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ABSITE > 35 Small Bowel > Flashcards

35 Small Bowel Flashcards

1
Q

Most common causes of small bowel obstruction?

A

Adhesion (requires previous surgery)
Hernia
Cancer

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2
Q

Most common causes of large bowel obstruction?

A

Cancer

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3
Q

Signs and symptoms of proximal small bowel obstruction?

A

Intermittent pain (intense, colicky, relieved with vomiting)
Large volume vomiting (bilious)
Epigastric or periumbilical tenderness (mild)
No distention
+/- obstipation

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4
Q

Signs and symptoms of distal small bowel obstruction?

A 
Intermittent/constant pain 
Low volume vomiting (progressively feculent)
Diffuse and progressive tenderness 
Moderate to marked distention
Obstipation
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5
Q

Signs and symptoms of closed loop small bowel obstruction?

A 
Progressive, intermittent, constant pain; rapidly worsening
May have prominent vomiting (reflex)
Diffuse and progressive tenderness 
Absent distention
\+/- Obstipation
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6
Q

Signs and symptoms of colon and rectum obstruction?

A 
Continuous pain
Intermittent vomiting (feculent)
Diffuse tenderness 
Marked distention
Obstipation
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7
Q

Symptoms of bowel obstruction?

A

Nausea and vomiting
Crampy abdominal pain
Failure to pass gas or stool

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8
Q

AXR findings in obstruction?

A

Air-fluid level
Distended loops of small bowel
Distal decompression
Absence of air in the colon or rectum

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9
Q

Why do you need aggressive fluid resuscitation in obstruction?

A

3rd spacing of fluid into the bowel lumen occurs

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10
Q

Why do you get air with a bowel obstruction?

A

Swallowed nitrogen (O2 can be absorbed)

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11
Q

Treatment of small bowel obstruction?

A

Bowel rest
NG tube
IV fluids
(Response - 80% of partial SBO, 40% of complete SBO)

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12
Q

Indication for surgical intervention in SBO?

A

Progessing pain
Peritoneal signs, Fever, Increasing WBCs (suggestive of strangulation/perforation)
Failure to resolve

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13
Q

anatomy and physiology: fund of small and large intestines

A

small = nutrient and water absorption … large = water absorption

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14
Q

anatomy and physiology: duodenum - parts

A

bulb = first portion, 90% of ulcers here …. descending = 2nd portion = contains ampulla of vater (duct of Wirsung, panc and CBD ducts meet) and duct of Santorini (accessory duct) … transverse = 3rd … ascending = 4th

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15
Q

anatomy and physiology: duodenum - retroperitoneal parts

A

descending (2nd portion with ducts entering) and transverse (3rd)

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16
Q

anatomy and physiology: duodenum - unique characteristic of 3rd and 4th portions

A

transition point at the acute angle between the aorta (posterior) and SMA (anterior)

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17
Q

anatomy and physiology: duodenum - vascular supply

A

superior (off GDA) and inferior (off SMA) pancreaticoduodenal arteries … both have anterior and posterior branches …. many communications between these arteries

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18
Q

anatomy and physiology: jejunum - describe

A

100cm long, long vasa recta, circular muscle folds

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19
Q

anatomy and physiology: jejunum - function

A

site of max absorption of everything except B12 (t ileum), bile acids (non conjugated at ileum, conjugated at terminal ileum), iron (duod), folate (t ileum) …. 95% of NaCl and 90% of water absorbed in jejunum

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20
Q

anatomy and physiology: jejunum - vasular supply

A

SMA

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21
Q

anatomy and physiology: ileum - describe, absorption, vascular supply

A

150cm long, short vasa recta, flat …. absorb non conj bile acids (ileum), conj bile acids, folate, B12 (t ileum)

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22
Q

anatomy and physiology: describe jejunum vs ileum

A

jej = 100cm, long vasa recta, circular muscle folds …. ileum = 150cm, short vasa recta, flat

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23
Q

anatomy and physiology: absorption throughout small bowel

A

jejunum = max site of all absorption, except …. ileum = non-conj bile acids … t ileum = con bile acids, b12, folate

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24
Q

anatomy and physiology: vascular supply throughout small bowel

A

duo = superior (off GDA which is off celiac then common hepatic) and inferior (off SMA) pancreaticoduodenal arteries (both with anterior and posterior branches) … jej = SMA, long vasa recta …. ileum = SMA, short vasa recta

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25
Q

anatomy and physiology: enzymes in intestinal brush border

A

maltase, sucrase, limit dextrinase, lactase

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26
Q

anatomy and physiology: normal sizes of small bowel, t colon, cecum

A

3, 6, 9cm

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27
Q

anatomy and physiology: branches of SMA

A

inferior pancreaticoduodenal artery … jejunal and ileal branches … ileocolic artery, appendicular artery, accessory appendicular artery … right colic artery … middle colic artery

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28
Q

anatomy and physiology: cell types

A

absorptive cells …. goblet cells (mucin secretion) … paneth cells (secretory granules, enzymes) … enterochromaffin cells (APUD, 5-hydroxytryptinase release, carcinoid precursor) … Brunner’s glands (alkaline solution) … Peyer’s patches (lymphoid tissue, increased in ileum) … M cells (APCs in intestinal wall)

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29
Q

anatomy and physiology: IgA

A

released into gut, also in mom’s milk

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30
Q

anatomy and physiology: Fe

A

small bowel has both heme and Fe transporters

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31
Q

anatomy and physiology: gut motility

A

migrating motor complex … phase 1 = rest …. phase 2 = acceleration and GB contraction … phase 3 = peristalsis, motilin is most important hormone and acts here …. phase 4 = deceleration

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32
Q

anatomy and physiology: bile salts/acids absorption

A

95% of bile salts are reabsorbed … 50% passive (non conj), 45% t ileum, 5% colon … 50% active (conj), only in t ileum (Na/K ATPase) - get gallstones after t ileum resection 2/2 malabsorption of bile acids

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33
Q

short gut syndrome: sx

A

diarrhea, steattorhea, weight loss, nutritional deficiency (lose fat, b12, electrolytes, water)

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34
Q

short gut syndrome: dx

A

based on sx, not length of bowel …. sudan red stain checks for fecal fat … schilling test = checks for b12 absorption (radiolabeled b12 in urine)

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35
Q

short gut syndrome: amnt of bowel needed

A

about 75cm to survival off TPN, 50cm with competent ileocecal valve

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36
Q

short gut syndrome: tx

A

restrict fat, PPI to reduce acid, lomotil (diphenoxylate and atropine)

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37
Q

steatorrhea: causes

A

(1) gastric hypersecretion of acid —> dec pH —> inc intestinal motility —> interferes with fat absorption ….. (2) interruption of bile salt resorption (i.e. terminal ileum resection) interferes with micelle formation and fat absorption)

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38
Q

steatorrhea: tx

A

control diarrhea (lomotil), dec oral intake esp of fats, pancrease, PPI

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39
Q

nonhealing fistula: causes

A

FRIENDS = Foreign body, Radiation, IBD, Epithelialization, Neoplasm, Distal obstruction, Sepsis/infection

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40
Q

nonhealing fistula: high output fistulas

A

more common with proximal bowel (duo or prox jejunum) and are less likely to close with conservative mgmt

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41
Q

nonhealing fistula: colonic fistulas

A

more likely to close than small bowel fistulas

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42
Q

nonhealing fistula: workup of pts w persistent fever

A

check for abscess (fisulogram, abd CT, upper GI with SBFT)

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43
Q

nonhealing fistula: MC causes and mgmt of fistulas

A

most fistulas are iatrogenic and treated conservatively (NPO, TPN, skin protection / stoma appliance, ocreotide), most close without surgery

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44
Q

nonhealing fistula: surgical options

A

(most heal with conservative mgmt) - resect bowel segment containing fistula and perform primary anastomosis

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45
Q

obstruction: MC causes

A

without previous surgery - small bowel 2/2 hernia, large bowel 2/2 cancer …. with previous surgery - small bowel 2/2 adhesions, large bowel 2/2 cancer

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46
Q

obstruction: sx

A

n/v, crampy abd pain, failure to pass gas or stool

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47
Q

obstruction: abd xray

A

air-fluid level, distended loops of small bowel, distal decompression

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48
Q

obstruction: fluid issues

A

3rd spacing of fluid into bowel lumen, need aggressive fluid resuscitation

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49
Q

obstruction: air with bowel obstruction

A

from swallowed nitrogen

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50
Q

obstruction: tx

A

bowel rest, NGT, IVF … cure 80% of partial SBO and 40% of complete SBO

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51
Q

obstruction: surgical indications

A

80% partial and 40% complete SBOs can be managed conservatively …. progressing pain, peritoneal signs, fever, increasing WBCs (all signs of strangulation or perforation), or failure to thrive

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52
Q

signs and sx of bowel obstruction: pain, vom, tenderness, distenion, obstipation - proximal small bowel, open loop

A

pain is intermittent, intense, colicky, often relieved with emesis …. vom is large V, bilious, frequent … tenderness is epigastric or periumbilical, mild unless strangulated bowel … distention absent …. +/- obstipation

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53
Q

signs and sx of bowel obstruction: pain, vom, tenderness, distenion, obstipation - distal small bowel, open loop

A

pain is intermittent to constant … vom is low V and frequency, progressively feculent with time … TTP is diffuse and progressive … distention is moderate to marked … +obstipation

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54
Q

signs and sx of bowel obstruction: pain, vom, tenderness, distenion, obstipation - small bowel, closed loop

A

pain is progressive, intermittent, constant, rapidly worsens … vom may be prominent (reflex) … TTP is diffuse, progressive … distention often absent … +/- obstipation

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55
Q

signs and sx of bowel obstruction: pain, vom, tenderness, distenion, obstipation - colon and rectum

A

pain is continuous …. vom is intermittent, not prominent, feculent when present … TTP is diffuse … distention is marked … obstipation is present

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56
Q

signs and sx of bowel obstruction: open loop prox small bowel, open loop distal small bowel, closed loop small bowel, colon and rectum - pain

A

intermittent, intense, colicky, often relieved w emesis …. intermittent to constant … progressive, intermittent, constant, rapidly worsens … continuous

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57
Q

signs and sx of bowel obstruction: open loop prox small bowel, open loop distal small bowel, closed loop small bowel, colon and rectum - emesis

A

large V, bilious, frequent … low V, low freq, progressively feculent … may be prominent (reflex) … intermittent, not prominent, feculent if present

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58
Q

signs and sx of bowel obstruction: open loop prox small bowel, open loop distal small bowel, closed loop small bowel, colon and rectum - TTP

A

epigastric or peiumbilical, mild unless strangulated bowel …. diffuse and progressive … diffuse, progressive, diffuse

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59
Q

signs and sx of bowel obstruction: open loop prox small bowel, open loop distal small bowel, closed loop small bowel, colon and rectum - distention

A

absent …. moderate to marked …. often absent … marked

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60
Q

signs and sx of bowel obstruction: open loop prox small bowel, open loop distal small bowel, closed loop small bowel, colon and rectum - obstipation

A

+/- …. present … +/- …. present

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61
Q

gallstone ileus: describe

A

SBO 2/2 gallstone, usually in t ileum

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62
Q

gallstone ileus: imaging findings

A

classically air in biliary tree in a pt w SBO

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63
Q

gallstone ileus: cause

A

fistula between GB and second portion of the duo

64
Q

gallstone ileus: tx

A

remove stone from t ileum … can leave GB and fistula if pt too sick, o/w cholecystectomy and close duod

65
Q

MC cause of painless lower GI bleeds in kids <2yo

A

Meckel’s diverticulum

66
Q

Meckel’s diverticulum: rule of 2s

A

2ft from ileocecal valve, 2% of population, present within first 2 years of life

67
Q

Meckel’s diverticulum: true or false

A

true diverticulum

68
Q

Meckel’s diverticulum: caused by?

A

failure of closure of omphalomesenteric duct

69
Q

Meckel’s diverticulum: MC tissue found in Meckel’s vs MC to cause sx

A

pancreatic tissue - which can cause diverticulitis …. sx usually 2/2 gastric mucosa (bleeding is MC sx)

70
Q

Meckel’s diverticulum: MC presentation in kids vs adults

A

painless lower GI bleed in kids <2yo (account for 50% of painless LGI bleed in kids <2yo) …. obstruction in adults

71
Q

Meckel’s diverticulum: mgmt if incidental finding

A

usually not removed unless gastric mucosa suspected (diverticulum feels thick) or has very narrowed neck

72
Q

Meckel’s diverticulum: dx

A

can get meckel’s scan (99Tc) if having trouble localizing –> mucosa will light up

73
Q

Meckel’s diverticulum: tx

A

diverticulectomy for uncomplicated diverticulitis or bleeding … need segmental resection for complication diverticulitis (i.e. perforation), neck >1/3 diameter of the normal bowel lumen or if diverticulitis involves base …. if incidental finding, usually not removed unless gastric mucosa suspected (diverticulum feels thick) or has very narrowed neck

74
Q

duodenal diverticula: workup

A

need to r/o GB-duo fistula

75
Q

duodenal diverticula: mgmt/tx

A

observe unless perforated, bleeding, causing obstruction, highly sx …. if sx - segmental resection … if juxta-ampullary - usually can’t resect, do choledochojejunostomy (biliary sx) or ERCP w stent (pancreatitis sx), AVOID whipple

76
Q

Crohn’s disease: describe

A

inflammatory bowel disease causing intermittent abd pain, diarrhea, and weight loss …. can also cause bowel obstructions and fistulas

77
Q

Crohn’s disease: MC patients

A

15-35 yo at 1st presentation, inc in Ashkenazi jews

78
Q

Crohn’s disease: extraintestinal manifestations

A

arthritis, arthralgias, pyoderma gangrenosum, erythema nodosum ocular diseases, growth failure, megaloblastic anemia from folate and vit b12 malabsorption

79
Q

Crohn’s disease: location

A

can occur anywhere from mouth to anus, usually pares rectum … t ileum is MC involved bowel segment

80
Q

Crohn’s disease: anal/perineal disease

A

1st presentation in 5% …. tx w flagyl … MC sx in anal disease is large skin tags

81
Q

Crohn’s disease: MC sites for initial presentation

A

t ileum and cecum - 40% … colon only - 30% … small bowel only - 20% … perianal - 5%

82
Q

Crohn’s disease: dx

A

colonoscopy with biopsies and enteroclysis can help make dx

83
Q

Crohn’s disease: pathology

A

transmural involvement, segmental disease (skip lesions), cobblestoning, narrow deep ulcers, creeping fat, fistulas

84
Q

Crohn’s disease: medical tx

A

5-ASA and loperamide for maintenance, steroids for acute flaures … remicade (infliximab, TNF-alpha inhibitor) for fistulas and steroid-resistant disease …. NO agents exist that affect the natural course of the disease … TPN - may induce remission and fistula closuer with small bowel Crohn’s disease

85
Q

Crohn’s disease: % that need surgery

A

90% eventually need surgery

86
Q

Crohn’s disease: surgical indications

A

surgery is NOT curative (unlike UC) … do NOT need clear margins, just get 2cm away from gross disease with surgery ….. obstruction (often partial and can be initially treated conservatively) … abscess (usually treated with perc drainage) … megacolon (perforation occurs in 15%, usually contained) … hemorrhage (unusual but can occur) … blind loop obstruction (need resection) … fissures (NO lateral internal sphincteroplasty in pts with Crohn’s) … enterocutaneous fistula (can usually treat conservatively but surgery if non healing) … perineal fistula (unroof and r/o abscess then let it heal on its own) … anorectovaginal fistulas (may need rectal advancement flapp, possible colostomy)

87
Q

Crohn’s disease: mgmt of pts with diffuse disease of colon

A

proctocolectomy and ileostomy - NO pouches or ilio-anal anastomosis with Crohn’s

88
Q

Crohn’s disease: mgmt incidental findings of IBD in pt with presumed appendicitis who has normal appendix

A

remove appendix to prevent future confounding dx

89
Q

Crohn’s disease: stricturoplasty - describe

A

longitudinal incision through stricture, then close transversely

90
Q

Crohn’s disease: stricturoplasty - when to consider

A

if pt has multiple bowel strictures to save small bowel length …. usually not good for 1st operation because it leaves diseased bowel behind

91
Q

Crohn’s disease: stricturoplasty - complications

A

10% leakage/abscess/fistula rate with stricturoplasty (all of which can be treated conservatively)

92
Q

Crohn’s disease: stricturoplasty - recurrence rate

A

50% recurrence rate requiring surgery for Crohn’s disease after resection

93
Q

Crohn’s disease: complications from removing t ileum

A

(1) dec B12 uptake –> megaloblastic anemia … (2) dec bile salt uptake –> osmotic diarrhea (bile salts) and steatorrhea in colon …. (3) decrease oxalate binding to Ca 2/2 intraluminal fat (fat binds Ca) –> oxalate then gets absorbed in colon –> released in urine —> Ca-oxalate kidney stones (hyperoxaluria) … (4) gallstones 2/2 malabsorption of bile salt (conj salt actively transported in t ileum)

94
Q

Chron’s disease: cancer risk in pancolitis

A

same colon CA risk as UC

95
Q

carcinoid: hormones involved

A

release bradykinin and serotonin

96
Q

carcinoid: describe role of 5ht

A

produced in Kulchitsky cells (enterochromaffin cell or argentaffin cell) … part of amine precursor uptake decarboxylase system (APUD) … 5-HIAA is breakdown product of 5HT, can measure in urine

97
Q

carcinoid: carcinoid syndrome - caused by what?

A

caused by bulky liver mets

98
Q

carcinoid: carcinoid syndrome - sx

A

intermitted flushing (kallikrein), diarrhea (5ht) are hallmarks … also asthma-like sx (bradykinin) and R heart valve lesions

99
Q

carcinoid: carcinoid syndrome - workup

A

chromogranin A level - highest sensitivity for detecting carcinoid … octreotide scan - best for localizing tumor not seen on CT

100
Q

carcinoid: carcinoid syndrome - significance in pt w small bowel primary

A

indicates mets to liver (liver usually clears 5ht)

101
Q

carcinoid: carcinoid syndrome - surgical mgmt

A

if resect liver mets then you should also do cholecystectomy in case of future embolization

102
Q

carcinoid: MC site

A

appendix (50% here), ileum and rectum are the next most common

103
Q

carcinoid: small bowel

A

patients at inc risk for multiple primaries and other unrelated malignancies

104
Q

carcinoid tumor tx

A

if in appendix and <2cm, do appy …. if in appendic and >=2cm or involving base, do R hemicolectomy …. other places in GI tract, treat like any cancer (segmental resection with lymphadenectomy) …. chemo (streptozocin, 5FU) used for unresectable disease)

105
Q

carcinoid syndrome palliation

A

octreotide

106
Q

carcinoid: assoc bronchospasm tx

A

aprotinin

107
Q

carcinoid: assoc flushing tx

A

alpha blockers (i.e. phenothiazine)

108
Q

carcinoid: false + 5-HIAA

A

fruits

109
Q

intussusception in adults: vocab, causes, px, tx

A

intussusceptum is the segment of bowel that invaginates into the intussuscipiens …. can be 2/2 small bowel or cecal tumors (worrisome in adults b/c often malignant lead point) … MC px is obstruction … tx w resection

110
Q

benign small bowel tumors: list

A

adenomas, peutz-jeghers syndrome

111
Q

benign small bowel tumors: ademoas - MC location, px,

A

most found in duodenem …. p/w bleeding, obstruction … tx w resection when identified (often done w endoscope)

112
Q

benign small bowel tumors: peutz-jeghers syndrome - inheritance, dsecribe px, cancer risk, mgmt

A

autosomal dominant …. hartomas throughout GI tract (small and large bowel), mucocutaneous melanotic skin pigmentation … pts have inc extraintestinal malignancies (MC breast cancer) and small risk of GI malignancies … NO role of ppx colectomy

113
Q

malignant small bowel tumors: list

A

adenocarcinoma (most common malignant small bowel tumor, but rare overall), leiomyosarcoma, lymphoma

114
Q

malignant small bowel tumors: adenocarcinoma - epi, location, sx, tx

A

rare overall, MC malignant small bowel tumor … high proportion in duodenum … sx = obstruction, jaundice … tx = resection and adenectomy, Whipple if in 2nd portion of duodenum

115
Q

malignant small bowel tumors: adenocarcinoma - duodenal CA risk factors

A

FAP, Gardner’s, polyps, adenomas, von Recklinghausen’s

116
Q

malignant small bowel tumors: leiomyosarcoma - MC locations, dx, r/o what, tx

A

jejunum and ileum, most extaluminal … hard to differentiate from leiomyoma (>5 mitoses/HPF, atypia, necrosis) …. r/o GIST (check for c-kit) …. tx = resect, NO adenectomy needed

117
Q

malignant small bowel tumors: lymphoma - MC location

A

ileum

118
Q

malignant small bowel tumors: lymphoma - assoc w what

A

Wegener’s, SLE, AIDS, Crohn’s, celiac sprue

119
Q

malignant small bowel tumors: lymphoma - type

A

usually NHL B cell type

120
Q

malignant small bowel tumors: lymphoma - post-transplant risk

A

inc risk bleeding and perforation

121
Q

malignant small bowel tumors: lymphoma - dx

A

abd CT, node sampling

122
Q

malignant small bowel tumors: lymphoma - tx

A

wide en bloc resection (include nodes) unless 1st or 2nd portion of the duodenum (chemo-XRT, NO whipple)

123
Q

malignant small bowel tumors: lymphoma - survival

A

40% 5 year survival

124
Q

stomas: parastomal hernias

A

highest incidence w colostomies, generally well tolerated and do not need repair (unless symptomatic)

125
Q

stomas: MC infection

A

candida

126
Q

stomas: diversion colitis

A

i.e. Hartmann’s pouch …. 2/2 lack of short-chain fatty acids … tx w short-chain fatty acid enemas

127
Q

stomas: MC cause of stenosis

A

ischemia … tx w dilation if mild

128
Q

stomas: MC cause of fistula near stoma site

A

Crohn’s

129
Q

stomas: abscesses

A

often underneath stoma site 2/2 irrigation device

130
Q

stomas: inc rate of what with ileostomy

A

gallstones and uric acid kidney stones

131
Q

appendicitis: px

A

1st anorexia, 2nd peiumbilical pain, 3rd emesis … pain gradually migrates to the RLQ as peritonitis sets in …. kids more often have higher fever and more vomiting and diarrhea …. elderly can have minimal signs/sx

132
Q

appendicitis: MC age

A

20-35yo

133
Q

appendicitis: WBC count

A

can be normal

134
Q

appendicitis: CT findings

A

diameter >7mm or wall thickness >2mm (looks like bull’s eye), fat stranding, no contrast in appendiceal lumen …. try to give rectal contrast

135
Q

appendicitis: area most likely to perf

A

midpoint of anti-mesenteric border

136
Q

appendicitis: MC cause in kids vs adults

A

hyperplasia (i.e. after viral illness) vs fecalith

137
Q

appendicitis: pathophys

A

luminal obstruction (hyperplasia in kids vs fecalith in adults) —> distention of appendix —> venous congestion and thrombosis —> ischemia —> gangrene necrosis —> rupture

138
Q

appendicitis: mgmt of CT showing walled-off perforated appendix in elderly

A

usually non-operative … perc drainage and interval appendectomy at later date if sx are improving (but may need R hemicolectomy if suspect cancer) … consider sollow-up barium enema or colonoscopy to r/o perf’ed cecal CA

139
Q

appendicitis: MC to rupture

A

children and elderly 2/2 delayed dx

140
Q

appendicitis: in infants

A

infrequent

141
Q

appendicitis: perforation

A

patients more ill overall, can have evidence of sepsis

142
Q

appendicitis: during pregnancy - most likely to _______ in each trimester

A

MC cause of acute abd pain in 1st trimester … more likely to occur in 2nd trimester (just isn’t the MC cause of abd pain then) … more likely to perforate in 3rd trimester

143
Q

appendicitis: during pregnancy - surgical approach

A

make incision where the pt is having pain … appendix is more likely to migrate cephalad (more superiorly)

144
Q

appendicitis: during pregnancy - px in 3rd trimester

A

may have RUQ pain

145
Q

appendicitis: during pregnancy - mortality w rupture

A

35% fetal mortality

146
Q

appendicitis: during pregnancy - w/u of suspected appendicitis in pregnancy

A

beta-hcg and abd u/s to r/o ob/gyn causes of pain

147
Q

appendix mucocele: causes

A

benign or malignant mucous papillary tumor

148
Q

appendix mucocele: mgmt

A

resect …. open so you don’t spill tumor content … R hemicolectomy if malignant

149
Q

appendix mucocele: complications of rupture

A

pseudomyxoma peritonei (spread of tumor implants throughout peritoneum)

150
Q

appendix mucocele: MCC of death

A

SBO from peritoneal tumor spread

151
Q

regional ileitis

A

can mimic appendicitis, 10% develop Crohn’s

152
Q

gastroenteritis

A

n/v, diarrhea

153
Q

presumed appendicitis but find ob/gyn problem: common problems, mgmt

A

often ruptured ovarian cyst, thrombosed ovarian vein, regional enteritis not involving cecum … still perform appendectomy (prevents future confounding dx)

154
Q

ileus vs obstruction

A

ileus = dilation is uniform throughout stomach, small bowel, colon, rectum, WITHOUT decompression … obstruction = the IS bowel decompression distal to the obstruction

155
Q

causes of ileus

A

surgery (MC), electrolyte abnormalities (dec K), peritonitis, ischemia, trauma, drugs

156
Q

typhoid enteritis: cause, px, tx

A

salmonella …. kids, RLQ pain, diarrhea, fever, HA, maculopapular rash, leukopenia, rare bleeding/perforation …. tx w bactrim

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