Bowel conditions Flashcards
Define appendix
a prominent lymphoid tissue which regresses with age
What causes appendicitis
What bacteria cause appendicitis
Obstruction - fecalith, bezoar, filarial worms, lymphoid hyperplasia
Infection
Enterus vemicularis
Pathogenesis of appendicitis [5]
- Fills with mucous and swell
- eventually causing thrombosis, occlusion of small vessels and stasis of lymphatic flow.
- Appendix becomes ischaemic and necrotic
- Bacteria leak out through walls and pus forms around the appendix.
- Eventual rupture
Presentation Appendicitis
Symptoms [3]
Signs [5]
Symptoms
- Periumbilical pain that moves to RIF
- Anorexia - pain usually proceeds any vomiting
- Usually constipated +/- diarrhea
Signs
- Tachycardia, fever,
- furred tongue, foetor
- lying still, positive cough test
- Guarding, rebound tenderness,
- McBurney’s point, Rovsings sign
What is Murphys triad
Investigations: appendicitis [5]
Murphys triad
- Pain, vomiting, fever
- FBC (neutrophilic leucocytosis)
- CRP
- Urine test - neutrophils + leucocyte (no nitrites), pregnancy test
- USS >6cm diameter + rule out gynae
- CT (not routine)
Appendicitis management
Simple appendicitis [2]
Perforated appendicitis [2]
Simple appendicitis: laparoscopic appendectomy, prophylactic IV abx (metronidazole and cefuroxime)
Perforated appendicitis: copious abdominal lavage and appendectomy
What are the differentials for appendicitis [8]
What should you beware in elderly?
Gastroenteritis IBS, Crohns Constipation Peptic ulcer UTI Ectopic pregnancy PID Mesenteric adenitis
Beware of underlying malignancy in elderly
Describe an atypical presentation of appendicitis [2]
Retrocaecal retroperitoneal appendix > flank or RUQ pain, PR painful
Can occur in pregnancy
Complications of appendicitis
- Perforation
- Appendix mass - when inflamed appendix becomes covered in omentum, could also be in tumor
- Appendix abscess
What is ischaemic colitis [2]
Presentation [3]
Ischaemic colitis describes an acute but transient compromise in the blood flow to the large bowel. This may lead to inflammation, ulceration and haemorrhage.
Bloody diarrhea + abdo pain
Where is common site
Splenic flexure
How do you Dx [2] and treat [2]
CT = 1st line
AXR
Supportive
Surgery if peritonitis / perforation / haemorrhage
What is mesenteric ischaemia?
Aetiology
Typically small bowel in contrast to ischaemic colitis
Due to embolism of SMA etc
What are the symptoms [4]
Mesenteric ischemia
Sudden onset abdo pain out of proportion of physical exam findings
Rectal bleeding
Diarrhoea
Fever
What are RF for bowel ischaemia / mesenteric [7]
Age Smoking, Cocaine Hypertension, DM Malignancy Endocarditis, AF** (mesenteric) Surgery Abdominal aneurysm
How do you treat mesenteric ischaemia
Urgent surgery - laparotomy
High mortality
What is a volvulus [2]
Torsion of bowel resulting in a closed loop obstruction that can cause strangulation or incarceration
Where is volvulus common
Sigmoid
Can occur gastric / caecal
What are symptoms of volvulus [3]
Describe presentation of small intestine, caecal, sigmoid
- Absolute constipation
- Abdo pain + bloating
- N+V
Small intestine: SBO symptoms
Caecal: LBO symptoms
Sigmoid: sudden left sided abdominal pain with abdominal distention
What is bowel volvulus associated with [5]
Elderly, Constipation
Neuro: Duchennes / PD
Schizophrenia
Chagas disease
Caecal - preg / adhesions / fistula, Crohns
How do you Dx and Rx [3]
AXR
Central distended bowel in cecum
Tx of volvulus
Caecal [2]
Sigmoid [2]
Caecal
- Laparotomy for resection of affected segment
- +/- anastomosis
Sigmoid
- Emergency sigmoidoscopy, rectal tube insertion and
- Laparotomy for sigmoidectomy +/- anastomosis
Gastric volvulus
Aetiology
Risk factors [2]
Aetiology: twisting of stomach more than 180 degrees
Risk factors:
- Congenital eg pyloric stenosis
- Acquired (surgery)
Gastric volvulus
Symptoms [3]
Ix [2]
Mx [2]
Symptoms:
- Vomiting, pain, failure to pass NGT
- saliva regurgitation
- dysphagia
Ix: erect CXR, AXR (gastric dilation, double fluid level)
Mx: resuscitation, laparotomy
