Twisting of the intestine Flashcards

1
Q

Types

A

Volvulus

Midgut malrotation

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2
Q

What is volvulus twisting

A

Complete twisting of a loop of intestine around its mesenteric attachment site

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3
Q

Where can a volvulus occur

A
Stomach
SI
Caecum
Transverse colon
Sigmoid colon
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4
Q

Clinical presentation of volvulus

A

Rapid onset and bilious vomiting
Possible palpable abdominal mass
Ischaemia can lead to acute abdominal pain, abdominal distention and peritonitis.
Blood may pass per rectum.

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5
Q

Pathophysiology of volvulus

A

Sections of colon filled with faeces and distended with gas can twist on its mesenteric pedicle to create closed loop obstruction.
This can cause backing of GI tract -> Vomiting and bleeding.
Bile from the bile duct is also backed up, hence the bilious vomiting.

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6
Q

Aetiology of volvulus

A

Tends to develop in long-standing constipation with large, elongated, relatively atonic colon (particularly in the sigmoid)

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7
Q

Epidemiology of volvulus

A

More common in the elderly.

Rare in infants and children (when not with a malrotation)

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8
Q

Diagnosis fo volvulus

A

Plain abdominal X ray

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9
Q

Treatment of volvulus

A

(Sigmoid) Decompression - sigmoidoscope is passed into the loop and a flatus tube alongside it. This produces a rush of liquid faeces and flatus and relief.
Surgery - Resection may be required in frequent recurrence.

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10
Q

Complications of volvulus

A

Recurrence.

If untreated: Perforation and peritonitis (life threatening)

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11
Q

What is midgut rotation

A

Twisting of the entire midgut about the axis of the superior mesenteric artery

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12
Q

Clinical presentation of midgut rotation

A

Can be asymptomatic.
Intermittent intestinal obstruction.
If a volvulus develops, the obstruction will be complete. Bilious vomiting (green/yellow vomit).
Failure to thrive, anorexia, constipation and bloody stool.
Older children: Recurrent abdominal pain, cyclical vomiting.

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13
Q

Pathophysiology of midgut rotation

A

A twisting of the midgut causes the passage of faecal matter to be slowed and obstructed.
This causes backing up of GI tract -> vomiting and bleeding.
Bile from the bile duct is also backed up, hence the bilious vomiting.

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14
Q

Aetiology of midgut rotation

A

Congenital
At the 4th week of gestation, the GI tract is a straight tube in the abdomen. In the next 8 weeks, the midgut rotates and becomes fixed to the posterior abdominal wall. Arrest of development at any stage narrows the mesenteric base and impairs fixation.
This creates high risk of volvulus.

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15
Q

Epidemiology of midgut rotation

A

1/500 live births.

90% are diagnosed within first year of life

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16
Q

*Diagnosis of midgut rotation

A

Contrast studies:

Duodenojejunal junction is misplaced either at or to the right of the midline

17
Q

Treatment of midgut rotation

A

Surgery: Volvulus is a devastating complication, so corrected even if asymptomatic

18
Q

Complications of midgut rotation

A

Volvulus can develop

Leading to complete bowel obstruction and potentially a rupture -> life threatening peritonitis