Appendix and bowel

Question 1

What could be the causes of appendicitis?

Answer 1

• faecolith (hard stool)
• bacterial
• viral
• parasitic

Question 2

Explain the pathology of appendicitis

Answer 2

• mucosal inflammation
• lymphoid hyperplasia
• obstruction

Question 3

What happens between the appendix and the greater omentum during appendicitis?

Answer 3

• as the appendix swells it sticks to the greater omentum

Question 4

What type of infection can occur if the appendix bursts?

Answer 4

• peritonitis

Question 5

What are the symptoms of appendicitis?

Answer 5

• start of with central pain, then shifts to right ileac fossa
• sore when the laugh/cough
• gone off food
• Rosving Sign
• Psoas sign

Question 6

What are the clinical symptoms of appendicitis?

Answer 6

• mild pyrexia
• mild tachycardia
• localised right ileac fossa pain

Question 7

What manouvers can be carried out to investigate appendicitis?

Answer 7

• rebound- pressure applied, and then released quickly, pain will be felt when pressure removed
• rosvings sign –> pressure applied to the left abdomin and pain felt in the right

Question 8

What tests can be carried out to confirm appendicitis?

Answer 8

• AXR
• USS
• Bloods
• Urinalysis

Question 9

Management of appendicitis?

Answer 9

• pain relief
• surgery
• antibiotics

Question 10

What are the symptoms of small bowel obstruction?

Answer 10

• pain (Bowel dilates)
• absolute constipation
• vomiting
• abdominal distension

Question 11

What investigations should be done to test for small bowel obstruction?

Answer 11

• urinalysis
• bloods
• AXR
• Contrast CT scan of abdo

Question 12

Treatment of a small bowel obstruction?

Answer 12

• drip and suck
• fluids with potassium
• drain with NG tube

Question 13

What may be some risk factors for small bowel obstruction?

Answer 13

• post operative adhesions –> fibrous scar tissue
• hernias
• IBD

Question 14

What is a complication of bowel obstruction?

Answer 14

• may cause blood vessels to collapse
• leads to ischaemia
• necrosis and perforation

Question 15

What is the pathophysiology of bowel obstruction?

Answer 15

• any part of the GI tract
• dilation of bowel proximal
• peristalsis is disrupted

Question 16

Explain the symptoms of upper small bowel obstruction?

Answer 16

• acute presentation

- large volumes vomited

Question 17

Explain the symptoms of distal small bowel/large bowel obstruction?

Answer 17

• colicky abdo pain and distension

- vominting

Question 18

When does vomiting occur in bowel obstruction?

Answer 18

• the more proximal the obstruction the earlier vomiting develops

Question 19

What causes constipation during bowel obstruction?

Answer 19

• propulsion of bowel contents is arrested

Question 20

What does chronic incomplete obstruction leads to?

Answer 20

• gradual hypertrophy of the muscle of bowel wall proximally
• peristaltic activity in this hypertrophic muscle is responsible for bouts of colicky pain

Question 21

Why do symptoms of large bowel obstruction develop more gradually?

Answer 21

• due to the large capacity of the colon and caecum and their absorptive activity

Question 22

What may be the clinical observations of an intestinal obstruction?

Answer 22

• dehydration
• abdominal distension
• visible peristalsis
• obstructing abdominal mass may be palpable

Question 23

What is the management of intestinal obstruction?

Answer 23

• nil by mouth
• IV cannula and fluids
• NG tube to decompress the stomach

Question 24

What are some causes of bowel obstruction?

Answer 24

• adhesions or bands
• incarcerated abdominal wall hernia
• internal hernia
• volvulus
• tumout
• inflammatory strictures

Question 25

Explain a volvulus?

Answer 25

- a mobile loop of bowel rotates causing obstruction at its neck

Question 26

Explain intussusception

Answer 26

- a segment of bowel wall becomes telescoped into the segment distal to it

Question 27

Explain Ogilvie's syndrome

Answer 27

- acute dilation of the colon in the absence of colonic instruction in acutely unwell patients