Bowel obstruction

Question 1

3 classifications of bowel obstruction

Answer 1

mechanical/paralytic
open/closed
simple/strangulated

Question 2

3 categories of mechanical bowel obstruction and example

Answer 2

luminal e.g. gall stones
within the wall e.g. stricture
outside the wall e.g. adhesion, hernia, volvulus

Question 3

4 categories of paralytic ileus

Answer 3

sympathetic activity
local
bioechemical
pharmacological

Question 4

3 causes of sympathetic activity induced colon paralysis

Answer 4

reflex- post op
retroperitoneal- bleed
malignant infiltration

Question 5

Example of local cause of paralytic ileus

Answer 5

bacterial infection

Question 6

2 biochemical causes of paralytic ileus

Answer 6

K, urea

Question 7

2 pharm causes of paralytic ileus

Answer 7

loperamides, anticholinergics

Question 8

Pathophysiology of bowel obstruction fluid loss

Answer 8

oedematous bowel causes the loss of fluid into the lumen, no reabsorption due to the obstruction

Question 9

Motility proximal to the obstruction is

Answer 9

flaccid and non-functional

Question 10

Motility distal to the obstruction is

Answer 10

normal

Question 11

clinical px of mechanical obstruction

Answer 11

colicky pain in waves
distension
vomiting
constipation
dehydration
active bowel sounds

Question 12

Px of small bowel mechanical obstruction compared to lg bowel

Answer 12

high freq pain centrally
late distension
early vomiting
late constipation

Question 13

where is the pain in a large bowel mechanical obstruction?

Answer 13

lower abdomen

Question 14

px of a paralytic obstruction

Answer 14

diffuse discomfort
small and large bowel distension
gastric distension
constipation
dehydration 
abdominal distension
non-tender
no BS

Question 15

Px of strangulation obstruction

Answer 15

persistent localised pain
locally tender
local oedema

Question 16

4 questions to consider when faced with a bowel obstruction

Answer 16

is there an obstruction?
location- which bowel?
level?
cause?

Question 17

3 main causes of bowel obstruction

Answer 17

adhesions, hernia, masses

Question 18

diagnosis of bowel obstruction

Answer 18

plain radiology- AXR, erect CXR

CT to confirm diagnosis and elicit more info

Question 19

3 steps to bowel obstruction management

Answer 19

Resuscitate- dip and suck: replace fluids, NG tube to remove fluid and air
Plan- operative or non-operative
Intervention- options available

Question 20

5 indications for surgical mx of bowel obstruction

Answer 20

established or suspected strangulation
failure of resolution post non-operative mx
virgin abdomen
hernia
adhesive obstruction

Question 21

6 aspects of non-operative care of bowel obstruction

Answer 21

NG suction
analgesia
fluid and electrolyte replacement 
repeated evaluation
limited time period
dexamethasone for metastatic lesions

Question 22

5 things to consider when assessing bowel viability

Answer 22

colour
mobile
peristalsis 
pulse in mesentery
bleeding

Question 23

2 scenarios for stent use?

Answer 23

bridge to surgery

palliative care

Question 24

What is a volvulus?

Answer 24

twist or abnormal rotation

Question 25

Tx for volvulus

Answer 25

flexible sigmoidoscopy to decompress

Question 26

define shock

Answer 26

a pathological condition that can suddenly affect the haemodynamic equilibrium, usually manifested by the failure to perfuse or oxygenate vital organs.

Question 27

3 main categories of shock

Answer 27

hypovolemic cardiogenic distributive

Question 28

5 investigation for PR bleeding causing shock

Answer 28

``` gastroscopy CT angiogram mesenteric angiogram colonoscopy surgery ```

Question 29

4 benefits of colonoscopy compared to angiography

Answer 29

widely available cheap less invasive biopsy can be taken

Question 30

3 benefits of angiography compared to colonscopy

Answer 30

can detect small bowel lesions unprepared colon detection of angiodysplasia

Question 31

5 causes of lower GI bleeding

Answer 31

``` diverticular disease haemorrhoids ischaemic colitis rectal ulcer ulcerative colitis ```

Question 32

5 causes of haematemesis

Answer 32

``` peptic ulcer gastroduodenal ulcer oesophagitis varices Mallor Weiss tear ```

Question 33

3 Ix for haematemesis

Answer 33

bloods AXR, CXR, erect CXR endoscopy

Question 34

Tx for oesophageal varices

Answer 34

banding

Question 35

Tx for Mallory Weiss tear

Answer 35

adrenaline injection

Question 36

Tx for ulcers

Answer 36

adrenaline injection and mechanical clips

Question 37

4 aspects to ulcer follow up

Answer 37

PPI H. pylori eradication stop NSAIDs repeat endoscopy

Question 38

How do oesophageal varices develop?

Answer 38

if there is liver disease then there is backflow of blood from the portal circulation down the path of least resistance. This means that there is redistribution of blood into the oesophageal vessels causing dilations.

Question 39

3 tx for oesophageal varices

Answer 39

monitoring anti hypertensives e.g propanolol banding

Question 40

Tx of perianal abscess

Answer 40

incision and drainage

Question 41

2 symptoms of perianal abscess

Answer 41

erythematous, painful to touch

Question 42

what is a fistula?

Answer 42

abnormal connection between 2 epithelial surfaces

Question 43

complication of fistula

Answer 43

repeated infections

Question 44

3 tx of fistula

Answer 44

cut it open to prevent repeated infection fistula glue fistula plug LIFT procedure to dissect it out

Question 45

what is a perianal haematoma ?

Answer 45

thrombosed external haemorrhoid

Question 46

tx for perianal haematoma?

Answer 46

analgesic, laxative, ice packs, compression

Question 47

risk factors for haemorrhoids

Answer 47

constipation, straining, poor bowel habits, sitting on the toilet for too long

Question 48

tx for haemorrhoids

Answer 48

banding, excision

Question 49

where do anal fissures occur?

Answer 49

anterior and posteriorly

Question 50

what is an anal fissure?

Answer 50

tearing of the perianal skin

Question 51

2 causes of anal fissure

Answer 51

trauma | hard stool

Question 52

2 symptoms of anal fissure

Answer 52

painful, glass like tearing

Question 53

Mx of anal fissure

Answer 53

laxative, anaglesia, cream to relax the muscle, surgery

Question 54

Which HPV virus causes low grade anal warts?

Answer 54

6 and 11

Question 55

Which HPV virus causes high grade anal warts?

Answer 55

16, 18, 31, 33

Question 56

anal warts can lead to what

Answer 56

anal cancer

Question 57

tx of anal warts

Answer 57

excision, cryotreatment, topical

Question 58

2 risk factors for anal cancer

Answer 58

HIV+ | anal sex

Question 59

what type of surgery is used to excise anal cancer?

Answer 59

ELAPE

Question 60

Tx for rectal prolapse

Answer 60

reduce, ice packs, gel, laxatives, surgery