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GI > W3 Diseases of the Small Bowel > Flashcards

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
Q

How can small bowel obstruction lead to sepsis?

A

Increased bowel wall permeability so microbes can move into peritoneal cavity

26
Q

Why are patients usually hypokalaemic and alkalotic with small bowel disease?

A

Loss of K+ ions and HCl due to vomiting

27
Q

Why treat small bowel obstruction patients with antithromboembolism measures?

A

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
Q

How long is standard drip and suck treatment for?

A

Up to 72 hrs

29
Q

What cause of bowel obstruction do you use drip and suck for?

A

Adhesional

30
Q

What small bowel obstruction cause will drip and suck not work on?

A

Hernias

31
Q

Why would you intervene with drip and suck treatment ?

A

If signs of:

  • strangulation + ischaemia of bowel
  • perforation
  • closed loop obstruction
32
Q

What usually causes closed loop obstruction?

A

Adhesions

33
Q

What type of surgery is done for small bowel obstruction?

A

Laparotomy

34
Q

What can cause mesenteric ischaemia?

A
  • embolus

- thrombosis

35
Q

What artery supplies the small bowel?

A

Superior mesenteric artery

36
Q

How does chronic mesenteric ischaemia present?

A

Cramping pain usually after eating (like angina of gut)

37
Q

What happens to the small bowel when mesenteric ischaemia is acute and SMA is obstructed?

A

Whole small bowel usually gets infarcted and dies

38
Q

What artery supplies the colon?

A

Inferior mesenteric artery

39
Q

What happens to the colon when IMA is blocked?

A

colon usually lives because of marginal artery

40
Q

Where does embolus usually come from in mesenteric ischaemia?

A

Usually from AF and clot forms in left atrium

41
Q

What is in situ thrombosis usually caused by?

A

-General gubbedness i.e. patient is trying to die

42
Q

How can Virchows triad contribute to in situ thrombosis in mesenteric ischaemia?

A
  • dehyrdrated
  • hypercoaguable
  • local compression of vessels
  • vasoconstricting drugs
43
Q

What is key clue in acute setting to diagnose?

A

-Little old person
normal AXR
-colicky pain
-clue = lots of analgesia pain out of proportion to clinical findings

44
Q

Why does alkalosis and hypokalaemia eventually become acidosis and hyperkalaemia and death in mesenteric ischaemia?

A

Due to anaerobic metabolism and lysis of ischaemic cells which leads to build up of lactic acid and release of intracellular K+

45
Q

What will gases show in advanced stages of mesenteric ischaemia?

A

acidosis (low pH, high H+,,

46
Q

What will bloods usually show in mesenteric ischaemia?

A
  • lactate elevated
  • CRP may be normal
  • WCC may be slightly raised
47
Q

What tests diagnose mesenteric ischaemia?

A
  • Gases
  • Bloods
  • CT angiogram
  • at laparotomy
48
Q

What are the options when treating mesenteric ischaemia?

A
  • resect non-viable intestines
  • re-anatomose or staple and plan return if not stable
  • SMA embolectomy if possible
  • open and close laparotomy
49
Q

What is a common cause of small bowel haemorrhage?

A
  • Vascular malformations

- Ulcerations

50
Q

How are vascular malformations treated?

A

First with interventional radiology e.g. embolisation

51
Q

Where is Meckel’s diverticulum usually situated?

A

About 60cm from IC valve

52
Q

At what age does Meckel’s diverticulum usually present?

A

Before 2 years of age

53
Q

What is Meckel’s diverticulum a remnant of?

A

Omphalomesenteric duct

54
Q

What is another name for omphalomesenteric duct?

A

Vitelline duct

55
Q

What complications can Meckel’s diverticulum cause?

A
  • Bleed (haematochezia)
  • Ulcerate
  • obstruction
  • malingnant change
56
Q

What is haematochezia?

A

Passage of fresh blood through the anus

57
Q

What can ileal diverticulum inflammation mimic in terms of its symptoms?

A

Appendicitis

58
Q

Which side of the ileum does Meckel’s diverticulum lie?

A

antimesenteric border of the ileum i.e. the opposite side to where the mesentery is attached

59
Q

Where do the left and right vitelline arteries originate from?

A

Primitive dorsal aorta

60
Q

What does the right vitelline artery eventually become?

A

Superior mesenteric artery (that supplies a terminal branch to the diverticulum)

61
Q

What does the left terminal artery do?

A

It involutes

62
Q

Why is Meckel’s diverticulum susceptible to obstruction or infection?

A

Due to having its own blood supply

GI (29 decks)

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