Flashcards in *Intestinal Problems (lecture 7) Deck (24)
What are the 2 types of bowel obstruction?
What are the causes of small bowel obstruction?
Extrinsic compression (adhesions, hernias, volvulus)
Intraluminal (tumour, gallstones)
Initial management of a small bowel obstruction?
IV fluids (with potassium)
NG tube (to decompress the stomach - ryles tube)
Catheter and urine output monitoring
What is "drip and suck"?
NG to decompress the stomach - "suck"
IV fluids - "drip"
What electrolyte imbalance do patients with small bowel obstruction tend to have?
What are the appropriate investigations for a small bowel obstruction?
AXR (to look for dilated small bowel loops)
What type of obstructions do you always need to do surgery for?
How long should you drip and suck for?
Up to 72 hours for adhesion however intervene earlier if strangulation, ischaemia, perforation
Surgical management of treatment of small bowel obstruction?
Laparotomy - can be done laparoscopically
Find the obstruction by following collapse or dilated bowel
Resect if necessary
How does ischaemic gut appear in comparison to the normal gut?
Symptoms of chronic mesenteric ischaemia?
"angina of the gut"
Loss weight as eating brings on the pain
Symptoms of acute mesenteric ischaemia?
Severe abdominal pain
Few abdominal signs
Investigations for acute mesenteric ischaemia?
May be increased Hb (due to loss of plasma)
May be a modestly raised amylase
Abdominal x-ray shows a gasses abdomen
Many only diagnosed at laproscopy
How is acute mesenteric ischaemia treated?
resuscitation with fluids
Metronidzole and gentamicin
Thrombolysis can be performed if reperfusionable
Dead bowel resected
Investigations for chronic mesenteric ischaemia?
Treatment of chronic mesenteric ischaemia?
Angioplasty and stent insertion
When does appendicitis tend to present?
Usually childhood/ young adulthood
Another peak in elderly population
What can happen in terms of the omentum in relation to appendicitis?
Presence of inflammation in the abdomen can bring the greater momentum over to cover it
The small bowe can adhere to this causing a phlegmonous mass
Signs of appendicitis?
Mild pyrexia (never a high temperature initially)
Localised pain in RIF
What is Rosving's sign?
a sign of appendicitis. If palpation of the left lower quadrant of a person's abdomen increases the pain felt in the right lower quadrant, the patient is said to have a positive Rovsing's sign and may have appendicitis.
What is mesenteric adenitis?
Mesenteric adenitis means swollen (inflamed) lymph glands in the tummy (abdomen), which cause abdominal pain. It is not usually serious and usually gets better without treatment. Mesenteric adenitis is a fairly common cause of abdominal pain in children aged under 16 years. It is much less common in adults.
Investigations for acute appendicitis?
Blood test may reveal high neutrophil levels and high CRP
USS may help
AXR to exclude other causes
Management of acute appendicitis?