Small Bowel Obstruction and Appendicitis Flashcards Preview

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Flashcards in Small Bowel Obstruction and Appendicitis Deck (31):
1

What is the sign of a small bowl obstruction on CXR?

Someone has swallowed a caterpillar.

2

What is the pathophysiology of small bowel obstruction?

Increase in fluid
Increase in Gas (From bacteria)
The wall becomes more distended
Ischaemia
Perforation

3

How does a patient with small bowl obstruction present?

Pain
Absolutely constipation
Vomiting
Burping
Abdominal distension
Borborygmi
Faeculent vomiting
Find the cause

4

Wat causes small bowl obstructions?

Adhesions/ Herniation - most common
Bezoar - lump of hair
Gallstones
Tumour
Crohn's
Radiation

5

What are the investigations of Small bowl obstruction?

Those that assess the state of the patient:

Urinalysis
Bloods
Gases

Those that confirm the diagnosis:

AXR
Contrast CT scan and abdomen
Gastrograffin studies

6

What would appear on a CXR for small bowel obstruction?

Air fluid level
Caterpillar swallowed - dilated loops of the small bowel

7

What is the treatment for a patient with Small bowel obstruction?

ABC
analgesia
Fluids and Potassium
Hypokalaemic/alkalotic
Catheterise
HG tube
Antithomboembolism measure

8

When would you operate for a small bowel obstruction?

Hernias
Strangulation of hernia
Perforation
Ischaemia

9

What is the surgical management of small bowel obstruction?

Laparotomy

Operative principals:
Antibiotics
Antithombin
Midline incision
Find the obstruction by following the collapsed/dilated small bowel.

10

What is the complications of small obstruction?

Mesenteric ischaemia

11

What are the different types of mesenteric ischaemia?

Embolus
Thrombosis

12

What are the signs of chronic mesenteric ischaemia?

SMA
Cramps
Angina of the guts
Atheroscloersis

13

What are the signs of acute mesenteric ischaemia?

Small bowel infarction and dies
Colon lives - Marginal artery. (Causes bloody diarrhoea)

14

What are the causes of Mesenteric ischaemia?

Embolus (usually from AF) - sticks in the narrow SMA

In situ thrombosis from general gubbedness

15

How is mesenteric ischaemia diagnosed?

Pain out of proportion to clinical findings
Acidosis
lactate elevated
High iron feel
White cell count may be up
CT angiogram
Intervene before your patient is moribund

CRP is normal

16

How is mesenteric ischaemia fixed?

Theatre
Resect if viable
Re-anastomse
SMA embolectomy

17

How is small bowl haemorrhage treated?

ABC
Exclude upper source
Vascular malformation
Ulcerations
CT angiogram

18

What is Mecekel's diverticulum?

A Meckel's diverticulum, a true congenital diverticulum, is a slight bulge in the small intestine present at birth 60 cm from IC valve

Present before 2 years
Bleed
Ulcerate obstruction
Obstruction
Malignant change

19

What is the commonest appendicitis?

Appendicitis

20

Describe the appendix?

Vestigal organ
most are retrocaecal

Supplied by the appendicular artery

21

What is McBurney's point?

1/3 way along the ASIS and the umbilicus
This the most tender point in Appendicitis

22

What causes appendicitis?

Faecolith
Bacterial
Viral
Parasites

23

What is the pathology of appendicitis?

Inflammation
Greater momentum sticks over the appendix to wall off the appendix
Small bowel adheres
Phegmonous mass
Peitonitis

24

What are the clinical features of appendicitis?

Centrail pain that migrates to the right iliac fossa
Anorexia
nausea
Vomiting
Bowels may not move
Rectal tenderness

25

What are the signs of appendicitis?

Mild Pyrexia (not very high)
Mild tachycardia
Localised pain in Right Iliac Fossa
Rosvings sign - press on left iliac fossa which causes pain on the right
Psoas - cannot lift right hip
Obturator - internally rotate of hip hurts
Pointing of pain - first all over, then right iliac fossa

26

What are the signs of a pelvic appendix appendicitis ?

Diarrhoea
Frequency of nicturition

27

What are the signs of post illial appendix appendicitis?

Diarrhoea
Vomiting
White cell count high

28

What are the differential diagnosis of appendicitis in children?

Gastroenteritis
Mesenteric adenitis
Neckel's diverticulum
Intususseption
Henoch-schonlein purpura
Lobar Pneumonia

29

What are the differential diagnosis of appendicitis in adults?

Terminal ileitis
Ureteric colic
Acute Pyelonephritis
Perforated Ulcer
Pancreatitis
Rectus sheath haemotoma
Ovarian cysts
Salpingitis
Ectopic pregnancy

30

What score can be used for appendicitis?

The Alvarado score
Migration of pain
Anorexia
Nausea
Tenderness
Rebound pain
Elevated temperature
Leucocytosis
Shift to the left for neutrophils

31

What is the management of appendicitis?

Analgesia
Antipyretics
Antibiotics
Appendicectomy