wk 4 7 pathology of small intestine and appendix

Question 1

obstruction of the small bowel can be due to problems within the lumen, within the wall of the lumen, or outside the wall.
examples of eac h

Answer 1

within - gallstones, food, bezoar (solid indigestible material)

wall - tumour, crohns, radiation

outwith - adhesions, herniation

Question 2

associated symptoms with small intestine obstruction

Answer 2

pain (central/colicky - abdominal, children)
absolute constipation 
vomiting 
burping 
abdominal distension

Question 3

borborygmi

Answer 3

rumbling/gurgling noise made by movement of fluid and gas in intestines

Question 4

suspected bowel obstruction, appropriate investigations

Answer 4

urinalysis 
blood tests
ABG
Abdominal X-ray, CT scan 
Gastrogaffin studies

Question 5

outline ‘drip and suck’

Answer 5

Airways, Breathing, Circulation 
Analgesia
Fluids with K (usually hypokalaemic/alkalotic) 
catheterise 
Nasogastric tube(Ryles - draining) 
antithromboembolism measures

Question 6

t/f hernia can be resolved through drip and stuck

Answer 6

false

Question 7

how long will drip and suck be considered

Answer 7

72 hours

Question 8

when would a drip and suck be stopped earlier

Answer 8

signs of strangulation, perforation, ischaemia

Question 9

associated symptoms/cause of chronic mesenteric ischaemia

Answer 9

cramps (angina of gut)

atherosclerosis - superior mesenteric artery

Question 10

likely outcome of acute mesenteric ischaemia of small bowel

Answer 10

gets infarcted and dies

Question 11

likely outcome of acute mesenteric ischaemia of large intestine

Answer 11

usually does not infarct - supplied by marginal artery

Question 12

virchows triad is associated with hiigh risk throembolism, what are the 3 fctors

Answer 12

hypercoagulability
stasis of blood flow
endothelial damage

Question 13

t/f dehydration can slow blood flow

Answer 13

true

Question 14

t/f vasoconstriction can lead to in situ thrombosis

Answer 14

true

-dehydrated
-vasoconstriction
virchows triad

Question 15

diagnosing bowel ischaemia

Answer 15

pain out of proportion to clincial findings 
acidosis (low pH, high H+, high BE
lactate elevated
CRP - normal (may)
WCC - up slightly 
CT angiogram 
Laparotomy

Question 16

treatment for acute bowel ischaemia

Answer 16

resection if non-viable (unable to survive independently)

anastamose/staple for planned return

viable - unable to perform SMA embolectomy

Question 17

meckels diverticulum is the remnant of which duct

Answer 17

omphalomesenteric duct

vitelline duct

Question 18

although meckels diverticulum can occur anywhere in the small intestine, where is it found in relation to the ileoceacal valve

Answer 18

2 feet

Question 19

possible complicatons of meckels diverticulum

Answer 19

bleeding
ulceration (meckels diverticulitis)
obstruction
maligancy

Question 20

the appendix can vary in location, mostly being retrocaeca. however what is a constant in all appendixes

Answer 20

it is the convergence of the three taeniae

Question 21

causes of appendicitis

Answer 21

obstruction of lumen - faecolith
bacterial
viral
parasites

Question 22

outline the pathology of appendicitis

Answer 22

musocal inflammation 
lymphoid hyperplasia 
obstruction 
mucus/exudate build up 
venous obstruction 
ischaemia 
perforation

Question 23

the presence of inflammation in abdomen causes what change

Answer 23

positioning of greater omentum

Question 24

phlegmonous mass is associated with appendicitis, define

Answer 24

inflammatory tumour consisting of inflamed appendix, adjacent viscera and greater omentum

Question 25

symptoms of appendicitis

Answer 25

``` central pain - migrates to RIF anorexia nausea 1/2 vomits may not have bowel movemens vague pain - pelvic rectal tenderness ```

Question 26

signs of appendicitis

Answer 26

``` mild pyrexia mild tachycardia localised pain in RIF guarding rebound - (pain felt after stomach pressed) ```

Question 27

``` there are specific signs which are characteristic of appenditicits. these are rosvings psoas obturator pointing explain each ```

Answer 27

rosvings - pressiing left = pain on right psoas - right hip flexed, keeps inflamed appendix off the psoas (muscle) obturator - appendix is touching obturator internus, flexing hip + internal rotation = pain pointing - where did it start - where is it now

Question 28

appropriate investigations in appendicitis

Answer 28

Ultrasound Abodminal X ray Bloods (CRP, WWC) Urinalysis

Question 29

MANTRELS is used in the alvarado score, what score is required for appendicitis to be likely? other symptoms

Answer 29

``` Migration (pain - RLQ) Anorexia Nausea (+ vomiting) Tenderness (RLQ) Rebound pain Elevated temp Leukocytosis Shift of WBC to left ``` >5 sore to move/cough/laugh flushed face foetor oris (bad breath)

Question 30

management of apppendicitis

Answer 30

``` analgesia antipyretic (reduce fever) antiibiotics theatre -appendicetomy - laparascopic - open - laparotomy ```

Question 31

other than appendicitis, what else can develop in appendix

Answer 31

appendix mass abscess neoplasms

Question 32

outline treatment of appendix mass

Answer 32

antibiotics 1st line (if carcinoma excluded) | operate if complicated/worsen

Question 33

treatment of appendix abscesss

Answer 33

radiological drainage

Question 34

in carcinoid appendix, what can be stained for

Answer 34

chromagrannin