UGI/CR - Colon part 3

Question 1

What is meant by metachronous?

Answer 1

cancer occuring > 6 months after the original cancer

Question 2

Follow up after CRC surgery (2)

Answer 2

CEA ev 3 months

Colonoscopy ev 3 years

Question 3

Mx obstructing (6)

Answer 3

A-E
Analgesia + NG tube compression 
AXR/errect CXR 
CT - level obstruction
Gastrograffin (show level + therapeutic effect)

Question 4

Sx of bowel obstruction - small bowel (3)

Answer 4

Bilious vomiting
Faeculant vomiting if distal)
Pain
Constipation w/o pass of wind

Question 5

Signs bowel obstruction (7)

Answer 5

Distention 
Tinkling bowel sounds 
Dehydration 
Central resonance to percusion + dull flanks 
Scars 
Palpable mass 
Abdo wont be tender

Question 6

What is paralytic ileus

Answer 6

Temporary disruption of normal peristaltic activity w/o mechanical blockage

Question 7

Causes of paralytic ileus (4)

Answer 7

Post surgery
Systemic infections
Metabolic disturbance
Neurological disorders

Question 8

mx paralytic ileus

Answer 8

NG + NBM

Question 9

Differentiating SBO and Paralytic ileus - bowel sounds

Answer 9

Bowel sounds = present SBO

Bowel sounds = absent paralytic ileus

Question 10

Differentiating SBO and Paralytic ileus - AXR findings

Answer 10

Air in colon paralytic ileus
None in SBO
Diffuse air fl levels paralytic ileus

Question 11

What is Pseudo-obstruction

Answer 11

= name for LBO when no identifiable cause can be found

= form paralytic ileus

Question 12

Causes of SBO (5)

Answer 12

Adhesions 
Hernias
Chrons 
Intussusception 
Extrinsic involvement by cancer

Question 13

Causes of LBO (4)

Answer 13

Carcinoma of colon
Diverticular disease
Sigmoid volvulus
Constipation

Question 14

Complications of bowel obstruction (6)

Answer 14

Strangulation --> ischaemia + necrosis 
Eventually bowel proliferates 
Electrolyte imbalance 
Volume depletion in severe cases (hypovolaemia)
Vascular compromise 
Sepsis

Question 15

Ix bowel obstruction (10)

Answer 15

Bloods - FBC/U+E/Amylase/LFT
ABG
Urinalysis 
Supine AXR
Erect CXR 
Contrast enema 
CT

Question 16

Ix findings bowel obstruction - AXR

Answer 16

Distended proximal bowel

Absent gas distally

Question 17

Ix findings bowel obstruction - Erect CXR

Answer 17

Fl levels in SBO

Air under diaphragm if perforation

Question 18

Why do contrast enema for bowel obstruction Ix

Answer 18

Differentiates obstruction + pseudo-obstruction

Can ID level of obstruction + ileo-caecal competency

Question 19

Mx of SBO (4)

Answer 19

A-E resus
Urinary catheter
IV ABx
Ryles tube - NBM + NG Decompression

Question 20

Mx LBO

Answer 20

Hartmans

Enema + manual evac if b/c fecal impaction

Question 21

Sx bowel strangulation (4)

Answer 21

increasing pain/tenderness
leucocytosis
Systemic upset
Peritonism

Question 22

What is volvulus

Answer 22

Twisting of loop of bowel around its mesenteric axis –> obstruction + venous occlusion at base of mesentery

Question 23

Who gets sigmoid volvulus

Answer 23

Elderly, constipated pt

Question 24

XR appearance sigmoid volvulus

Answer 24

Coffee bean appearance XR

Question 25

Tx sigmoid volvulus

Answer 25

Insertion of long flatus tube advanced into sigmoid often untwists volvulus If unsuccessful --> laparotomy

Question 26

Who gets caecal volvulus

Answer 26

Young kids b/c = congenital malformation

Question 27

XR appearance caecal volvulus

Answer 27

Embryo

Question 28

Tx caecal volvulus

Answer 28

Untwisting via laparotomy

Question 29

SBO vs LBO - vomiting

Answer 29

Absent/faeculant in LBO | Bilious + green SBO + nausea

Question 30

SBO vs LBO - constipation

Answer 30

Absolute in LBO | May not be absolute in SBO

Question 31

SBO vs LBO - progression

Answer 31

Progression more rapid in SBO

Question 32

SBO vs LBO - pain

Answer 32

Colicky + poorly localised SBO

Question 33

PS of malrotation of bowel w/ midgut volvulus

Answer 33

Obstruction w/ PR bleed/mucus | Abnormal bowel position on AXR w/ contrast

Question 34

Causes of faecal impaction - general factors (6)

Answer 34

``` Poor diet Dehydration Lack of exercise IBS Old age Pain ```

Question 35

Anorectal causes of faecal impaction (3)

Answer 35

Fissure Stricture Rectal prolapse

Question 36

metabolic causes of faecal impaction (3)

Answer 36

Hypercalcaemia Hypothyroidism Hypokalaemia

Question 37

Drug causes of faecal impaction (5)

Answer 37

``` Opiates Anticholinergics Fe Aluminium based antacids Diuretics ```