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W3 Diseases of the Small Bowel Flashcards

1
Q

How does small bowel obstruction present on xray?

A

Looks like person has swallowed fluffy caterpillar

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2
Q

How does small bowel obstruction present?

A
  1. pain (colicky, central)
  2. absolute constipation
  3. faeculent vomiting
  4. burping
  5. abdominal distension
  6. borborygmi
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3
Q

Describe the pain of bowel obstruction.

A

Central colicky pain

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4
Q

What builds up in lumen of small bowel?

A
  • Fluid

- Gas

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5
Q

Where does the gas in obstructed small bowel lumen come from?

A
  • Air swallowed

- Gas from fermentation process from bacteria building up from obstruction

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6
Q

Describe what happens pathophysiologically in obstruction of small bowel.

A
  1. Fluid + gas build-up
  2. Ischaemia (occlusion of venous and arterial supplies) + death of tissue
  3. Perforation
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7
Q

What are the three areas in which a bowel obstruction can come from?

A
  1. from within the lumen
  2. from within the wall
  3. from outside the wall
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8
Q

What is a bezoar?

A

ball of hair

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9
Q

What are three examples of causes of bowel obstruction from within the lumen?

A
  1. gallstone
  2. food
  3. bezoar
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10
Q

What are three examples of causes of bowel obstruction from within the wall?

A
  1. Tumour
  2. Crohn’s
  3. Radiation strictures (due to radiation enteritis)
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11
Q

What are the two examples of causes of bowel obstruction ?

A
  1. adhesions

2. herniation

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12
Q

What happens to the proximal bowel in bowel obstruction?

A

It dilates and develops altered motility

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13
Q

What is are the two gasses that makes up the majority of the gas that builds up in an obstructed bowel?

A
  • Nitrogen

- Hydrogen Sulphide

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14
Q

What happens to the part of bowel beyond the bowel obstruction?

A

Carries on as normal until its empty when it contracts and becomes immobile

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15
Q

What is borborygmi?

A

Noisy gurgly bowel sounds

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16
Q

What is important to figure out in a small bowel obstruction?

A

What the cause is

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17
Q

What do you look for on abdomen when looking for a a cause of small bowel obstruction?

A
  • scar from previous abdominal surgery

- hernias (femoral/inguinal)

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18
Q

What investigations are carried out in terms of assessing the state of the patient?

A
  • urinalysis (kidney injury?)
  • bloods
  • gases
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19
Q

What investigations are carried out to confirm the diagnosis?

A
  • AXR
  • Contrast CT scan of abdomen
  • Gastrograffin studies (rare)
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20
Q

What is gastrograffin?

A

Oral water-soluble radiological contrast agent

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21
Q

How can bowel obstruction present on AXR with aptient standing?

A

Air-fluid rainbows

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22
Q

What phrase is associated with treatment for small bowel disease and what does it describe?

A
  • “Drip and suck”

- IV drip and NG tube sucking out fluid and gas

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23
Q

What is treatment for small bowel disease?

A
  • conservative
  • IV analgesia
  • Fluids with potassium
  • catheterise
  • Large NG tube (Ryles tube) to suck out
  • Antithromboembolism measures
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24
Q

What can perforation lead to in small bowel obstruction and how come it happens?

A
  • Perforation can lead to peritonitis

- Due to necrosis of bowel wall

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25
How can small bowel obstruction lead to sepsis?
Increased bowel wall permeability so microbes can move into peritoneal cavity
26
Why are patients usually hypokalaemic and alkalotic with small bowel disease?
Loss of K+ ions and HCl due to vomiting
27
Why treat small bowel obstruction patients with antithromboembolism measures?
As they are at higher risk of DVT due to lying down, being dehydrated and may be more prone due to underlying cause of obstruction
28
How long is standard drip and suck treatment for?
Up to 72 hrs
29
What cause of bowel obstruction do you use drip and suck for?
Adhesional
30
What small bowel obstruction cause will drip and suck not work on?
Hernias
31
Why would you intervene with drip and suck treatment ?
If signs of: - strangulation + ischaemia of bowel - perforation - closed loop obstruction
32
What usually causes closed loop obstruction?
Adhesions
33
What type of surgery is done for small bowel obstruction?
Laparotomy
34
What can cause mesenteric ischaemia?
- embolus | - thrombosis
35
What artery supplies the small bowel?
Superior mesenteric artery
36
How does chronic mesenteric ischaemia present?
Cramping pain usually after eating (like angina of gut)
37
What happens to the small bowel when mesenteric ischaemia is acute and SMA is obstructed?
Whole small bowel usually gets infarcted and dies
38
What artery supplies the colon?
Inferior mesenteric artery
39
What happens to the colon when IMA is blocked?
colon usually lives because of marginal artery
40
Where does embolus usually come from in mesenteric ischaemia?
Usually from AF and clot forms in left atrium
41
What is in situ thrombosis usually caused by?
-General gubbedness i.e. patient is trying to die
42
How can Virchows triad contribute to in situ thrombosis in mesenteric ischaemia?
- dehyrdrated - hypercoaguable - local compression of vessels - vasoconstricting drugs
43
What is key clue in acute setting to diagnose?
-Little old person normal AXR -colicky pain -clue = lots of analgesia pain out of proportion to clinical findings
44
Why does alkalosis and hypokalaemia eventually become acidosis and hyperkalaemia and death in mesenteric ischaemia?
Due to anaerobic metabolism and lysis of ischaemic cells which leads to build up of lactic acid and release of intracellular K+
45
What will gases show in advanced stages of mesenteric ischaemia?
acidosis (low pH, high H+,,
46
What will bloods usually show in mesenteric ischaemia?
- lactate elevated - CRP may be normal - WCC may be slightly raised
47
What tests diagnose mesenteric ischaemia?
- Gases - Bloods - CT angiogram - at laparotomy
48
What are the options when treating mesenteric ischaemia?
- resect non-viable intestines - re-anatomose or staple and plan return if not stable - SMA embolectomy if possible - open and close laparotomy
49
What is a common cause of small bowel haemorrhage?
- Vascular malformations | - Ulcerations
50
How are vascular malformations treated?
First with interventional radiology e.g. embolisation
51
Where is Meckel's diverticulum usually situated?
About 60cm from IC valve
52
At what age does Meckel's diverticulum usually present?
Before 2 years of age
53
What is Meckel's diverticulum a remnant of?
Omphalomesenteric duct
54
What is another name for omphalomesenteric duct?
Vitelline duct
55
What complications can Meckel's diverticulum cause?
- Bleed (haematochezia) - Ulcerate - obstruction - malingnant change
56
What is haematochezia?
Passage of fresh blood through the anus
57
What can ileal diverticulum inflammation mimic in terms of its symptoms?
Appendicitis
58
Which side of the ileum does Meckel's diverticulum lie?
antimesenteric border of the ileum i.e. the opposite side to where the mesentery is attached
59
Where do the left and right vitelline arteries originate from?
Primitive dorsal aorta
60
What does the right vitelline artery eventually become?
Superior mesenteric artery (that supplies a terminal branch to the diverticulum)
61
What does the left terminal artery do?
It involutes
62
Why is Meckel's diverticulum susceptible to obstruction or infection?
Due to having its own blood supply

GI (29 decks)

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