Surgical Lower GI Flashcards
What is appendicitis?
Inflammation or infection of the appendix
In appendicitis caused by obstruction, what is the most common cause?
Faecolith
Who is the classical exam patient with appendicitis?
Young child or teenager
What are the symptoms and signs of appendicitis?
Abdominal pain - umbilical to RIF shift
Signs of infection (Fever, nausea, tachycardia)
Rosving’s (pressing on LIF causes pain in RIF)
Psoas - patient keeps right hip flexed
Mcburney’s point - point of max pain
What investigations are done to diagnose appendicitis?
Clinical diagnosis
Ultrasound for women and children
Bloods - CRP and WCC
What pre-surgical care is done for appendicitis?
Analgesia
Antipyretics
Antibiotics
What is the surgical procedure done in appendicitis?
Laparoscopic appendectomy
What is bowel obstruction?
Blockage of the bowel leading to accumulation of fluid or gas, ischaemia or perforation
What are some causes of bowel obstruction?
Gallstones Food/faeces Bezoar Tumours Crohn's Radiation Adhesions Herniation Masses
What are the symptoms of bowel obstruction?
Colicky central abdominal pain Absolute constipation Vomiting Borborygmus Abdominal distension Tinkling bowel sounds
What investigations can help diagnose bowel obstruction?
AXR or contrast CT
ABGs and bloods
Laparotomy if suspected complication
What pre-surgical treatment is given for bowel obstruction?
IV fluids
NG tube
Analgesia for pain
What is ischaemic colitis?
Inflammation but not total tissue death due to ischaemia
What are the causes of ischaemic colitis?
Atherosclerotic narrowing in intestinal blood vessels (most common) Hypotension Obstruction Cocaine and meth Iatrogenic
Who tends to get ischaemic colitis?
Elderly
Those with coagulopathy or AF
Intra-abdominal masses
What are the symptoms of ischaemic colitis?
Abdominal pain/cramping Fresh blood in stool Urgency Diarrhoea Nausea
What investigations can diagnose ischaemic colitis?
US/AXR/CT to view bowel
CT/MRI angiography
Colonoscopy
What is the management for minor cases of ischaemic colitis?
Self resolve
Analgesia
IV fluid
Fix cause
What is the management for major cases of ischaemic colitis or prophylaxis of total ischaemia?
Embolectomy
Colectomy
What is true bowel ischaemia?
Bowel tissue dies due to lack of blood supply
What is the common cause of true bowel ischaemia?
Atherosclerosis
What are the symptoms of true bowel ischaemia?
Sudden severe abdominal pain
Blood in stool
Forceful/painful bowel movements
What investigation can diagnose true bowel ischaemia?
Exploratory laparotomy
CT/MRI angiography
What is the management for true bowel ischaemia?
Colectomy to remove infarcted tissue
Restore vasculature as best as possible
What is a general complication post-op?
One affecting any of the body systems
What is a local complication post-op?
One specific to the operation
What are the CVD post-op complications?
MI
Haemorrhage
DVT
How does a post-op haemorrhage present?
Obvious blood
Tachycardia
Hypotension
Oliguria
What are the respiratory post-op complications?
Atelectasis (failure of lungs to expand, causing collapse and infection)
Pneumonia
PE due to DVT
What are the GI post-op complications?
Ileus
Anastomotic dehiscence
Adhesions
Short gut syndrome
What are adhesions?
The formation of scar tissue that can cause organs to stick to each other
What is short-gut syndrome?
Malabsorption due to insufficient residual small bowel
Leads to metabolic abnormalities
