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GI (Y1) > Disease of the small intestine and appendix - Week 4 > Flashcards

Disease of the small intestine and appendix - Week 4 Flashcards

1
Q

Give the typical presentation of small bowel obstruction.

A 
Distension
Vomiting
Borborygmi
Pain
Faeculent vomiting
Presence of a cause
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2
Q

What is meant by borborygmi?

A

a rumbling or gurgling noise made by the movement of fluid and gas in the intestines

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3
Q

Which investigations are necessary to confirm small bowel obstruction?

A

AXR
Contrast CT scan of abdomen
Gastrograffin studies

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4
Q

Which biochemical markers suggest small bowel obstruction?

A

hypokalaemic and alkalotic

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5
Q

What is the treatment for small bowel obstruction?

A

Antithromboembolic drugs, analgesia, K+ solution, ‘Drip and suck’ using NG tube. If no resolution within 72 hrs, laparotomy.

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6
Q

Why is mesenteric ischaemia so worrying?

A

Has no marginal artery so tissue will certainly die

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7
Q

How can chronic mesenteric ischaemia present?

A

Food fear, cramps, weight loss

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8
Q

Is acute mesenteric ischaemia usually caused by an embolus or a thrombus?

A

Embolus

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9
Q

Acute mesenteric ischaemia is usually caused by…

A

Embolus from AF lodging in SMA

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10
Q

How is mesenteric ischaemia diagnosed?

A

Pain out of proportion to the clinical findings
Acidosis on gases (low pH, high H+ concentration, high BE)
Lactate elevated
CRP may be normal
WCC may be up a bit
CT angiogram

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11
Q

How is mesenteric ischaemia treated?

A

SMA embolectomy, removal of diseased small intestine, close over and prepare patient & family for the worst

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12
Q

How is small intestinal haemorrhage diagnosed?

A

CT angiogram

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13
Q

How is small intestinal haemorrhage treated?

A

Usually by interventional radiology

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14
Q

Give some complications of Meckel’s Diverticulum.

A

Bleed (haematochezia)
Ulcerate/meckels diverticulitis
Obstruction
Malignant change (0.5%)

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15
Q

Which artery is clamped in appendectomy?

A

Appendicular artery

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16
Q

In which age groups is appendicitis most common?

A

Childhood/Early adulthood and elderly

17
Q

Appendicitis is caused by…

A

Obstruction of the lumen with faecolith

18
Q

What is the infective link in appendicitis?

A

Often occurs with waves of infection, especially in children

19
Q

Give the classical symptoms of appendicitis.

A 
Central pain that migrates to RIF
Anorexia
Nausea
One or two vomits
May not have moved bowels
Pelvic: vaguer pain localisation: rectal tenderness
Elderly
20
Q

What is meant by Rosving’s sign?

A

Pressing on the left causes pain on the right

21
Q

What is meant by Psoas?

A

Patient keeps the right hip flexed as this lifts an inflamed appendix off the psoas

22
Q

Give some differential diagnoses of appendicitis in children.

A 
Gastroenteritis
Mesenteric adenitis
Meckel’s diverticulum
Mesenteric Adenitis
Intususseption
Henoch-Schonlein Purpura
R Lower lobe pneumonia
23
Q

What is meant by Intususseption?

A

Small bowel folds in on itself

24
Q

Give some differential diagnoses of appendicitis in women.

A

Mittelschmerz
Ovarian cyst
Salpingitis
Ectopic pregnancy

25
Q

Which investigations are important to carry out in suspected appendicitis in women & children?

A

Urinalysis and Ultrasound

26
Q

Which mnemonic is used for assessing the likelihood of appendicitis?

A

MANTRELS

27
Q

What does MANTRELS stand for?

A 
Migration of pain to RIF
Anorexia
Nausea and Vomiting
Tenderness in RLQ
Rebound pain
Elevated temperature
Leukocytosis
Shift of WBC to left
28
Q

What is the treatment for appendicitis?

A 
Analgesia	
Antipyretics
Theatre
Antibiotics
Laparoscopic Appendicectomy
29
Q

Give some complications of appendicitis.

A 
Pelvic abscess
Wound infection
Intra-abdominal abscess
Ileus – bowels stop working
Respiratory
DVT/PE
Portal pyaemia
Faecal fistula
Adhesions
Right sided inguinal hernia
30
Q

How common is carcinoid of the appendix?

A

1 in every 300 to 400 appendixes

31
Q

What is the 5 yr survival for carcinoid of the appendix?

A

92%

GI (Y1) (79 decks)

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