Small Intestine Flashcards
(35 cards)
Describe the pathophysiology associated with intestinal foreign bodies
gas and fluid accumulation
- fermentation
- increased secretions
- decreased absorption
- intestinal wall edema
wall ischemia
- mucosal sloughing
- bacterial translocation
- risk of perforation
What are the clinical signs associated with intestinal foreign bodies?
- vomiting
- anorexia
- depression
- abdominal pain
- diarrhea
How are intestinal foreign bodies diagnosed?
- radiograph
- contrast radiographs
- ultrasound
What radiographic results indicated an intestinal foreign body?
- multiple loops of gas filled intestines
- SI:LF height > 2
How is an intestinal foreign body treated?
- enterotomy if healthy
- resection and anastomosis if necrotic tissue
What is used to evaluate viability of intestine?
- peristalsis pinch test
- color
- pulsation of vessels
- wall texture/thickness
- flurescein infusion
- surface oximetry
Describe the basic enterotomy incision for removal of a foreign body
- longitudinal
- distal to obstruction
- on anti-mesenteric border
What does it mean to “omentalize”?
Why is it done?
- pushing omentum onto surgical site
- angiogenic (aids in healing)
- helps minimize leakage
- controls infection
- allows lymph drainage
Which is the layer of strength when closing the intestine?
submucosa
What are the methods of anastomosis with staplers?
- triangular end-end
- skin stapler
- inverting end-end
- side-side anastomosis
What is serosal patching?
securing an antimesenteric border of small intestine over a suture line or defect
What is the major concern with linear foreign bodies?
mesenteric perforation of the intestines
What is the clinical presentation of a linear foreign body?
- vomiting, anorexia, depression
- abdominal pain
- clumping and pleating of intestine
What is seen of radiograph of a linear foreign body?
- plicated intestines
- bunched in central abdomen
How is a linear foreign body treated?
- if asymptomatic, free FB from tongue
- enterotomy
- catheter technique
What is the catheter technique for removal of linear FBs?
- free the FB cranially
- 1 cm incision into proximal duodenum
- tie FB to catheter
- milk catheter down intestines
- unplicating intestines over the catheter
What are the post-op complications with removal of foreign bodies?
- septic peritonitis
- adhesions caused by disruption of fibrinolysis
- dehiscence
- intestinal ileus
- short bowel syndrome
What are the causes of intestinal ileus?
- stimulation of sympathetic nervous system
- rough tissue handling
- long surgical time
- extensive resection
What are the clinical signs of intestinal ileus?
- regurgitation
- vomiting
- pain
How is intestinal ileus treated?
fluids
electroyltes
prokinetics
What is Short Bowel Syndrome?
- removal of too much bowel, so the body cannot compensate
- decreased muscosal surface area
- gastric and intestinal hypersecretions
- decreased intestinal transit time
What are the clinical signs of short bowel syndrome?
- persistent, watery diarrhea
- malnutrition
- weight loss
How are intussusceptions treated?
enteroplication
- suture intestinal loops at 3-5 cm intervals along lateral wall
- prevents recurrence
- avoid tight turns
What is mesenteric torsion?
- intestine twists on the mesenteric axis
- compression of cranial mesenteric arteries
- ischemic necrosis of all intestines
