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GI and General Surgery > Small Bowel > Flashcards

Small Bowel Flashcards

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1
Q

What is a hernia?

A

an abnormal protrusion of a viscus outwith its normal body cavity

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2
Q

What are predisposing factors for hernias?

A 
coughing 
constipation 
pregnancy 
obesity 
heavy lifting
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3
Q

What are the different types of hernia?

A 
hiatus 
incisional 
epigastric 
obturator 
paraumbilical 
umbilical 
femoral 
inguinal (direct or indirect)
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4
Q

What is an incisional hernia?

A

protrusion of contents of cavity through an incision (after operation) - usually abdo surgery
structurally weakened anterior abdo wall

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5
Q

What is a paraumbilical hernia?

A

through linea alba (around umbilical region - not umbilicus itself)

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6
Q

What is an umbilical hernia?

A

congenital

  • omphalocele
  • gastroschisis

operate if not resolved by 3 years

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7
Q

What is an obturator hernia?

A

hernia of pelvic floor through obturator foramen into obturator canal

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8
Q

How does an obturator hernia present?

A

mass in medial upper thigh, symptoms of bowel obstruction?

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9
Q

What are the differences between a direct and an indirect inguinal hernia?

A

indirect - bowel enters canal via deep inguinal ring, lateral to inferior epigastric vessels, controlled by digital pressure over internal/deep inguinal ring when patient coughs

direct - weakness in posterior wall of canal (transversalis fascia), medial to inferior epigastric vessels, poorly controlled by digital pressure over deep ring

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10
Q

Where is the deep inguinal ring?

A

midpoint of inguinal ligament

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11
Q

How would a hernia present?

A

non pulsatile, reducible, soft and non tender swelling

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12
Q

What is a strangulated hernia? How would it present?

A

comprimised blood supply - ischaemia
pain ++
irreducible and tender tense lump

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13
Q

What is an incarcerated hernia?

A

contents unable to return to original cavity

irreducible

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14
Q

How would an obstructed hernia present?

A

distension, vomiting, constipation

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15
Q

How can you tell the difference between an inguinal and a femoral hernia?

A

location

superomedial to pubic tubercle - inguinal
inferolateral to pubic tubercle - femoral

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16
Q

How are hernias diagnosed?

A

clinical diagnosis

USS if unclear diagnosis

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17
Q

What are the indications for surgery for hernias?

A

symptomatic
risk of complications (e.g. femoral hernias)
strangulation (urgent surgery)

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18
Q

What is the conservative management of hernias?

A

discuss symptoms of hernia emergencies (strangulation) and tell to go to A+E if they have them

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19
Q

What is the surgical management of hernias?

A

open or laparascopic mesh repair

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20
Q

What are the complications of hernia surgery?

A

chronic pain
recurrence
damage to structures e.g. vas deferens

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21
Q

What hernia has a high risk of strangulation?

A

femoral

due to narrow neck of canal

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22
Q

Who is more likely to get femoral hernias?

A

elderly women

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23
Q

What can cause a bowel obstruction?

A

intraluminal

  • faecal impaction
  • gallstone ileus
  • foreign object

mural (wall)

  • carcinoma
  • inflammatory strictures
  • diverticular strictures
  • radiotherapy strictures

extramural

  • hernias
  • peritoneal mets
  • adhesions
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24
Q

What causes a large bowel obstruction until proven otherwise?

A

cancer

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25
What is a functional obstruction or paralytic ileus?
bowel not mechanically blocked but still not working | causes - inflammation, post surgery, electrolyte derangement
26
Why is urgent fluid resuscitation needed in bowel obstruction?
when bowel segment occluded gross dilatation of proximal limb results in increased peristalsis secretion of large volumes of electrolyte rich fluid
27
What is a closed loop obstruction?
when a second obstruction occurs proximally to first obstruction
28
What can cause a closed loop obstruction?
e. g. large bowel obstruction and competent ileocaecal valve | e. g. volvulus
29
What happens in a closed loop obstruction?
bowel continues to dilate and dilate, stretches wall until ischaemia or perforation
30
What are the clinical features of a bowel obstruction?
crampy abdo pain (secondary to increased peristalsis) - should not have guarding or rebound tenderness - unless ischaemia developing vomiting - if large bowel, ?no vomiting - due to ileocaecal valve absolute constipation - develops later on in proximal obstruction distension - tympanic percussion
31
When might you get bilious vomit in bowel obstruction?
if obstruction is distal to duodenal papilla
32
What are the investigations for suspected obstruction?
``` urgent bloods - electrolyte changes venous blood gas - ischaemia - increased lactate - metabolic derangement (vomiting, dehydration) CT scan with IV contrast - more sensitive than AXR - can show site and cause AXR ```
33
How can you tell if it is small bowel or large bowel obstruction on AXR?
- small bowel: central abdo, >3cm, valvulae conniventes visible - large bowel: peripheral location, >6cm, haustral lines visible
34
What is the conservative management of bowel obstruction?
NBM analgesia IV fluids, catheter and fluid balance NG tube - decompress bowel
35
What is the surgical management of bowel obstruction?
laparotomy (?bowel resection)
36
What are the indications for surgery in bowel obstruction?
failure to improve 48 hrs conservative signs of ischaemia or closed loop obstruction small bowel obstruction in abdo with no previous surgery cause that needs correcting (tumour, hernia)
37
What would signs of ischaemia be in bowel obstruction?
pain worse with movement focal tenderness pyrexia guarding, rebound tenderness
38
What is a volvulus?
twisting of a loop of intestine around its mesenteric attachment leads to closed loop obstruction
39
Wherecan a volvulus occur?
sigmoid | caecum
40
Why do volvulus most often occur in the sigmoid colon?
long mesentry
41
What sign is seen on AXR in sigmoid volvulus?
coffee bean sign
42
What is a caecal volvulus?
colonic obstruction + competent ileocaecal valve
43
What is the management of a volvulus?
sigmoidoscope decompression and flatus tube surgery if: ischaemia or performation, failed decompression, necrotic bowel
44
What are risk factors for volvulus?
male neuropsychiatric conditions previous abdo surgery
45
What is Meckel's diverticulum?
congenital outpouching of terminal ileum - embryonic remnant - gastric mucosa (secretes stomach acid)
46
How does Meckel's diverticulum present?
acute abdo pain usually children usually asymptomatic
47
How is Meckel's diverticulum diagnosed and treated?
radionucleide scan - absorbed differently by stomach cells in diverticulum surgical excision
48
What is angiodysplasia of the colon?
formation of AVMs between previously healthy blood vessels in the bowel
49
What are the clinical features of angiodysplasia?
fresh, intermittent rectal bleeding painless anaemia
50
What is the management of angiodysplasia?
endoscopy coagulation | if more severe: embolisation or surgical resection
51
How does GI malabsorption present?
``` weight loss, malnutrition abdo bloating steatorrhoea diarrhoea flatulence ```
52
What are the causes of GI malabsorption?
infection - giardiasis pancreatic insufficiency - CF, cancer bowel causes - Crohn's, coeliac, lactose intolerance, Whipples, tropical sprue
53
How would you investigate malabsorption?
bloods: FBC, B12, anti TTG, calcium, folate stool sample (microscopy) hydrogen breath test OGD and biopsy
54
What is coeliac disease?
autoimmune hypersensitivity to gluten | T cell mediated response leading to villous atrophy
55
How is coeliac disease diagnosed?
serum anti-TTG | confirmed with OGD + duodenal biopsy (villous atrophy)
56
How is coeliac managed?
life long gluten free diet
57
How does coeliac disease present?
``` chronic, intermittent diarrhoea failure to thrive fatigue persistent GI symptoms anaemia weight loss ```
58
What is lactose intolerance?
deficiency of lactase enzyme, causing intolerance of lactose symptoms on eating dairy
59
What causes lactose intolerance?
congenital - rare | usually secondary to infection, insult to bowel
60
What is Whipples disease?
rare bacterial infection caused by Tropheryma whipplei causes multisystem disorder middle aged men
61
How does Whipples disease present?
symptoms of malabsorption arthritis hyperpigmentation
62
How is Whipples diagnosed and managed?
OGD and biopsy PAS +ve macrophages, saggy mucosa long term antibiotics
63
How is bacterial overgrowth diagnosed?
hydrogen breath test

GI and General Surgery (10 decks)

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