Small Bowel Diseases Flashcards

1
Q

In what 3 places can cause an obstruction in the small bowel occur

A

Within the lumen
Within the wall
Outside the wall

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2
Q

Describe the 5 symptoms a patient would present with in a small bowel obstruction

A
Pain (colicky, central)
Absolute constipation
Vomiting
Burping
Abdominal Distension
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3
Q

What could cause an obstruction within the lumen

A

Gallstones - fistulates the small bowel and then passes through before becoming stuck in the ileocaecal junction
Food
Bezoar (stony concretion formed in the stomach)

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4
Q

What could cause an obstruction within the wall?

A

Tumour,
Crohn’s disease,
Radiation

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5
Q

What could cause an obstruction outside the wall?

A

Adhesions,

Hernias (bits of bowel going places they shouldn’t)

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6
Q

What is Borborygmi?

A

a rumbling or gurgling noise made by the movement of fluid and gas in the intestines.

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7
Q

What investigations should we do for a suspected bowel obstruction?

A

Urinalysis
Full set of Bloods
Blood gases

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8
Q

How do we confirm the diagnosis of a small bowel obstruction

A

AXR
Contrast CT of abdomen
Gastrograffin studies

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9
Q

What is the treatment for a small bowel obstruction

A
ABC
Analgesia
Fluids with potassium
Catheterise
NG tube to drain the stomach 
Anti-thromboembolism measures
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10
Q

Why do we give potassium to the patient?

A

K+ will have been lost in vomit

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11
Q

What is drip and suck?

A

Conservative treatment

patient receives fluids and has a drainage NG

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12
Q

How long do we drip and suck for?

A

72 hours is standard

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13
Q

What 3 reasons would we intervene earlier than 72 hours?

A

Strangulation
Perforation
ischaemia

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14
Q

What type of operation is performed to resolve an obstruction

A

Laparotomy - complete opening up of the stomach

Sometimes laparoscopic (keyhole)

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15
Q

What can cause mesenteric ischaemia?

A

Embolus, thrombosis (arterial and venous)

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16
Q

Describe chronic mesenteric ischaemia

A

Superior Mesenteric artery
cramps
angina of the gut
atherosclerosis

17
Q

Describe acute mesenteric ischaemia

A

Small bowel usually gets infarcted

18
Q

Why is the small bowel more likely to die than the large bowel?

A

Small only has one blood supply

the colon has the marginal artery of Drummond

19
Q

How do we diagnose mesenteric ischaemia?

A

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

20
Q

How do we fix mesenteric ischaemia?

A

QUICKLY!
resect if non-viable
re-anastomse or staple and planned return

21
Q

How can we investigate a haemorrhage?

A
ABC 
Exclude upper source 
Vascular malformations
Ulceration
CT angiogram
22
Q

Describe Meckel’s Diverticulum

A

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

23
Q

What are 6 complications with Meckel’s Diverticulum

A
Bleed - prone to ulceration
Ulcerate 
Obstruction 
Malignant change
Diverticulitis 
Perforation
24
Q

How can we treat Meckel’s Diverticulum

A

Surgery to remove large diverticula

this is controversial

25
Q

What is the most common emergency operation

A

Appendectomy

26
Q

Describe the appendix

A
Vestigial organ 
Vermiform appendix 
retrocaecal
the tip can vary in location 
The base is constant - at the convergence of the three taenia
27
Q

Is appendicitis more common in men or women

A

Men

28
Q

Who is usually affected by appendicitis

A

Children / early adulthood

29
Q

What is the class picture for appendicitis

A
Central pain that migrates to the right ileac fossa
Anorexia
Nausea
no more than 1 or 2 vomits
Mild ocnstipation
30
Q

What are the clinical signs of appendicitis

A
Mild pyrexia
Mild tachycardia 
Localised painin the right ileac fossa
Guarding of the abdomen
Rebound tenderness
31
Q

Name 4 tests for appendicitis and describe each one

A

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?

32
Q

What are the 4 special cases of appendicitis - what is special?

A

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

33
Q

What is the Alvarado score?

A

The Alvarado Score for Acute Appendicitis determines likelihood of appendicitis based on symptoms, signs, and lab data.

34
Q

How do we manage appendicitis?

A
Analgesia 
Antipyretics 
Theatre 
Antibiotics 
Appendectomy
35
Q

What type of operation is best for an appendectomy

A

Laparasopic

36
Q

What are the 3 main emergency conditions affecting the small bowel?

A

Obstruction
Infarction
Haemorrhage