Bowel obstruction and herniae Flashcards Preview

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Flashcards in Bowel obstruction and herniae Deck (69):
1

Bowel __ to obstruction dilates

proximal

2

Presents within hrs of obstruction, vomit large volumes (___) =

small bowel obstruction
gut secretions

3

present gradually with colicky abdo pain, distension and faeculent vomiting

distal small bowel/colon obstruction

4

The more ___ the obstruction the earlier vomiting occurs

proximal

5

vomiting of semi-digested food eaten 1/2 days ago (no bile) suggests

gastric outflow syndrome

6

The ileocaecal valve being ___ delays onset of symptoms of obstruction

incompetent (50:50 whether comp/not)

7

in a closed loop obstruction the ileocaecal valve is ___ results in ___

competent
distention and perforation of the caecum

8

If tenderness is present in suspected bowel obstruction then ____ is occuring

strangulation
(usually obstructions are relatively non-tender)

9

colicky episodes in incomplete bowel obstruction can be ___ prominent that in complete because

more
if chronic then proximal bowel hypertrophies

10

Investigations for bowel obstruction =

supine AXR (shows gas and dilated loops)
then CT if needed

11

Management of bowel obstruction =

nil by mouth
NG tube to decompress stomach
IV cannula for bloods, fluids and electrolytes

12

small bowel dilations on supine AXR =

central and have valvulae coniventes

13

colon dilations on supine AXR =

round periphery of abdomen and have haustra

14

Mechanical causes of bowel obstruction =

strictures
volvulus
hernias
adhesions
tumours
bolus
intussusception

15

Inflammatory strictures in Crohn's/diverticula usually cause ___ obstruction

incomplete

16

If bowel is strangulated venous/arterial flow is cut off first?

venous (then arterial backP => gangrene)

17

In mechanical causes of obstruction can see ___
this is not true for adynamic causes

clear cut off between dilated and non-dilated bowel

18

Risk factors for paralytic ileus =

recent GI surgery, inflammation with peritonitis, diabetic ketoacidosis

19

Paraltic ileus present's similarly to small bowel obstruction but __+__ not present

pain
tinkling

20

Treatment of paralytic ileus =

drip and suck
wait for peristalsis to return

21

Ogilvie's syndrome =

Pseudo-obstruction of the colon
acute dilatation of colon wo an obstruction makes patient acutely unwell

22

Pseudo-obstruction of the colon is associated with

hip replacement surgery
CABG
pneumonia
# of spine
frail and elderly

23

Pseudo-obstruction mechanism behind it =

sympathetic overrides parasympathetic and colon distends with gas

24

If pseudo-obstruction causes respiratory problems(diaphragm splinting)/pain then treatment =

colonoscopy to decompress

25

Hernia =

abnormal protrusion of a viscus outwith its normal body cavity

26

Commonest to least common 4 hernias

inguinal (80%)
umbilical (8%)
incisional(7%)
femoral (5%)

27

majority of abdominal hernias are from natural openings/weak areas

weak areas

28

Risk factors for herniae is anything that ___

increases intra-abdo pressure

29

reducible/ireducible hernia cause problems and need surgery?

irreducible

30

Incarcerated irreducible hernia =

too big to fit back in

31

obstructed irreducible hernia ->___ where __ is occluded

strangulation
venous drainage occluded first then arterial inflow back P => gangrene and friable

32

Most important modifiable risk factor for incisional herniae

suture technique
to prevent use tension suture and mass closure of linea alba

33

vertical/transverse incisions are morely to cause an incisional hernia

vertical

34

True umbilical hernia only occur in ___

kids congenitally

35

If true umbilical hernia don't resolve by age __ only then will you operate

3yrs

36

Paediatric inguinal herniae are more common in M/F and ___
High risk of strangulation in under 1yos so

M 9:1
low birth wt/prem babies
operate within 24hrs

37

hydrocele =

peritoneal fluid in the testis
can occur due to patent processus vaginalis

38

hydrocele treatment =

not operated on unless large/aesthetics
usually recede by themselves

39

Epigastric hernia are more common in ___
usually contain
arise from

M3:1
extraperitoneal fat
congenital linea albus weakness

40

treatment of epigastric herniae =

sutures/mesh

41

Femoral canal is made up of
anteriorly=
medially=
laterally=
posteriorly =

ant = inguinal ligament
medial - lacunar lig
lateral = femoral vein
post = pectinate lig

42

inferior and lateral to pubic tubercle and flatten groin crease =

femoral hernia

43

Thin, elderly female hernia =

femoral hernia

44

femoral hernia are more common in M/F

F 10:1
however if see a groin hernia in a female is still more likely it will be inguinal, get me?

45

superior and medial to pubic tubercle and increases groin crease =

inguinal hernia

46

Inguino-scrotal herniae are most likely to be direct/indirect?

indirect

47

deep ring of inguinal canal location =

mid inguinal point
(more superior and lateral than superficial)

48

superficial ring of inguinal canal location =

above and medial to pubic tubercle

49

anterior wall of inguinal canal =

external oblique aponeurosis

50

floor of inguinal canal =

inguinal and lacunar lig

51

roof of inguinal canal =

conjoint tendon

52

posterior wall of inguinal canal =

transversalis fascia and conjoint tendon(medially)

53

Hesselbach's triangle =

inguinal lig inferiorly
inferior epigastric vessels laterally
leteral border of rectus sheath medially

54

__ inguinal herniae occur through Hesselbach's triangle

direct

55

Inguinal herniae that go through posterior wall
are medial to inferior epigastric vessels

direct

56

direct/indirect are often bilateral inguinal herniae

direct

57

inguinal herniae that is poorly controlled by finger over deep ring - comes back out

direct

58

inguinal herniae more common in old men =
don''t usually get surgery because ___

direct
low strangulation risk and are old

59

Indirect inguinal herniae go through ___
lie ___ to inferior epigastric vessels and go with the ___

deep inguinal ring
lateral
cord

60

Congenital (eg. PPV) inguinal hernia are usually

indirect

61

indirect inguinal herniae occur more commonly in ___

M 10:1
younger males

62

hernia controlled by digital P over deep ring = stays in =

indirect inguinal hernia

63

indirect/direct inguinal herniae have more risk of complications and so are more likely to get ___

indirect
surgery

64

Operations for inguinal herniae (more commonly for indirect)

suture (eg. Bassini), open mesh (Lichtenstein), TAPS/TEPS, herniotomy (for congenital), herniorraphy (repair wall defect)

65

Post-op after hernia repair = 2 things

no driving for a wk
no heavy lifting for 1 month

66

Testicular scrotal swelling indicates

testicular cancer

67

scrotal swellings could be due to (4)

testicular cancer
epidydymal cyst
hydrocele
inguino-scrotal hernia

68

in scrotal swellings if can get above it then it is in the ___ and is not a ___

scrotum eg. a hydrocele
not a hernia

69

If can feel scrotal swelling is separate to testiicles then it is a ___

epididymal cyst