Bowel Presentations

Question 1

What are the Ax of GIP?

Answer 1

Mst common

• peptic ulcer
• sigmoid diverticulum

Inflammatory/ischaemic

• diverticulitis
• meckel’s diverticulum
• cholecystitis
• mesenteric ischaemia

Trauma

• excessive vomiting
• anasto

Question 2

What are the clinical features of GIP?

Answer 2

• Sharp onset pain
• malaise, N&V
• peritonism (rigid abdomen)

Question 3

What are the Sx if thoracic perforation occurs in GIP?

Answer 3

• chest or neck pain - radiate to back
• resp sx
• pleural effusion signs
• crepitus

Question 4

What are the differential dx for GIP?

Answer 4

• acute pancreatitis
• MI
• ruptured AAA
• tubo-ovarian pathology

Question 5

What Ix will you order for GIP?

Answer 5

Bedside

• Urinalaysis - exclude tubo ovarian abcesses

Bloods

• Routine bloods
• G&S

Imaging

• CXR:
  
  • signs of thoracic perforastion
  • free air under diaphragm
  • pneumomediastinum
• AXR
  
  • pneumoperitoneum
  • Rigler’s sign
• CT (gold standard)

Question 6

What are the initial mx for GIP?

Answer 6

Drip and suck

• NBM
• NGT
• IV fluid
• Broad s[pec antibiotic
• commence individualised mx after definitive diagnosis made

Question 7

What is a general surgical approach for GIP?

Answer 7

Thorough washout

Question 8

What is Gastroenteritis (GE)?

Answer 8

Inflammation of GI tract. Usually caused by infection

Question 9

What is the general rule with length of time of sx?

Answer 9

• hours: bacteria
• days: virus (most common cause in develop worl)
• weeks: bacteria
• montghs: parasite

Question 10

Define diarrhoea

Answer 10

3 or more loose stools c inc. liquid per day

Question 11

Define acute diarrhoea & chronic

Answer 11

• Loose stools less than 14 days
• Loose stools more than 14 days

Question 12

What is dysentery?

Answer 12

loose stools with blood and mucys

Question 13

What is traveller’s diarrhoea?

Answer 13

more than 3 loose stools within 24hrs of foreign travel

Question 14

What are he RF for GE?

Answer 14

• Poor food preperation
• Poor hygiene
• Immunocompromised

Question 15

What are he sx of GE?

Answer 15

• N&V
• Abdominal cramps
• Diarrhoea
• weight loss, opyrexia, night sweats

*to rule out traveller’s diarrhoea, ask

• recent travels
• infected family/friends
• bowel habits

Ask recent use of antibiotics

Question 16

What Ix will help you with GE?

Answer 16

• Stool culture
• blood culture

Question 17

What is the mx for GE?

Answer 17

* self limiting

COnservative

• rehydration
• notify appropriate body

Question 18

What virus causes GE?

Answer 18

• Norovirus (most common in adults)
• Adenovirus (most common in children)
• Rotavirus

Question 19

What bacteria causes GE?

Answer 19

• campylobacter (chicken, egg, milk) - most common
• E.coli (traveller’s diarrhoea)
• Salmonella (undercooked chiceken, raw eggs)
• shigella (dairy and water)
• C.diff - hospital acquired

Question 20

What parasites causes GE?

Answer 20

• cryptosporidum - causes self limiting water diarrhea
• entamoeba histolytica - can result in liver abcess
• giardia
• Schistosoma - can lead to eosinophilia and chronic liver disease

Question 21

What are the non infective causes of GE?

Answer 21

• radiation
• IBD
• chronic ischaemic colitis
• microsco[pic colitis

Question 22

How would you manae paralytic ileus?

Answer 22

• electrolyte abnormality corrected
• IVF administered
• NG tube decompression
• opiate analgesia

Question 23

How would you tx Acute colonic pseudo-obstruction?

Answer 23

• Neostigmine (cholinesterase inhibitor) given to encourage motility
• Endoscopic colonic decompression in those failing to respond.
• Surgery