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CBL Y3 > Surgery A - Colorectal disease > Flashcards

Surgery A - Colorectal disease Flashcards

1
Q

62 y/o morbidly obese gentleman.

pc: 72hr hx LHS abdo pain & nausea, passing loose stool

OE: flushed, clammy, abdomen tender in left iliac fossa and suprapubic area.

Obs are within range

list four differential?

A
  • diverticulitis
  • colitis
  • gastroenteritis
  • IBS
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2
Q

62 y/o morbidly obese gentleman.

pc: 72hr hx LHS abdo pain & nausea, passing loose stool

OE: flushed, clammy, abdomen tender in left iliac fossa and suprapubic area.

what investigations would you do?

A
  • Urine dip, stool culture
  • FBC, CRP, U&Es, amylase, lactate
  • Erect CXR
  • CTPA
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3
Q

62 y/o morbidly obese gentleman.

pc: 72hr hx LHS abdo pain & nausea, passing loose stool

OE: flushed, clammy, abdomen tender in left iliac fossa and suprapubic area.

how would you manage this patient?

A
  • A-E assessment
  • analgesia / antiemetics
  • antibiotics
  • IV fluids
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4
Q

potential complications of diverticulitis?

A
  • pericolic abscess
  • perforation
  • fistula- bladder (colovesical), vagina (colovaginal), skin (colocutaneous)
  • stricture
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5
Q

62 y/o morbidly obese gentleman.

pc: 72hr hx LHS abdo pain & nausea, passing loose stool

OE: flushed, clammy,

Obs were normal however now patient is deteriorating .

NOW patient is:

  • in pain, lying very still
  • abdo tender, guarding and rigidity
latest obs: 
38.6 degees
135bpm
88/65mmHg
24 RR
94% sats

what is the patients clinical picture?

A

tachycardia, fever, tachypnoea, neutrophilia = systemic inflammatory response criteria

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6
Q

How would you define sepsis?

A

any two of the SIRS criteria

  • t.cardia
  • t.pnoea
  • fever
  • neutrophilia

WITH
- source of infection

EQUALS
- sepsis!

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7
Q

how would you resuscitate and stabilise a septic patient?

A
  • A to E approach
  • initiate sepsis 6: oxygen, IV fluids, urinary catheter, blood cultures, antibiotics and lactate
  • escalate to senior staff : critical care
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8
Q

what pieces of information in a patients history may indicate severe sepsis?

A
  • AKI
  • hypotension
  • raised lactate

as these suggest inadequate perfusion / organ dysfunction

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9
Q

what is serum lactate a measure of?

A
  • lactic acid is a product of anaerobic respiration

- serum lactate is a marker of perfusion and hypoxia

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10
Q

62 y/o morbidly obese gentleman.

pc: 72hr hx LHS abdo pain & nausea, passing loose stool

OE: flushed, clammy,

Obs were normal however now patient is deteriorating .

NOW patient is:

  • in pain, lying very still
  • abdo tender, guarding and rigidity
latest obs: 
38.6 degees
135bpm
88/65mmHg
24 RR
94% sats

given the clinical picture what procedure may the patient require?

A

clinical picture SEPSIS

emergency laporatory

Hartman’s procedure (sigmoid resection + colostomy)

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11
Q

what are three features of bowel obstruction?

A
  • abdominal distension
  • vomiting
  • absolute constipation
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12
Q

74 y/o male
pc: 48hr hx diffuse abdo pain, not bowel movements or flatus for 3 days

hpc: over past few months noticed abdomen becoming more distended, decreased appetite, weight loss, passing looser stools.

OE: abdo distended and tympanic, tender over RIF, palpable liver edge.

DRE: empty rectum

differential diagnosis?

A

bowel obstruction

  • abdo distension
  • vomiting
  • absolute constipation
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13
Q

74 y/o male
pc: 48hr hx diffuse abdo pain, not bowel movements or flatus for 3 days

hpc: over past few months noticed abdomen becoming more distended, decreased appetite, weight loss, passing looser stools.

OE: abdo distended and tympanic, tender over RIF, palpable liver edge.

DRE: empty rectum

investigations for this patient?

A

FBC, U&Es, LFTs, CRP, ABG/lactate

Abdo X-ray, CXR

CTPA

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14
Q

what radiological features would you expect to see on a patients abdo X-ray showing large bowel obstruction?

A
  • dilated loops of colon

small bowel loops may also be dilated if incompetent ileocaecal valve

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15
Q

what are three causes of large bowel obstruction?

A
  • diverticular stricture
  • colorectal malignancy
  • volvulus
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16
Q

initial management steps for patient with large bowel obstruction?

A
  • A-E assessment
  • IV fluids
  • NG tube
  • Urinary catheter
  • ABG lactate
17
Q

65 y/o female

pc: 12 hr hx abdo pain + vomiting
pmh: T1DM, previous abdo surgery

OE: dehydrated, actively vomiting bile, abdo distended but soft and non-tender

auscultation: tinkling bowel sounds

midline laparotomy scare is well healed and no evidence of incisional or groin hernias

likely diagnosis?

A

bowel obstruction

- due to adhesions secondary to previous surgery

18
Q

investigations for a patient with suspected small bowel obstruction?

A

FBC, U&Es, CRP, LFTs, ABG/lactate

Abdo x-ray, CXR

Gastrograffin (therapeutic and diagnostic) contrast

CT

19
Q

how would you manage patient with bowel obstruction where Abdo X-ray shows multiple distended loops of small bowel.

How would you initially manage this patient?

A
  • analgesia/ antiemetics
  • urinary catheter
  • NG tube, IV fluids (drip and suck)
  • CT

if not settled with conservative management:
- laparotomy & adhesiolysis

20
Q

what is adhesiolysis?

A
  • surgical procedure
  • removes adhesions in surgery
  • adhesions are the scar tissue formed over the surgical wounds
21
Q

65 y/o female

pc: 12 hr hx abdo pain + vomiting
pmh: T1DM, previous abdo surgery

OE: dehydrated, actively vomiting bile, abdo distended but soft and non-tender

auscultation: tinkling bowel sounds

as the patient has diabetes and is vomiting, how would you manage them>

A
  • patient vomiting & NBM : stop short acting insulin
  • start variable rate insulin infusion
  • monitor blood sugars
22
Q

89 y/o male

pc: 12hr hx abdo pain and distension
pmh: vascular dementia, parkinsons, IHD, constipation

OE: cachectic, dehydrated, abdo grossly distended, tympanic with tinkling sounds.

Abdo X-ray: very distended loop of large bowel arising from left lower quadrant

most likely diagnosis?

A

sigmoid volvulus
- is a cause of large bowel obstruction

same clinical presentation of LBO
- constipation, abdo bloating, nausea and/or vomiting

associated with chronic neurological conditions: Parkinson’s, MS

23
Q

what clinical signs might be concerning for bowel ischaemia or gangrene?

A
  • tenderness/ peritonism
  • SIRS response - t.cardia, t.pnoea, leucocytosis, pyrexia
  • raised inflammatory markers / raised lactate
24
Q

appropriate intervention for patient with sigmoid volvulus?

A
  • flexible sigmoidoscopy & decompression - leave flatus tube in-situ
  • if strangulation / ishcaemia then emergency laparotomy

CBL Y3 (25 decks)

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