UGI/CR - Colon part 3 Flashcards
What is meant by metachronous?
cancer occuring > 6 months after the original cancer
Follow up after CRC surgery (2)
CEA ev 3 months
Colonoscopy ev 3 years
Mx obstructing (6)
A-E Analgesia + NG tube compression AXR/errect CXR CT - level obstruction Gastrograffin (show level + therapeutic effect)
Sx of bowel obstruction - small bowel (3)
Bilious vomiting
Faeculant vomiting if distal)
Pain
Constipation w/o pass of wind
Signs bowel obstruction (7)
Distention Tinkling bowel sounds Dehydration Central resonance to percusion + dull flanks Scars Palpable mass Abdo wont be tender
What is paralytic ileus
Temporary disruption of normal peristaltic activity w/o mechanical blockage
Causes of paralytic ileus (4)
Post surgery
Systemic infections
Metabolic disturbance
Neurological disorders
mx paralytic ileus
NG + NBM
Differentiating SBO and Paralytic ileus - bowel sounds
Bowel sounds = present SBO
Bowel sounds = absent paralytic ileus
Differentiating SBO and Paralytic ileus - AXR findings
Air in colon paralytic ileus
None in SBO
Diffuse air fl levels paralytic ileus
What is Pseudo-obstruction
= name for LBO when no identifiable cause can be found
= form paralytic ileus
Causes of SBO (5)
Adhesions Hernias Chrons Intussusception Extrinsic involvement by cancer
Causes of LBO (4)
Carcinoma of colon
Diverticular disease
Sigmoid volvulus
Constipation
Complications of bowel obstruction (6)
Strangulation --> ischaemia + necrosis Eventually bowel proliferates Electrolyte imbalance Volume depletion in severe cases (hypovolaemia) Vascular compromise Sepsis
Ix bowel obstruction (10)
Bloods - FBC/U+E/Amylase/LFT ABG Urinalysis Supine AXR Erect CXR Contrast enema CT
Ix findings bowel obstruction - AXR
Distended proximal bowel
Absent gas distally
Ix findings bowel obstruction - Erect CXR
Fl levels in SBO
Air under diaphragm if perforation
Why do contrast enema for bowel obstruction Ix
Differentiates obstruction + pseudo-obstruction
Can ID level of obstruction + ileo-caecal competency
Mx of SBO (4)
A-E resus
Urinary catheter
IV ABx
Ryles tube - NBM + NG Decompression
Mx LBO
Hartmans
Enema + manual evac if b/c fecal impaction
Sx bowel strangulation (4)
increasing pain/tenderness
leucocytosis
Systemic upset
Peritonism
What is volvulus
Twisting of loop of bowel around its mesenteric axis –> obstruction + venous occlusion at base of mesentery
Who gets sigmoid volvulus
Elderly, constipated pt
XR appearance sigmoid volvulus
Coffee bean appearance XR
Tx sigmoid volvulus
Insertion of long flatus tube advanced into sigmoid often untwists volvulus
If unsuccessful –> laparotomy
Who gets caecal volvulus
Young kids b/c = congenital malformation
XR appearance caecal volvulus
Embryo
Tx caecal volvulus
Untwisting via laparotomy
SBO vs LBO - vomiting
Absent/faeculant in LBO
Bilious + green SBO + nausea
SBO vs LBO - constipation
Absolute in LBO
May not be absolute in SBO
SBO vs LBO - progression
Progression more rapid in SBO
SBO vs LBO - pain
Colicky + poorly localised SBO
PS of malrotation of bowel w/ midgut volvulus
Obstruction w/ PR bleed/mucus
Abnormal bowel position on AXR w/ contrast
Causes of faecal impaction - general factors (6)
Poor diet Dehydration Lack of exercise IBS Old age Pain
Anorectal causes of faecal impaction (3)
Fissure
Stricture
Rectal prolapse
metabolic causes of faecal impaction (3)
Hypercalcaemia
Hypothyroidism
Hypokalaemia
Drug causes of faecal impaction (5)
Opiates Anticholinergics Fe Aluminium based antacids Diuretics
