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Year 3 > Volvulus (GI) > Flashcards

Volvulus (GI) Flashcards

1
Q

Define volvulus.

A

Twisting of a loop of bowel on its mesentery –> compromised blood flow and closed loop obstruction

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2
Q

What is volvulus one of the most common causes of?

A

Intestinal obstruction

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3
Q

What are the two most common sites of volvulus in adults?

A
  • sigmoid volvulus (65-80%) - LBO by sigmoid colon twisting around sigmoid mesocolon
  • caecal volvulus (20-30%) - developmental failure of peritoneal fixation of proximal bowel (in majority, caecum is retroperitoneal so not at risk of twisting)
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4
Q

What are the risk factors for sigmoid volvulus? (5)

A
  • older patients
  • chronic constipation
  • Chagas disease
  • neurological conditions e.g. Parkinson’s
  • psychiatric conditions e.g. schizophrenia
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5
Q

What are the risk factors for caecal volvulus? (3)

A
  • all ages (vs older patients in sigmoid volvulus)
  • adhesions
  • pregnancy
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6
Q

How does volvulus present in neonates or infants?

A

Midgut volvulus secondary to intestinal malrotation

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7
Q

What are some general clinical features of volvulus? (3)

A
  • abdominal pain - steady, may have colicky characteristics, varies from vague discomfort –> excruciating
    • severe unremitting pain = gangrenous bowel
    • pain decreases after explosive passage of stool/gas
    • periumbilical/hypogastric pain
  • slowly progressive symptoms of bowel obstruction - abdominal pain, distension, N&V (bilious), constipation/diarrhoea
  • constipation
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8
Q

What might you see on examination of volvulus? (8)

A
  • diffuse abdominal distension and tenderness
  • faint/no bowel sounds
  • rigid abdomen
  • guarding
  • rebound tenderness (peritonitis)
  • fever
  • haematochezia (passing fresh blood through anus)
  • tachycardia/hypotension in bowel ischaemia
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9
Q

What are the signs of bowel ischaemia? (3)

A
  • tachycardia
  • hypotension
  • rebound tenderness (peritonitis)
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10
Q

What are signs of caecal volvulus?

A

Features of SBO and recurrent episodes of RLQ abdominal pain

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11
Q

What are the features of gastric volvulus? (3)

A
  • failure to pass NG tube
  • epigastric pain
  • vomiting
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12
Q

What are the signs of midgut volvulus (secondary to intestinal malrotation) in infants? (5)

A
  • bilious vomiting
  • haematochezia (fresh blood through anus)
  • haematemesis
  • hypotension
  • tachycardia
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13
Q

What is the first-line investigation for volvulus?

A

Abdominal x-ray

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14
Q

What scans can we do in volvulus? (3)

A
  • abdominal XR - dilated bowel loops, abdominal free air with perforation
  • CT scan - whirl sign
  • barium enema - bird’s beak sign
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15
Q

What do we see on abdominal XR in sigmoid volvulus? (3)

A
  • large bowel obstruction (large, dilated loop of colon often with air-fluid levels)
  • coffee-bean sign (two dilated loops with no haustration)
  • LUQ–>RLQ
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16
Q

What do we see on abdominal XR in caecal volvulus? (3)

A
  • may see small bowel obstruction
  • kidney bean/embryo sign (marked dilation of 1 loop with haustration)
  • RLQ–>LUQ
17
Q

What sign might you see in CT in volvulus?

A

Whirl sign

18
Q

What sign might you see in barium enema in volvulus?

A

Bird’s beak sign

19
Q

What might ABG show in volvulus?

A

May be normal or metabolic acidosis, elevated lactate

20
Q

What are some differential diagnoses for volvulus? (4)

A
  • other forms of LBO (especially carcinoma of sigmoid colon)
  • pseudo-obstruction (reduced colonic motility and dilatation)
  • giant sigmoid diverticulum
  • severe constipation
21
Q

What initial management is needed for bowel obstruction (volvulus)? (3)

A

Initial resuscitation:

  • IV fluids
  • NBM
  • placement of NGT
22
Q

How do we manage sigmoid volvulus?

A
  • rigid sigmoidoscopy with rectal tube insertion (detorsion)
  • surgery - if signs of peritonism or decompression not working:
    • sigmoid colectomy (haemodynamically stable patient with viable bowel)
    • Hartmann procedure (haemodynamically unstable patient/ischaemic bowel)
23
Q

How do we manage caecal volvulus?

A

Operative management - right hemicolectomy often needed

24
Q

How do we manage midgut volvulus secondary to intestinal malrotation (neonates/infants)?

A

Ladd procedure (emergency surgery)

25
Q

What are some complications of volvulus? (3)

A
  • recurrence
  • bowel obstruction
  • perforation and faecal peritonitis

Year 3 (175 decks)

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