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GI > Small bowel and Appendix > Flashcards

Small bowel and Appendix Flashcards

1
Q

what position are most appendicitis

A

retrocaecal

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2
Q

when does an appendicitis usually happen

A

childhood/ young adulthood

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3
Q

what can cause an appendicits

A

obstruction of the lumen with faecolith, bacterial, viral, parasites

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4
Q

what is the pathology of an appendicitis

A 
Lumen may or may not be occluded
Mucosal inflammation
Lymphoid hyperplasia
Obstruction
Build up of mucus and exudate
Venous obstruction
Ischaemia..bacterial invasion through wall
Perforation
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5
Q

what is hyperplasia

A

the enlargement of an organ or tissue caused by an increase in the reproduction rate of its cells
Presence of inflammation in abdomen brings the greater omentum
Small bowel adheres
Phlegmonous mass
Peritonitis can be fatal

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6
Q

what are the 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
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7
Q

what are the clinical signs of appendicitis

A

mild pyrexia, mild tachycardia, localised pain in RIF, guarding, rebound

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8
Q

what is rosving’s sign

A

pressing on the left causes pain on the right- seen in appendicitis

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9
Q

what is psoas sign

A

patient keep the right hip flexed as this lifts an inflamed appendix off the psoas

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10
Q

what is the psoas

A

The psoas is a deep-seated core muscle connecting the lumbar vertebrae to the femur

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11
Q

what is the obturator sign

A

if appendix is touching the obturator internus, flexing the hip and internally rotating will cause pain

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12
Q

what might be seen in pelvic appendicitis

A

diarrhoea, frequency of micturition (passing urine)

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13
Q

what might be seen in postileal appendicitis

A

rare- diarrhoea and vomitting

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14
Q

what might be seen in retrocaecal appendicitis

A

might have very few signs

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15
Q

what can be the differential diagnosis of appendicitis in children

A 
Gastroenteritis
Mesenteric adenitis
Meckel’s diverticulum
Intususseption
Henoch-Schonlein Purpura
Lobar pneumonia
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16
Q

what are the differential diagnosis of appendicitis in adults

A 
Terminal ileitis
Ureteric colic
Acute pyelonephritis
Perforated ulcer
Pancreatitis
Rectus sheath haemotoma
17
Q

what are the differential diagnosis of appendicitis in women

A

Mittelschmerz
Ovarian cyst
Salpingitis
Ectopic pregnancy

18
Q

what are the differential diagnosis of appendicitis in the elderly

A

Sigmoid diverticulitis
Intestinal obstruction
Carcinoma of the caecum

19
Q

when is USS useful in appendicitis

A

in women and kids

20
Q

what investigations are useful in appendicitis

A

USS useful in women and kids

AXR to exclude other causes

Bloods (important CRP, WCC)

Urinalysis

21
Q

what score in used to calculate likelihood of appendicitis

A

alvarado- movement of pain, anorexia, nausea and vomiting, tenderness in RUQ, rebound, high temp, leukocytosis, sore to move/ cough/ laugh, flushed red face, foetor oris (bad smell)

22
Q

whats is the management for appendicitis

A

analgesia, antipyretics, theatre, antibiotics, appendicetomy (laparoscopic best)

23
Q

what is the treatment for an appendix mass

A

antiobiotics first line- as long as you exclude carcinoma, theatre if fails or complicated (tachycardia, worsening pain, increase in size, vomiting)

24
Q

what is an appendix abscess

A

not an appendix mass- usually delayed and has liquidised

25
Q

how is an appendix abscess treated

A

radiological drain

26
Q

what are the complications of appendix abscess

A 
Pelvic abscess
Wound infection
Intra-abdominal abscess
Ileus
Respiratory
DVT/PE
Portal pyaemia
Faecal fistula
Adhesions
Right sided inguinal hernia
27
Q

what will have to be replaced if the small bowel is removed

A

B12 and folate as that is where it is absorbed

28
Q

what are the symptoms of small bowel obstruction

A 
pain (colicky, central),
absolute constipation,
vomiting,
burping,
abdo distention
29
Q

what can cause small bowel obsbtruction

A

within the lumen:
-gallstone, food, bezoar

within the wall:
-tumour, crohns, radiation

outside the wall:
-adhesions, herniation

30
Q

what is the typical presentation of small bowel obstruction

A

distention, vomiting, borborygmi (rumbling or gurgling), pain, faeculent vomiting, presence of a cause

31
Q

what investigations should be done into small bowel obstruction

A

urinalysis, bloods, gases to asses state of patient

AXR, contrast CT, gastrograffin studies to confirm diagnosis

32
Q

what is the drip and suck management of small bowel obstruction

A

conservative management

  • ABC
  • analgesia
  • fluids with potassium
  • catheterise
  • NG tube
  • antithromboembolism measures

do this for up to 72 hours

intervene earlier if strangulation, perforation, ischaemia

33
Q

what are the types of mesenteric ischaemia

A

embolus (thrombosis),
chronic (SMA, cramps, like ischaemia of the guts, atherosclerosis),
acute

34
Q

what can cause mesenteric ischaemia

A

embolus usually from AFib (forms in LA, sticks in narrow SMA)

virchows triad- dehydrates, hypercoagulable, compression, vasoconstricting drugs

35
Q

what are the blood gases like in mesenteric ischaemia

A

acidosis, lactate elevated, WCC may by high

36
Q

what is the management for mesenteric ischaemia

A

prepare for the worst

if non viable resect, re-anastomse/ staple

if viable (rare) SMA embolectomy

37
Q

what can cause a small bowel haemorrhage

A

vascular malformations, ulcerations

38
Q

what are the complications of meckels diverticulum

A

bleed, ulcerate, obstruction, malignant change

39
Q

what is meckles diverticulum

A

congenital abnormalities of the small intestine

GI (64 decks)

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