Small bowel and appendix

Question 1

Obstruction pathophysiology

Answer 1

Fluid, gas, ischaemia, perforation

Question 2

Obstruction symptoms

Answer 2

Pain (colicky, central)
Absolute constipation
Vomiting
Burping
Abdominal distension

Question 3

Obstruction causes

Answer 3

Within lumen (gallstone, food, bezoar)
Within wall (tumour, Crohn's, radiation)
Outside wall (adhesions, herniation)

Question 4

Obstruction Ix

Answer 4

Urinalysis 
Bloods
Gases
AXR
CT of abdomen

Question 5

Drip and Suck

Answer 5

ABC
Analgesia
Fluids with potassium
Catheterise
NG Tube (ryles tube)
Anti-thromboembolism 
Up to 72 hours

Question 6

Mesenteric Ischaemia

Answer 6

Embolus, thrombosis (arterial and venous)
Chronic (SMA, cramps, angina of gut, atherosclerosis)
Acute (Small bowel gets infarcted, dies. Colon, lives)

Question 7

Appendicitis Pathology

Answer 7

Lumen may or may not be occluded
Lymphoid hyperplasia 
Obstruction
Build up of mucus and exudate
Venous onstruction
Ischaemia
Perforation
Inflammation in abdomen brings the greater omentum, small bowel adheres, phlegmonous mass

Question 8

Appendicitis Signs

Answer 8

Rosving’s, Psoas, Obturator

Question 9

Rosving’s sign

Answer 9

Pressing on left causes pain on right

Question 10

Psoas

Answer 10

Patient keeps right hip flexed as this lifts an inflammed appendix off the psoas

Question 11

Obturator

Answer 11

If appendix is touching obturator internus, flexing the hip and internally rotating will cause pain

Question 12

Neoplasms of appendix

Answer 12

Pseudomyxoma pertitonei

Carcinoid

Question 13

Carcinoid of appendix

Answer 13

Rare
Crypts of Lieberkuhn
Strains for chromagrannin

Question 14

Treat early appendicitis

Answer 14

Lap appendicectomy