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)
Describe chronic mesenteric ischaemia
Superior Mesenteric artery
cramps
angina of the gut
atherosclerosis
Describe acute mesenteric ischaemia
Small bowel usually gets infarcted
Why is the small bowel more likely to die than the large bowel?
Small only has one blood supply
the colon has the marginal artery of Drummond
How do we diagnose mesenteric ischaemia?
Pain is out of proportion to clinical findings
Acidosis on gasses (low pH. high H+ concentration, high BE
Lactate elevated
CRP may be normal
WCC may be up a bit
CT angiogram
How do we fix mesenteric ischaemia?
QUICKLY!
resect if non-viable
re-anastomse or staple and planned return
How can we investigate a haemorrhage?
ABC Exclude upper source Vascular malformations Ulceration CT angiogram
Describe Meckel’s Diverticulum
An embryological remnant of the vitello-intestinal duct and is present in 2% of the population.
Usually situated 50cm from the ileocaecal valve, may be of varying length and may be associated with other congenital abnormalities. Less than 5% produce symptoms due to complications
What are 6 complications with Meckel’s Diverticulum
Bleed - prone to ulceration Ulcerate Obstruction Malignant change Diverticulitis Perforation
How can we treat Meckel’s Diverticulum
Surgery to remove large diverticula
this is controversial
What is the most common emergency operation
Appendectomy
Describe the appendix
Vestigial organ Vermiform appendix retrocaecal the tip can vary in location The base is constant - at the convergence of the three taenia
Is appendicitis more common in men or women
Men
Who is usually affected by appendicitis
Children / early adulthood
What is the class picture for appendicitis
Central pain that migrates to the right ileac fossa Anorexia Nausea no more than 1 or 2 vomits Mild ocnstipation
What are the clinical signs of appendicitis
Mild pyrexia Mild tachycardia Localised painin the right ileac fossa Guarding of the abdomen Rebound tenderness
Name 4 tests for appendicitis and describe each one
Rosving’s- pressing on the left side of the body causes pain on the right
Psoas - Good test in children. Patient keeps the right hip flexed to keep the appendix off the psoas
Obturator - flexing the hip and internally rotating causes pain
Pointing - where did the pain start and where is it now?
What are the 4 special cases of appendicitis - what is special?
Obese - very difficult to examine and still claim hunger
Elderly - gangrene and perforate more frequently. Usually have comorbid disease
Children - dont sleep and wont eat
Pregnancy - appendix is moved up and out - risk of miscarriage . Emergency MRI is required
What is the Alvarado score?
The Alvarado Score for Acute Appendicitis determines likelihood of appendicitis based on symptoms, signs, and lab data.
How do we manage appendicitis?
Analgesia Antipyretics Theatre Antibiotics Appendectomy
What type of operation is best for an appendectomy
Laparasopic
What are the 3 main emergency conditions affecting the small bowel?
Obstruction
Infarction
Haemorrhage
