Pathology of Small Intestine and Appendix

Question 1

Small bowel obstruction comes with what kind of pain?

Answer 1

colicky pain increasing pressure during peristalsis pushing against obstruction – frequent

Question 2

How is small bowel obstruction diagnosed?

Answer 2

History and examination

plain abdominal X-ray

Question 3

Complications of SBO?

Answer 3

Strangulation

Management is different if not strangulated

Question 4

3 main extrinsic causes of SBO

Answer 4

Adhesions
Hernias
Cancer

Question 5

Intra-lumenal cause of SBO

Answer 5

Gall stone ileus

Question 6

On X-Ray, what does a SBO look like?

Answer 6

multiple distended loops in the centre of the abdomen

Question 7

Treatment of a non strangulated SBO

Answer 7

IV fluids + nasogastric suction

If no resolution over 24-48 hours then operate

Question 8

Treatment of a strangulated SBO

Answer 8

resuscitate
antibiotics
early surgery

Question 9

Symptoms of a strangulated SBO

Answer 9

constant pain
tender
sepsis -fever, flushed, fast pulse
shock

Question 10

If a strangulated SBO was left untreated what may happen?

Answer 10

It would perforate and septic cascade could lead to multi system organ failure

Question 11

What are the physical findings of small bowel crohn’s disease?

Answer 11

abdominal mass 
enterocutaneous fistula (inflammed bowel stuck to abdo wall, fistula between small intestine and skin)

Question 12

Who is most likely to get small bowel ischaemia and infarction?

Answer 12

elderly patients

arteriopaths - evidence of PVD, cardiac disease, stroke etc

Question 13

What are the clinical features of small bowel ischaemia and infarction?

Answer 13

severe, poorly localised pain
sepsis and shock
small rise in serum amylase

Question 14

What treatment of required for small bowel ischaemia and infarction?

Answer 14

revascularisation of the intestine

resect gangrenous intestine

Question 15

what is meckels diverticulum?

Answer 15

remnant of vitello intestinal duct

Question 16

what can meckels diverticulum contain?

Answer 16

ectopic gastric mucosa

Question 17

Is meckels diverticulum symptomatic in adults or children?

Answer 17

children

Question 18

why can meckles diverticulum produce pr bleeding?

Answer 18

ectopic gastric mucosa can secrete acid leading to erosion of lining of intestine giving rectal bleeding

Question 19

How is meckel’s diverticulum diagnosed?

Answer 19

Technicium Tc 99M scan

Question 20

what age group does appendicitis affect?

Answer 20

any

Question 21

Which group of people is appendicitis hard to diagnose in?

Answer 21

children and old people

Question 22

What are the initial symptoms (visceral) of appendicitis?

Answer 22

nausea
anorexia
vomiting 
low grade fever
central abdominal pain

Question 23

What do the initial symptoms of appendicitis progress to (parietal)?

Answer 23

Appendix rubs on abdominal wall giving:
right iliac fossa pain –McBurneys point (RLQ pain)
peritonism

Question 24

Treatment for appendicitis

Answer 24

laparoscopy, laparoscopic appendicectomy (remove appendix)
or
laparoscopy, open appendicectomy

Question 25

what colour is a carcinoid tumour of the appendix?

Answer 25

brown- yellow nodule

Question 26

What is appendicitis?

Answer 26

acute inflammation of the appendix resulting from obstruction of the appendical lumen

Question 27

Consequences of untreated appendicitis

Answer 27

``` necrosis perforation gangrene appendical abscess formation peritonitis ```

Question 28

In non-urgent presentations, what investigations can take place?

Answer 28

Contrast CT (useful but can take time to organise) USS Diagnostic laparatomy

Question 29

What should be used in pts with appendicitis that can't undergo surgery?

Answer 29

IV antibiotics (not curative but reduce mortality by 50%)