Small Bowel Disease Flashcards
What are the two types of bowel ischaemia?
Mesenteric arterial occlusion
Non-occlusive perfusion insufficiency
Describe the pathology of bowel ischaemia.
Mucosa -> mural infarct -> transmural infarct -> regeneration -> stricture -> gangrene
What are the main complications of ischaemia?
Perforation, peritonitis, sepsis, death
What causes Meckel’s diverticulum?
Incomplete regression of vitello-intestinal duct
Meckel’s diverticulum is usually asymptomatic, but what are the main complications?
Bleeding, perforation, diverticulitis
Name the two main types of malignant tumour in the small bowel.
Lymphoma, carcinoma
Are primary or secondary tumours more common in the small bowel?
Secondary
Describe the pathology of Coeliac’s.
Gluten (specifically gliadin) -> flattens mucosa -> increases intraepithelial lymphocytes (IELs) -> inflammation
Describe the red flag symptoms of Coeliac’s.
Weight loss, anaemia, failure to thrive, deficiencies, tumours
Which tests are used for diagnosis of Coeliac’s?
IgA serology. If positive, biopsy
Which tests are used for mesenteric ischaemia?
CT angiogram, laparotomy
Describe the surgical options for mesenteric ischaemia.
Not viable -> resection
Viable (rare) -> emblectomy
Too late/death -> open and close
What would an AXR show in small bowel obstruction?
A catepillar shape
What are the three main types of small bowel obstruction?
Lumen occlusion (i.e. gallstones)
Wall (tumours/Crohn’s)
Adhesions
What are the treatment options for small bowel obstruction?
ABC, resus, CT, gastrogaffin studies
Adhesions -> drip and suck
Occlusion -> surgery
What are the main causes of appendicitis?
Faecoliths, infection, tumour obstruction
How can appendicitis cause peritonitis?
Brings greater omentum in contact with the bowel
What is the main histological finding of peritonitis?
Yellow surface exudate
How does pain present in appendicitis?
Central colicky pain in the right iliac fossa
Guarding and rebound pain
Which four signs may indicate appendicitis?
Rosving’s, Psoas, Obturator, Pointing
What are the first steps for dealing with appendicitis?
FBC, urinalysis, analgesia, antipyretics, antibiotics
Laparascopic appendicectomy
What are the main complications of appendicits?
Infection (pneumonia), VTE, fistula, abscess
