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Flashcards in Small bowel obstruction Deck (30):
1

List some causes for a small bowel obstruction

Adhesion
Hernia
Cancer- small bowel cancers are extremely rare, but external cancers could trap a loop of small intestine

2

What are adhesions?

External compression of the small intestine.
The patient has usually had previous abdominal surgery and an adhesion is the abdominal response to healing.

3

What abdominal hernias are most common, and how do they cause a small bowel obstruction?

Inguinal, femoral, incisional and umbilica.
These all have the ability to attract and trap a loop of small bowel.
This happens because they offer a pathway of low resistance, so the bowel insinuates its way into the hernia and gets stuck there.

4

How does a small bowel obstruction present?

Colicky pain
Other symptoms are determined by where the obstruction is:
proximal- vomiting, no distension
distal- late vomiting, gross distension

5

How is small bowel obstruction diagnosed?

History
Examination
Plain abdominal X ray

6

What is the difference between large and small bowel colic?

In the small bowel, colicky pain occurs every 10 minutes or so, whereas in the large bowel it occurs 2 or 3 times an hour.

7

How can a small bowel obstruction be told apart from a large bowel obstruction on an X ray?

On an X ray, the distended loops of a large bowel obstruction would be around the outside of the abdomen.
The distended loops of a small bowel obstruction are in the centre of the abdomen.

8

What is the treatment of a small bowel obstruction if there is no strangulation?

IV fluids
Nasogastric suction
Operate if no resolution in 24-48 hours

9

What is strangulation of the bowel?
How does the patient present?

This is the point beyond ischaemia.
If there is an ischaemic bit of intestine and the blood supply isn't restored, the bowel will become gangrenous. When this is due to an obstruction this is called strangulation.
The patient has constant pain (not colicky), shock, and the three Fs of sepsis: fever, flush, fast pulse

10

What is the treatment of small bowel obstruction with strangulation?

Resuscitate
Antibiotics
Early surgery

11

How is Crohn's disease diagnosed?

Barium follow through/enema
Gastroscopy/colonscopy

12

What are clinical features of small bowel ischaemia and infarction?

Severe, poorly localised pain
Sepsis
Shock

13

Who tends to get small bowel ischaemia and infarction?

Elderly patients
Arteriopaths

14

Why is small bowel ischaemia sometimes confused with pancreatitis?

There is a small rise in amylase in small bowel ischaemia/infarction, and this is also present in pancreatitis.

15

What is the treatment for small bowel ischaemia/infarction?

Revascularise the intestine
Resect gangrenous intestine

16

What is abdominal angina?

Post prandial pain
Due to Poor blood supply to the intestine

17

What is Meckel's diverticulum?

A diverticulum that consists of all three layers of the intestinal wall (unlike in diverticular disease where it is just the mucosa and submucosa).
It is a remnant of vitello intestinal duct

18

What age group is affected by Meckel's diverticulum?

Children

19

What are the symptoms of Meckel's diverticulum?

Rectal bleeding
Obstruction
perforation
It can be an asymptomatic finding in adults

20

What is the 2/2/2 rule in Meckel's diverticulum?

It is 2 inches long
It is 2 feet from the terminal ileum colon junction
It is found in 2 percent of people

21

What causes the rectal bleeding in Meckel's diverticulum?

There can be ectopic gastric mucosa which can secrete acid. This can erode the lining of the small intestine, causing rectal bleeding.

22

What causes the obstruction in Meckel's diverticulum?

Sometimes a fibrous band exists between the diverticulum and the umbilicus. The child then develops obstruction secondary to this congenital adhesion.

23

What is a Technicium Tc 99M scan used to detect?

To detect gastric mucosa

24

Name one very common and one very rare disease of the appendix.

Common: acute appendicitis
Rare: Carcinoid tumour of the appendix

25

What are the clinical features of acute appendicitis?

Ill defined initial symptoms- visceral epigastric pain
Nausea and anorrhexia
These progress to Right iliac fossa pain and peritonism

26

What anatomical factors can contribute to atypical appendicitis?

The position of the appendix
The position of the caecum

27

What is the treatment for appendicitis?

Laparoscopy and laparascopic appendicectomy
or
Laparoscopy and open appendicectomy

28

What are the clinical features of carcinoid tumour of the appendix?

It is an asymptomatic finding
It is a brown-yellow nodule
They can be at the tip or the base of the appendix
Larger tumours and those at the base can produce metastases

29

How are carcinoid tumours of the appendix removed?

If they are at the tip: appendicectomy
If they are the base: Right hemicolectomy

30

What is the effect of liver metastases from the carcinoid tumour of the appendix?
Why does this effect not happen without metastases?

Carcinoid syndrome:
the carcinoid deposits secrete vasoactive amines
there is facial flushing and diarrhoea.

The original carcinoid tumour can also secrete these, but they are secreted into the portal venous system and metabolised in the liver.
If there is metastasis to the liver, the vasoactive amines are secreted into the systemic circulation.

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