wk 4 7 pathology of small intestine and appendix Flashcards
obstruction of the small bowel can be due to problems within the lumen, within the wall of the lumen, or outside the wall.
examples of eac h
within - gallstones, food, bezoar (solid indigestible material)
wall - tumour, crohns, radiation
outwith - adhesions, herniation
associated symptoms with small intestine obstruction
pain (central/colicky - abdominal, children) absolute constipation vomiting burping abdominal distension
borborygmi
rumbling/gurgling noise made by movement of fluid and gas in intestines
suspected bowel obstruction, appropriate investigations
urinalysis blood tests ABG Abdominal X-ray, CT scan Gastrogaffin studies
outline ‘drip and suck’
Airways, Breathing, Circulation Analgesia Fluids with K (usually hypokalaemic/alkalotic) catheterise Nasogastric tube(Ryles - draining) antithromboembolism measures
t/f hernia can be resolved through drip and stuck
false
how long will drip and suck be considered
72 hours
when would a drip and suck be stopped earlier
signs of strangulation, perforation, ischaemia
associated symptoms/cause of chronic mesenteric ischaemia
cramps (angina of gut)
atherosclerosis - superior mesenteric artery
likely outcome of acute mesenteric ischaemia of small bowel
gets infarcted and dies
likely outcome of acute mesenteric ischaemia of large intestine
usually does not infarct - supplied by marginal artery
virchows triad is associated with hiigh risk throembolism, what are the 3 fctors
hypercoagulability
stasis of blood flow
endothelial damage
t/f dehydration can slow blood flow
true
t/f vasoconstriction can lead to in situ thrombosis
true
-dehydrated
-vasoconstriction
virchows triad
diagnosing bowel ischaemia
pain out of proportion to clincial findings acidosis (low pH, high H+, high BE lactate elevated CRP - normal (may) WCC - up slightly CT angiogram Laparotomy
treatment for acute bowel ischaemia
resection if non-viable (unable to survive independently)
anastamose/staple for planned return
viable - unable to perform SMA embolectomy
meckels diverticulum is the remnant of which duct
omphalomesenteric duct
vitelline duct
although meckels diverticulum can occur anywhere in the small intestine, where is it found in relation to the ileoceacal valve
2 feet
possible complicatons of meckels diverticulum
bleeding
ulceration (meckels diverticulitis)
obstruction
maligancy
the appendix can vary in location, mostly being retrocaeca. however what is a constant in all appendixes
it is the convergence of the three taeniae
causes of appendicitis
obstruction of lumen - faecolith
bacterial
viral
parasites
outline the pathology of appendicitis
musocal inflammation lymphoid hyperplasia obstruction mucus/exudate build up venous obstruction ischaemia perforation
the presence of inflammation in abdomen causes what change
positioning of greater omentum
phlegmonous mass is associated with appendicitis, define
inflammatory tumour consisting of inflamed appendix, adjacent viscera and greater omentum
symptoms of appendicitis
central pain - migrates to RIF anorexia nausea 1/2 vomits may not have bowel movemens vague pain - pelvic rectal tenderness
signs of appendicitis
mild pyrexia mild tachycardia localised pain in RIF guarding rebound - (pain felt after stomach pressed)
there are specific signs which are characteristic of appenditicits. these are rosvings psoas obturator pointing explain each
rosvings - pressiing left = pain on right
psoas - right hip flexed, keeps inflamed appendix off the psoas (muscle)
obturator - appendix is touching obturator internus, flexing hip + internal rotation = pain
pointing - where did it start - where is it now
appropriate investigations in appendicitis
Ultrasound
Abodminal X ray
Bloods (CRP, WWC)
Urinalysis
MANTRELS is used in the alvarado score, what score is required for appendicitis to be likely? other symptoms
Migration (pain - RLQ) Anorexia Nausea (+ vomiting) Tenderness (RLQ) Rebound pain Elevated temp Leukocytosis Shift of WBC to left
> 5
sore to move/cough/laugh
flushed face
foetor oris (bad breath)
management of apppendicitis
analgesia antipyretic (reduce fever) antiibiotics theatre -appendicetomy - laparascopic - open - laparotomy
other than appendicitis, what else can develop in appendix
appendix mass
abscess
neoplasms
outline treatment of appendix mass
antibiotics 1st line (if carcinoma excluded)
operate if complicated/worsen
treatment of appendix abscesss
radiological drainage
in carcinoid appendix, what can be stained for
chromagrannin
