case 3 details

Question 1

LBO vs SBO/

++ common

Answer 1

80% SBO

20% LBO

hint: 80=vase; 20=nose

Question 2

LBO/

tests

hint: what is the risk of BO

Answer 2

CBC + lytes : if Anion gap acidosis =>bowel infarction or sepsis.

hint: CBC: WBC?=> inflammation

lyte=> acidosis

Question 3

LBO/ imaging

Answer 3

Plain radio=> air present? +

Barium enema or CT scan

hint: if there is air present, where is it exactly?

Question 4

LBO tx

Answer 4

1. Aggressive reH₂O=in + monitoring of U Output
2. Broad-spectrum Abx
3. Surgery consult

hint: prevent or conteract 3rd spacing

BO=>infraction=> sepsis=

Question 5

*LBO etiology/ 3 1st

Answer 5

1. cancer
2. sigmoid or cecal volvulus
3. diverticular disease

large bowel=> big net to get crab=cancer or to make huge ballon figure= volvulus

before u twist the inflated balloon

Question 6

SBO presentation

Answer 6

mm as LBO

Question 7

SBO etiology

Answer 7

Postsurgical adhesions; 70%

Malignant tumor; 10–20% (usually metastatic)

hernia

Question 8

SBO types

Answer 8

partial or complete.

Question 9

SBO types/

diff in tx

Answer 9

SBO partial: 85% resolve spontaneously/

SBP complete: 75% need sgx

Question 10

SBO/imaging

Answer 10

Plain radio=> air present? y/n +

CT scan=> air present + etiology

Question 11

SBO /tx in 5 steps

Answer 11

1. Fluid resuscitation:
   
   1. IV rehydration+ U output carefully.+
   2. Monitor VS orthostasis
2. Nasogastric suction = empty the stomach
3. Broad-spect. Abx : to prevent infection
4. Careful & frequent obs + repeated PE : 1st 12–24 hours
5. Frequent imaging & blood tests: plain radio+ CBC

surgery if : Signs of ischemia or hernia

Question 12

SBO/tx/

why fluid resuscitation via IV rehydration

Answer 12

IV rehydration :to correct the really bad intraVascular deH₂O from

decr. oral intake; vomiting;

+third spacing of fluid w/in the bowel.

Question 13

ischemic bowel subtype

Answer 13

small bowel:

• CMI=chronic mesenteric ischemia /
• AMI= acute mesenteric ischemia /

large bowel:

ischemic colitis (colitis=>colon= large bowel)

hint: obstruction does not alw lead to ischemia

Question 14

AMI presentation/

emergency?

sx

Answer 14

emergency!

sx:

O:abrupt onset of T= acute Q=severe abdominal pain

PE: pain is out of proportion to a relatively benign PE

Question 15

acute mesenteric ischemia=AMI/

etiology

Answer 15

superior mesenteric artery=SMA or celiac artery embolism (50%).

thrombosis (15–25%);/

low flow states w/o obstruction (15–30%)

Question 16

AMI mortality

Answer 16

up to 82%

Question 17

AMI tx

Answer 17

=>obstruction

Emergent revascularization (via

thromboEmbolEctomy; thrombolysis => no thrombus propagation

vascular bypass or angioplasty

+surgical resection of necrotic bowel .

=>nonobstructive mesenteric ischemia;

=>improved perfusion =super important!!

Question 18

AMI/rx

Answer 18

Intra-arterial papaVerine => better mesenteric blood flow ;

how ? Reduc. reactive mesenteric arteriolar vasoconstriction.

hint: AMI=> to prevent obstruction need to maintain fluid coming=>need big PAPA VÉrin

un verin

Question 19

ischemic colitis/presentation

Answer 19

left-sided abd. pain.+

Bloody or maroon stools or diarrhea

hint: colon,

Question 20

MOST common form or intestinal ischemia

Answer 20

Ischemic colitis

Question 21

ischemic colitis/risk factors

Answer 21

+60 years;

endo: DM
heart: CVD; HTN;

GU:hemodialysis/

blood: hypoalbuminemia;

some Rx

Question 22

ischemic colitis/tx

Answer 22

Therapy supportive= bowel rest+

IV hydration;

+broad-spectrum Abx