Small Bowel Diseases Flashcards
In what 3 places can cause an obstruction in the small bowel occur
Within the lumen
Within the wall
Outside the wall
Describe the 5 symptoms a patient would present with in a small bowel obstruction
Pain (colicky, central) Absolute constipation Vomiting Burping Abdominal Distension
What could cause an obstruction within the lumen
Gallstones - fistulates the small bowel and then passes through before becoming stuck in the ileocaecal junction
Food
Bezoar (stony concretion formed in the stomach)
What could cause an obstruction within the wall?
Tumour,
Crohn’s disease,
Radiation
What could cause an obstruction outside the wall?
Adhesions,
Hernias (bits of bowel going places they shouldn’t)
What is Borborygmi?
a rumbling or gurgling noise made by the movement of fluid and gas in the intestines.
What investigations should we do for a suspected bowel obstruction?
Urinalysis
Full set of Bloods
Blood gases
How do we confirm the diagnosis of a small bowel obstruction
AXR
Contrast CT of abdomen
Gastrograffin studies
What is the treatment for a small bowel obstruction
ABC Analgesia Fluids with potassium Catheterise NG tube to drain the stomach Anti-thromboembolism measures
Why do we give potassium to the patient?
K+ will have been lost in vomit
What is drip and suck?
Conservative treatment
patient receives fluids and has a drainage NG
How long do we drip and suck for?
72 hours is standard
What 3 reasons would we intervene earlier than 72 hours?
Strangulation
Perforation
ischaemia
What type of operation is performed to resolve an obstruction
Laparotomy - complete opening up of the stomach
Sometimes laparoscopic (keyhole)
What can cause mesenteric ischaemia?
Embolus, thrombosis (arterial and venous)