Teaching 19/04

Question 1

Causes of bowel obstruction in infants

Answer 1

• Pyloric stenosis
• Duodenal atresia
• Hirshsprungs
• Intussussception
• Imperforate anus

Question 2

Presentation of pyloric stenosis in infant

Answer 2

• Projectile vomitting - non bilious
• Hypochloraemic metabolic alkalosis - loss of K+ and Cl- from stomach acid

Question 3

What does hypochloraemic metabolic alkalosis do to oxygen disassociation curve?

Answer 3

• Shifts curve to left
• = Hb has more affinity for O2
• = less O2 delivered to tissues

= BAD for infant in pyloric stenosis

Question 4

Management pyloric stenosis

Answer 4

• Rehydration - IV 0.9% saline
• Defitive = pyloromyotomy

Question 5

What is duodenal atresia?

Answer 5

• Associated with in-utero polyhydraminos
• = stricture to duodenum due to vascular ischaemia
• Causes bilious vomitting (if distal to AoV) or non bilious if proximal
• X-ray shows double bubble sign

Question 6

How does intussusception present?

Answer 6

• PR bleeding - currant jelly

Question 7

Hirschsprungs disease diagnosis

Answer 7

• Full rectal biopsy

Question 8

Pathological vs non-pathological strictures

Answer 8

• Non-pathological - attach bowel to lateral wall, no consequences usually
• Pathological - attach bowel to anterior abdominal wall = problematic, can then cause bowel obstruction

Question 9

Do adhesions cause pain? other symptoms?

Answer 9

• If they pull on parietal peritoneum = PAIN
• Colicky with peristalsis
• Bloating
• Increase in bowel sounds
• Tinkling when fully obstructed
• Vomitting if pain is severe

Question 10

How does caecal cancer present?

Answer 10

• Subtle, often presents late with mets
• Often only iron def anaemia
• +/- mass on examination
• NO obstruction as stool is fluid here - can move past
• Unless blocking ileocaecal valve

Question 11

How does left sided colon cancer present?

Answer 11

• PR bleeding
• Change in bowel habit - diarrhoea then constipation and alternating, overflow?
• If gets to perforation, caecum will perf first due to closed loop (ileocaecal valve) and has weaker wall

Question 12

How does rectal cancer present?

Answer 12

• PR bleeding/mucus
• Tenesmus
• Wet wind - when break wind, faeces can come out alongside

Question 13

How does transverse colon cancer present?

Answer 13

• Mix of left sided and caecum - between each

Question 14

What happens in pathophys of diverticular disease?

Answer 14

• Usually stretch from bulky stool is detected by stretch receptors in bowel
• = contraction and peristalsis
• If not a lot of fibre in diet, segmented contraction occurs where sections of bowel almost become closed off
• Pressures can reach very high - 150mmHg
• Weak points are where blood vessels perforate to supply colon = outpouchings of colon here
• Get bleeding due to close proximity of polyps to BVs

Question 15

What is a phlegmon in diverticular disease?

Answer 15

• Localised area of acute inflammation in tissues
• This can stick to areas of small bowel nearly and can cause SBO

Question 16

Where is the renal angle where you ballot kidneys?

Answer 16

• Between last rib and lateral border of erector spinae muscle

Question 17

Sign on LUQ percussion in splenic rupture

Answer 17

• Ballances sign = LUQ dullness

Question 18

What is an acute abdomen?

Answer 18

Acute undiagnosed abdominal pain
If untreated, some causes could lead to death

Question 19

5 positions appendix can be

Answer 19