mass?
- antibiotics
- operation if possible
give some examples of appendicitis complications
- pelvic abscess
- wound infection
- intra-abdominal absess
what causes small bowel obstruction within the lumen?
gallstones, food, bezoar
what causes small bowel obstruction within the wall
tumour, Crohn’s disease, radiation
what causes small bowel obstruction outside the wall
adhesions, herniation
what is the presentation of small bowel obstruction?
- distension
- vomiting
- borborygmi
- pain
what investigations would you do if you were assessing the state of the patient?
- urinalysis
- bloods
- gases
what investigations would you do if you were confirming the diagnosis?
- AXR
- contract CT scan of abdomen
- gastrograffin studies
what would you do if you found SBO?
- ABC
- analgesia
- fluids with potassium
- they are usually hypokalaemic and alkalotic
- catheterise
- NG tubee
- antithrombolembolism
what causes mesenteric ischaemia?
- embolus from AF (forms in left atrium),
- thrombosis (virchows triad)
- chronic (like angina of the guts)
how do you diagnose mesenteric ischaemia?
- acidosis on gases
- lactate elevated
- CRP may be normal
- WCC may be up a bit
- CT angiogram
what is Meckel’s Diverticulum?
outpouching or bulge in the lower part of the small intestine
congenital
