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General (Surgery) > Small Bowel > Flashcards

Small Bowel Flashcards

1
Q

what are the most common types of hernia

A

inguinal hernias

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2
Q

definition of a hernia

A

protrusion of part or whole of an organ or tissue through the wall of the cavity that normally contains it

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3
Q

what are the 2 main subtypes of inguinal hernia and what is the difference between them

A

direct inguinal hernia = bowel enters inguinal canal directly through weakness in the posterior wall of the canal (termed Hesselbach’s triangle)

indirect inguinal hernia = bowel enters inguinal canal via the deep inguinal ring, they arise from incomplete closure of the processus vaginalis

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4
Q

what type of patients do direct inguinal hernias usually occur in

A

older patients , secondary to abdominal wall laxity or a significant increase in intra-abdominal pressure

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5
Q

what are the borders of Hesselbach’s triangle

A

lateral = inferior epigastric vessels

medial = lateral border of rectus abdominis

inferior = inguinal ligament

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6
Q

what is the relation of direct and indirect inguinal hernias with the inferior epigastric vessels

A

direct = medial to inferior epigastric vessels

indirect = lateral to inferior epigastric vessels

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7
Q

risk factors for inguinal hernias

A

male

increasing age

raised intra-abdominal pressure; chronic cough, heavy lifting, chronic constipation

obesity

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8
Q

clinical features of reducible inguinal hernias

A

lump in the groin which will disappear with minimal pressure or when the patient lies down, there can be mild to moderate discomfort which can worsen with activity or standing

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9
Q

what is an incarcerated inguinal hernia and what are its clinical features

A

incarcerated means that the bowel cannot be reduced back into the abdominal cavity

painful, tender, erythematous and may be signs of bowel obstruction if the bowel lumen is blocked

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10
Q

what is a strangulated inguinal hernia and what are its clinical features

A

strangulated means that its blood supply has become compromised leading to the bowel becoming ischaemic

presents as an irreducible, tender and tense lump with the pain being out of proportion to clinical signs, also with clinical features of obstruction

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11
Q

investigations into inguinal hernias

A

clinical diagnosis. if uncertain then MRI is recommended first line imaging

for features of obstruction or strangulation then CT will be required

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12
Q

management of inguinal hernias

A

all patients with symptomatic inguinal hernias should be offered surgical intervention

any patient showing signs of strangulation requires urgent surgical exploration

surgical; open mesh repairs are preferred in primary inguinal hernias, or laparascopic repairs which are preferred in bilateral or recurrent inguinal hernias

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13
Q

what are the indications for laparascopic repair of inguinal hernia rather than open mesh repair

A

bilateral

recurrent

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14
Q

what are the indications for urgent surgical intervention in inguinal hernias

A

incarcerated

obstruction of the bowel

strangulation leading to bowel ischaemia and potentially infarction

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15
Q

what are femoral hernias and why are they important to identify

A

occur when the abdominal viscera or omentum pass through the femoral ring and into the potential space of the femoral canal

high rate of strangulation

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16
Q

what are the anatomical borders of the femoral canal

A

superior border = femoral ring

anterior border = inguinal ligament

posterior border = pectineus

lateral border = femoral vein

medial border = lacunar ligament

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17
Q

risk factors for femoral hernias

A

female

pregnancy

raised intra-abdominal pressure

increasing age

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18
Q

investigations into femoral hernias

A

USS or CT abdo-pelvis

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19
Q

management of femoral hernias

A

all femoral hernias should be managed surgically, ideally within 2 weeks of presentation due to the high risk of strangulation

high vs low approach

high = above inguinal ligament (preferred)

low = below inguinal ligament

20
Q

what forms the borders of the femoral triangle

A

superior = inguinal ligament

lateral = medial border of sartorius muscle

medial = medial border of adductor longus

21
Q

why do all femoral hernias require surgical intervention

A

due to the high risk of strangulation

22
Q

what is an epigastric hernia

A

occurs in the upper midline through the fibres of the linea alba

secondary to chronic raised intra-abdominal pressure such as with obesity, pregnancy or ascites

23
Q

what is a paraumbilical hernia

A

herniation through the linea alba around the umbilical region

secondary to chronic raised intra-abdominal pressure

24
Q

what is a spigelian hernia

A

rare form of abdominal hernia that occurs at the semilunar line (the tendinous lateral border of the rectus, where the aponeuroses fuse) around the level of the arcuate line

present as small lump at the lower lateral edge of the rectus abdominus

they have a high risk of strangulation so should be repaired urgently

25
Q

what is an obturator hernia

A

hernia of the pelvic floor, occurring through the obturator foramen into the obturator canal

present with mass in upper medial thigh and often patients will have features of small bowel obstruction

26
Q

what is a Littre’s hernia

A

very rare form of abdominal herniation of a meckel’s diverticulum

27
Q

what is the name of the hernia that describes herniation of a Meckle’s diverticulum

A

Littre’s hernia

28
Q

what is gastroenteritis

A

term used to describe inflammation of the gastrointestinal tract, usually considered infective in origin

29
Q

what are the common symptoms of gastroenteritis and how does the duration of symptoms affect the thoughts on the causative agent

A

diarrhoea, vomiting, abdo pain

bacterial toxins = hours
viruses = days
bacteria = weeks
parasites = months

30
Q

risk factors for gastroenteritis

A

poor food prep

immunocompromised

poor personal hygiene

31
Q

why is recent use of antibiotics important in the context of gastroenteritis

A

could suggest potential C. difficile infection

32
Q

what are some important things to ask in the history of a patient presenting with gastroenteritis

A

recent travel abroad

affected family members

recent antibiotic use

bowel movements (blood, mucus)

33
Q

what investigation is often warranted in gastroenteritis

A

stool culture - especially in cases with blood and mucus in the stool

34
Q

management of gastroenteritis

A

rehydration - encourage oral fluid intake; if unable to tolerate fluids then admission for an IV fluid rehydration

exclusion from work

self-limiting

35
Q

common viral causes of gastroenteritis

A

norovirus - most common

rotavirus - infants and young children

adenovirus - children

36
Q

common bacterial causes of gastroenteritis

A

campylobacter - most common cause of food poisoning

E. coli - most common cause of travellers diarrhoea

salmonella

shigella

(all gram negative bacillus)

37
Q

common bacterial toxins that cause gastroenteritis

A

bacterial toxins arise from;

S. aureus

Bacillus cereus - found in reheated rice

clostridium perfringes

vibrio cholera - contaminated water supplies

38
Q

parasitic causes of gastroenteritis

A

crytposporidium

entamoeba histolytica

giardia intestinalis

schistosoma

39
Q

what investigation should you do if suspecting of a parasitic gastroenteritis

A

stool culture for ova, cysts and parasites

40
Q

infection with what bacteria can result in toxic megacolon

A

C. difficile

41
Q

what is the most common causative organism of hospital-acquired gastroenteritis

A

C. difficile

42
Q

what does dysentery mean

A

gastroenteritis characterised by loose stools with blood and mucus

43
Q

gastroenteritis ceasing within a few hours was most likely caused by what

A

bacterial toxins

44
Q

what type of bacteria is E. coli

A

gram negative bacillus

45
Q

what pathogen most commonly causes travellers diarrhoea

A

enterotoxigenic E. coli

General (Surgery) (7 decks)

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