Small Bowel Diseases

Question 1

How does a small bowel obstruction present?

Answer 1

abdominal pain
vomiting
abdominal distension
constipation

Question 2

What could be found on examination in a patient with a small bowel obstruction?

Answer 2

altered bowel habits
hernia
gallstones
PR bleeding
weight loss

Question 3

What is the management for small bowel obstruction?

Answer 3

IV fluids
Insert nasogastric tube
Catheterise
Monitor urine output
AXR
Antithromboembolism measures

Question 4

what is the surgical management of small bowel obstruction?

Answer 4

laparoscopy
give antibiotics
follow dilated or collapsed bowel to obstruction
Give antithromboembolic treatment

Question 5

What is mesenteric ischaemia?

Answer 5

a condition in which the supply of oxygen is too small to satisfy the needs of the intestines and is caused by an embolus from AF or thrombosis

Question 6

What would suggest a diagnosis of small bowel disease?

Answer 6

Pain that can’t be explained
Acidosis
High WCC
CPR is often normal

Question 7

What is Meckle’s Diverticulum?

Answer 7

a slight bulge in the small intestine present at birth - where small bowel attaches to the yolk sac

Question 8

Which layers of the small bowel are affected by Meckel’s Diverticulum?

Answer 8

All three layers

Question 9

What are the complications of Meckel’s diverticulum?

Answer 9

bleeding
ulceration
obstruction
malignant change

Question 10

What is the most common obstruction in appendicitis?

Answer 10

obstruction of the lumen by faecolith - causes problems with blood supply

Question 11

What can cause appendicitis?

Answer 11

bacteria, fungus or parasite

Question 12

What is the pathology of appendicitis?

Answer 12

lymphoid hyperplasia
build up of mucus
venous obstruction
peforation
small bowel adhesion

Question 13

what are the symptoms of appendicitis?

Answer 13

central pain which migrates to the RIF
anorexia
Nausea
Vomiting - episodic
Little bowel movement

Question 14

what are the signs of appendicitis?

Answer 14

mild pyrexia 
mild tachycardia 
guarding
rebound
localised pain in the RIF

Question 15

what is Rosving’s sign?

Answer 15

When pressing on the left of the abdomen causes pain on the right

Question 16

What is the clinical significance of psoas?

Answer 16

when the right hip is flexed the appendix is kept off the psoas and causes relief?

Question 17

Potential differential diagnosis of appendicitis in children?

Answer 17

gastroenteritis
mesenteric adentitis
Meckel’s diverticulum
lobar pneumonia

Question 18

Potential differential diagnosis of appendicitis in adults?

Answer 18

pancreatitis
urereric colic
terminal ileitis
ectopic pregnancy (women)

Question 19

Potential differential diagnosis of appendicitis in the elderly?

Answer 19

sigmoid diverticulitis
intestinal obstruction
carcinoma of the caecum

Question 20

Investigation for appendicitis

Answer 20

ultrasound (in women and children)
AXR - excludes constipation
FBC
Urinanalysis

Question 21

What is the management of appendicitis?

Answer 21

analgesia - for pain
antipyretics - for temperature
surgery
antibiotics
appendicectomy

Question 22

When should an appendix mass be operated on?

Answer 22

if complications occur - tachycardia, worsening pain, increasing in size

Question 23

How is an appendix abscess treated?

Answer 23

radiological drain