Flashcards in Small Bowel Obstruction and Appendicitis Deck (31):
What is the sign of a small bowl obstruction on CXR?
Someone has swallowed a caterpillar.
What is the pathophysiology of small bowel obstruction?
Increase in fluid
Increase in Gas (From bacteria)
The wall becomes more distended
How does a patient with small bowl obstruction present?
Find the cause
Wat causes small bowl obstructions?
Adhesions/ Herniation - most common
Bezoar - lump of hair
What are the investigations of Small bowl obstruction?
Those that assess the state of the patient:
Those that confirm the diagnosis:
Contrast CT scan and abdomen
What would appear on a CXR for small bowel obstruction?
Air fluid level
Caterpillar swallowed - dilated loops of the small bowel
What is the treatment for a patient with Small bowel obstruction?
Fluids and Potassium
When would you operate for a small bowel obstruction?
Strangulation of hernia
What is the surgical management of small bowel obstruction?
Find the obstruction by following the collapsed/dilated small bowel.
What is the complications of small obstruction?
What are the different types of mesenteric ischaemia?
What are the signs of chronic mesenteric ischaemia?
Angina of the guts
What are the signs of acute mesenteric ischaemia?
Small bowel infarction and dies
Colon lives - Marginal artery. (Causes bloody diarrhoea)
What are the causes of Mesenteric ischaemia?
Embolus (usually from AF) - sticks in the narrow SMA
In situ thrombosis from general gubbedness
How is mesenteric ischaemia diagnosed?
Pain out of proportion to clinical findings
High iron feel
White cell count may be up
Intervene before your patient is moribund
CRP is normal
How is mesenteric ischaemia fixed?
Resect if viable
How is small bowl haemorrhage treated?
Exclude upper source
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
What is the commonest appendicitis?
Describe the appendix?
most are retrocaecal
Supplied by the appendicular artery
What is McBurney's point?
1/3 way along the ASIS and the umbilicus
This the most tender point in Appendicitis
What causes appendicitis?
What is the pathology of appendicitis?
Greater momentum sticks over the appendix to wall off the appendix
Small bowel adheres
What are the clinical features of appendicitis?
Centrail pain that migrates to the right iliac fossa
Bowels may not move
What are the signs of appendicitis?
Mild Pyrexia (not very high)
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
What are the signs of a pelvic appendix appendicitis ?
Frequency of nicturition
What are the signs of post illial appendix appendicitis?
White cell count high
What are the differential diagnosis of appendicitis in children?
What are the differential diagnosis of appendicitis in adults?
Rectus sheath haemotoma
What score can be used for appendicitis?
The Alvarado score
Migration of pain
Shift to the left for neutrophils