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Flashcards in Small Bowel Diseases Deck (36):
1

In what 3 places can cause an obstruction in the small bowel occur

Within the lumen
Within the wall
Outside the wall

2

Describe the 5 symptoms a patient would present with in a small bowel obstruction

Pain (colicky, central)
Absolute constipation
Vomiting
Burping
Abdominal Distension

3

What could cause an obstruction within the lumen

Gallstones - fistulates the small bowel and then passes through before becoming stuck in the ileocaecal junction
Food
Bezoar (stony concretion formed in the stomach)

4

What could cause an obstruction within the wall?

Tumour,
Crohn's disease,
Radiation

5

What could cause an obstruction outside the wall?

Adhesions,
Hernias (bits of bowel going places they shouldn't)

6

What is Borborygmi?

a rumbling or gurgling noise made by the movement of fluid and gas in the intestines.

7

What investigations should we do for a suspected bowel obstruction?

Urinalysis
Full set of Bloods
Blood gases

8

How do we confirm the diagnosis of a small bowel obstruction

AXR
Contrast CT of abdomen
Gastrograffin studies

9

What is the treatment for a small bowel obstruction

ABC
Analgesia
Fluids with potassium
Catheterise
NG tube to drain the stomach
Anti-thromboembolism measures

10

Why do we give potassium to the patient?

K+ will have been lost in vomit

11

What is drip and suck?

Conservative treatment
patient receives fluids and has a drainage NG

12

How long do we drip and suck for?

72 hours is standard

13

What 3 reasons would we intervene earlier than 72 hours?

Strangulation
Perforation
ischaemia

14

What type of operation is performed to resolve an obstruction

Laparotomy - complete opening up of the stomach

Sometimes laparoscopic (keyhole)

15

What can cause mesenteric ischaemia?

Embolus, thrombosis (arterial and venous)

16

Describe chronic mesenteric ischaemia

Superior Mesenteric artery
cramps
angina of the gut
atherosclerosis

17

Describe acute mesenteric ischaemia

Small bowel usually gets infarcted

18

Why is the small bowel more likely to die than the large bowel?

Small only has one blood supply
the colon has the marginal artery of Drummond

19

How do we diagnose mesenteric ischaemia?

Pain is out of proportion to clinical findings
Acidosis on gasses (low pH. high H+ concentration, high BE
Lactate elevated
CRP may be normal
WCC may be up a bit
CT angiogram

20

How do we fix mesenteric ischaemia?

QUICKLY!
resect if non-viable
re-anastomse or staple and planned return

21

How can we investigate a haemorrhage?

ABC
Exclude upper source
Vascular malformations
Ulceration
CT angiogram

22

Describe Meckel's Diverticulum

An embryological remnant of the vitello-intestinal duct and is present in 2% of the population.
Usually situated 50cm from the ileocaecal valve, may be of varying length and may be associated with other congenital abnormalities. Less than 5% produce symptoms due to complications

23

What are 6 complications with Meckel's Diverticulum

Bleed - prone to ulceration
Ulcerate
Obstruction
Malignant change
Diverticulitis
Perforation

24

How can we treat Meckel's Diverticulum

Surgery to remove large diverticula
this is controversial

25

What is the most common emergency operation

Appendectomy

26

Describe the appendix

Vestigial organ
Vermiform appendix
retrocaecal
the tip can vary in location
The base is constant - at the convergence of the three taenia

27

Is appendicitis more common in men or women

Men

28

Who is usually affected by appendicitis

Children / early adulthood

29

What is the class picture for appendicitis

Central pain that migrates to the right ileac fossa
Anorexia
Nausea
no more than 1 or 2 vomits
Mild ocnstipation

30

What are the clinical signs of appendicitis

Mild pyrexia
Mild tachycardia
Localised painin the right ileac fossa
Guarding of the abdomen
Rebound tenderness

31

Name 4 tests for appendicitis and describe each one

Rosving's- pressing on the left side of the body causes pain on the right
Psoas - Good test in children. Patient keeps the right hip flexed to keep the appendix off the psoas
Obturator - flexing the hip and internally rotating causes pain
Pointing - where did the pain start and where is it now?

32

What are the 4 special cases of appendicitis - what is special?

Obese - very difficult to examine and still claim hunger
Elderly - gangrene and perforate more frequently. Usually have comorbid disease
Children - dont sleep and wont eat
Pregnancy - appendix is moved up and out - risk of miscarriage . Emergency MRI is required

33

What is the Alvarado score?

The Alvarado Score for Acute Appendicitis determines likelihood of appendicitis based on symptoms, signs, and lab data.

34

How do we manage appendicitis?

Analgesia
Antipyretics
Theatre
Antibiotics
Appendectomy

35

What type of operation is best for an appendectomy

Laparasopic

36

What are the 3 main emergency conditions affecting the small bowel?

Obstruction
Infarction
Haemorrhage

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