Teaching Sessions

Question 1

Outline an approach to bowel obstruction

Answer 1

Extraluminal, mural, intraluminal

Question 2

What are the two most common causes of bowel obstruction?

Answer 2

Adhesions and Hernias

Question 3

Name 4 extramural causes of bowel obstruction (6 listed)

Answer 3

Adhesions
Hernias
Malignancy 
Volvulus
Abscess
Endometriosis

Question 4

Name 3 mural causes of bowel obstruction (6 listed)

Answer 4

GI malignancy (large bowel, small bowel, or metastatic)
Stricture (eg due to Crohn’s or Meckel’s)
Radiation (causing stricture, usually)
Congenital malformations

Question 5

Name 3 luminal causes of bowel obstruction (5 listed)

Answer 5

Gallstone
Foreign body
Bezoar
Parasites
Feces, meconium

Question 6

What is gallstone ileus?

Answer 6

Obstruction due to gallstone in the small bowel.
Happens because a fistula forms between gallbladder and duodenum (or other, eg biliary tree, stomach) which releases gallstone

Question 7

What are the four signs of gallstone ileus on AXR?

Answer 7

• Pneumobilia (air in the biliary tree, w/o prior sphincterotomy)
• bowel obstruction (complete or partial)
• … gallstone (most commonly in iliac fossa)
• tumbling obstruction (serial images: obstruction is farther along)

Dx based on first three = Rigler triad

Question 8

What must you do after removing the culprit stone when doing surgery for gallstone ileus?

Answer 8

Run the proximal small bowel: significant portion of people have second stone

Question 9

What is Meckel’s diverticulum?

Answer 9

Small bowel diverticulum

Formed due to defective closing of embryonic structure

Question 10

What is the “rule of 2s” for Meckel’s?

Answer 10

• 2 inches long
• 2 feet proximal to the ileocecal valve
• 2% of the general population (M>F)

Question 11

How can Meckel’s be problematic?

Answer 11

• hemorrhage (most common)
• obstruction (volvulus, intussiception, Littre’s)
• perforation
• infection (Meckel’s diverticulitis)

Question 12

What ectopic tissue can be found in a Meckel’s? Why is it important?

Answer 12

Gastric! Produces acid
can contribute to hemorrhage and perforation
Damages area across the lumen from the diverticulum itself

Question 13

What are the three most common causes of pancreatitis?

Answer 13

Gallstones
Alcohol
(Together make up approx 80% of cases; distribution depends on local pop)

Idiopathic (10%)

Question 14

Name the other most common causes of pancreatitis

Answer 14

I GET SMASHED: Idiopathic, Gallstones, EtOH, then:
Trauma
Steroids
Mumps
Autoimmune
Scorpion (or, brown recluse spider?)
Hypercalcemia, high cholesterol
ERCP
Drugs

Question 15

What is highly likely for a patient presenting with painless jaundice?

Answer 15

Malignant obstruction (of the bile duct)