Teaching 19/04 Flashcards
Causes of bowel obstruction in infants
- Pyloric stenosis
- Duodenal atresia
- Hirshsprungs
- Intussussception
- Imperforate anus
Presentation of pyloric stenosis in infant
- Projectile vomitting - non bilious
- Hypochloraemic metabolic alkalosis - loss of K+ and Cl- from stomach acid
What does hypochloraemic metabolic alkalosis do to oxygen disassociation curve?
- Shifts curve to left
- = Hb has more affinity for O2
- = less O2 delivered to tissues
= BAD for infant in pyloric stenosis
Management pyloric stenosis
- Rehydration - IV 0.9% saline
- Defitive = pyloromyotomy
What is duodenal atresia?
- Associated with in-utero polyhydraminos
- = stricture to duodenum due to vascular ischaemia
- Causes bilious vomitting (if distal to AoV) or non bilious if proximal
- X-ray shows double bubble sign
How does intussusception present?
- PR bleeding - currant jelly
Hirschsprungs disease diagnosis
- Full rectal biopsy
Pathological vs non-pathological strictures
- Non-pathological - attach bowel to lateral wall, no consequences usually
- Pathological - attach bowel to anterior abdominal wall = problematic, can then cause bowel obstruction
Do adhesions cause pain? other symptoms?
- If they pull on parietal peritoneum = PAIN
- Colicky with peristalsis
- Bloating
- Increase in bowel sounds
- Tinkling when fully obstructed
- Vomitting if pain is severe
How does caecal cancer present?
- Subtle, often presents late with mets
- Often only iron def anaemia
- +/- mass on examination
- NO obstruction as stool is fluid here - can move past
- Unless blocking ileocaecal valve
How does left sided colon cancer present?
- PR bleeding
- Change in bowel habit - diarrhoea then constipation and alternating, overflow?
- If gets to perforation, caecum will perf first due to closed loop (ileocaecal valve) and has weaker wall
How does rectal cancer present?
- PR bleeding/mucus
- Tenesmus
- Wet wind - when break wind, faeces can come out alongside
How does transverse colon cancer present?
- Mix of left sided and caecum - between each
What happens in pathophys of diverticular disease?
- Usually stretch from bulky stool is detected by stretch receptors in bowel
- = contraction and peristalsis
- If not a lot of fibre in diet, segmented contraction occurs where sections of bowel almost become closed off
- Pressures can reach very high - 150mmHg
- Weak points are where blood vessels perforate to supply colon = outpouchings of colon here
- Get bleeding due to close proximity of polyps to BVs
What is a phlegmon in diverticular disease?
- Localised area of acute inflammation in tissues
- This can stick to areas of small bowel nearly and can cause SBO
Where is the renal angle where you ballot kidneys?
- Between last rib and lateral border of erector spinae muscle
Sign on LUQ percussion in splenic rupture
- Ballances sign = LUQ dullness
What is an acute abdomen?
Acute undiagnosed abdominal pain
If untreated, some causes could lead to death
5 positions appendix can be
