Small intestine and appendicitis

Question 1

what are the two most common causes of small bowel obs

Answer 1

adhesions and hernias

Question 2

causes of strictures of small bowel wall

Answer 2

IBD (Chrons)

Radiation

TB (also matted groups of LNs extrinsic to wall)

Question 3

when does Chron’s disease get surgical management

Answer 3

complications such as SBO and fistulae

Question 4

symptoms of SBO

Answer 4

colicky abdo pain
abdo distension
nausea and vomiting (bile stained)
obstipation

Question 5

what to look for on exam (SBO)

Answer 5

surg scars
masses
distension
peristalsis (silent later on)
irreducible hernias
Helen Mary Joseph LN and Virchows node?

Question 6

how to manage SBO

Answer 6

adhesions: give Drip and SUCK (NG tube to decompress stomach and bowel)
no improvement-surgery (lap)

hernias: reduce if viable bowel

foreign body: lap and enterotomy

first step: aggressive resus, NG tube and catheter
likely that urgent surgery will be required

Question 7

causes of spon SB perf in HIV positive patients

Answer 7

TB
Typhoid CMV

Question 8

which type of cancer causes carcinoid syndrome

Answer 8

neuro-endocrine neoplasms (present within the ileum usually)

Question 9

what is carcinoid syndrome

Answer 9

excess of serotonin secreted by NET
flushing
severe diarrhoea
wheezing
abdo cramping
peripheral oedema

only occurs in liver mets because liver would usually metabolise the serotonin

Question 10

how to manage carcinoid syndrome

Answer 10

octreotide

Question 11

most useful diagnostic test for carcinoid syndrome

Answer 11

5-HIAA

Question 12

what is uncomplicated appenditicitis

Answer 12

you dont have to operate, just managed with A/B

CT scan required:
1. no faecolith
2. no fluid surrounding the appendix or fluid in the peritoneum
3. no extraluminal gas

Question 13

when is a CT required with regards to acute appendicitis

Answer 13

over age of 40 as malignancy may masquerade as acute appendicitis

Question 14

3 steps of initial resus in a patient with acute appendicitis

Answer 14

1. fluid resus
2. broad spectrum IV A/B
3. analgesia-paracetamol and morphine

Question 15

what is the alvarado score used for

Answer 15

MANTRELS

socre < 5 means that acute append. can be excluded
hospital burden therefore reduced

high risk (high score): patients may benefit more from surgery than diag imaging

intermed risk: more likely to benefit from diag imaging

Question 16

how is a phlegmon managed

Answer 16

appendiceal mass essentially

A/B

Question 17

which imaging modality is used in children to diagnose AA

Answer 17

U/S

CT has radiation risk