Flashcards in Small Bowel Disease Deck (25)
What are some luminal causes of small bowel obstruction?
Bezoar (lump of hair)
What is a gallstone ileus?
Large gallstone migrates via fistulas into the small intestine and become lodged
What is the most common fistula associated with the gall bladder and small intestine?
What are some bowel wall causes of small bowel obstruction?
List some symptoms of small bowel obstruction
Colicky abdo pain
Absolute constipation (no flatus/burping)
What investigations are done for small bowel obstruction?
FBC, urinalysis, blood gases
AXR, contrast CT abdomen
Enema XR if necessary
Is surgery common for small bowel obstruction?
Not really as most settle with management
Outline general treatment of small bowel obstruction
Fluids + potassium (lose K in vomit)
NG tube draining
When would surgery be done early for small bowel obstruction?
PREVENT DEAD GUTS
In mesenteric/small bowel ischaemia, the colon is usually unaffected. True/False?
Marginal artery of Drummond provides collateral supply
What is the typical symptom of mesenteric ischaemia?
Essentially "angina of the gut"
What is the first-line treatment for mesenteric ischaemia?
Surgery! No faffing around
PREVENT DEAD GUTS
Upon surgery, if part of the intestine is necrotised, what is done?
Resected (up to a limit)
Where does Meckel's diverticulum occur?
How does it arise?
60cm from ileocaecal valve
Remnant of vitello-intestinal duct from development
When does Meckel's diverticulum present?
Usually before 2yrs of age
What is the most common cause of small bowel ischaemia?
Mesenteric atherosclerosis, thromboembolism
Which layer of the bowel is most sensitive to hypoxia? Why?
It is the most metabolically active part
Increasing the time of ischaemia increases the depth of small bowel infarction. True/False?
List some complications of small bowel ischaemia
Resolution (if short-term ischaemia)
Scarring, fibrosis -> stricture
Primary tumours of small bowel are commoner than secondary tumours. True/False?
Secondary tumours (metastases) are more common
List 3 primary tumours of small bowel
Which cells are lymphomas derived from?
What is coeliac disease?
Abnormal reaction to gluten + wheat products resulting in enterocyte damage + reduced absorption
What is the characteristic histological appearance of coeliac disease?
Flat mucosal biopsy