Small Intestine and colon Part 1 Flashcards
What causes the obstruction os the small intestine
80% are Lesions hernias, intestinal adhesion, intussusception and volvulus
10 to 15% are tumors, infraction and other causes of strictures, Crohn Disease
What are the manifestations of Intestinal Obstruction
Abdominal Pain and discomfort and vomiting and constipations
What is the mechanism of Intestinal Obstruction
Normal flow of intestinal contents is disrupted - proximal dilation + distal decompression
What are the complication of Intestinal obstructions
Bowel ischemia due to bloody supply being strangulated, inflammation leads to venous congestion, edema and distortion or normal bowel absorptive function - increased intraluminal fluid. Transudative fluid loss ( hypovolemia into peritoneal cavity, electrolyte disturbance
Shock
Perforation
What is the presentation of Small bowel Obstruction
Nausea and vomiting early Abdominal pain that comes and goes distension occurs constipation occurs Bowel sounds increased in X-ray the is an increase in air fluid levels
What is the presentation in Large Bowel Obstruction
Nausea and vomiting late Abdominal pain that comes and goes distension occurs constipation occurs Bowel sounds increased in X-ray the is an increase in air fluid levels
What is the prestantion of Pseudo-Obstruction
Nausea and vomiting occurs Abdominal pain is minimal distension occurs constipation occurs Bowel sounds decrease in X-ray the is an increase in air
What are the causes of small bowel obstruction
S - stricture H - hernia - 2nd cause A- adhesion - MCC V -volvulus I - intussception N - Neoplasm 3rd cause G - Gallstones
What are the causes of large bowel obstruction
Cancer
Diverticulitis
Volvulus
What is adhesions
Fibrous Band that forms between tissues Natural part the body’s healing process after surgery, similar to how a scar forms. Adhesion extend from within one tissue across to another, usually across a virtual space such as the peritoneal cavity. adhesion formation post surgery typically occurs when 2 injured surfaces are close to one another. this often cause inflammation and cause fibrin deposition onto the damage tissues.
What is a hernia
Defect in fascia - protrusion of bowel into sac. Males are more likely than females. Most common is the indirect (50%).
What is the Progression of the Hernia?
Entrapment, Incarceration, Strangulation ( Blood supply to the part of the bowel is blocked) and Infarction
What are the risk factors of hernia
Chronic Cough Pregnancy Constipation Obesity Ascites Straining Hernia repair Heavy lifting
What are the features of Hernia
Bulging with the patients coughs, sits ups and goes away when the patient is upon or when reduces
REMEMBER MD’s don’t lie
What is Volvulus? What is the most common area
Rotation of a segment of bowel about its mesenteric axis.
Sigmoid Colon due to the shape
What is intussusception
Part of bowel folds into another section of bowel ( telescoping) Mostly seen in the Kids: M>F
What are the complications of Intussusception
Obstruction, infarction and necrosis
What are the clues of intussusception
Sausage shaped Palpable mass
Rectal Bleeding
Kids Crises and draws knees up to chest
DONUT!!!!! or Target sign!!!
What is a major of Intussusception
There may be HSP or Henoch-Scholein Purpura. This is mainly in kids that follows an upper respiratory infection. there may be vasculitis, purport on buttock and legs, along with abdominal pain and Arthritis.
What is colonic Pseudo-Obstruction and what are the types
Symptoms similar to intestinal blockage but no physical signs of blockage.
Paralytic ileus and Ogilvie’s syndrome
What is paralytic ileus?
Temporary paralysis of myeneteic plexus. tends to occur in postoperative surgeries and medications
What is ogilivie syndrome
Acute pseudo obstruction. tends to happen in bedridden patients that have a serious extra intestinal illness like trauma, infection and cardiac
What is ischemic bowel disease
is a medical condition in which injury of the small intestine occurs due to not enough blood happens in the splenic flexure or the watershed region
What are the causes of ischemic bowel disease
Clots Atrial Fibrillations DVT Cardiac Vegetation Malignancy
Low Perfusion/ Hemorrhage CHF Shock Dehydration Vasoconstriction drugs
