YEAR 3 & 5 CORE CONDITIONS > Gastrointestinal > Flashcards

Gastrointestinal Flashcards

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1
Q

What can cause GORD?

A
  • Abnormalities of lower oesophageal sphincter e.g. transient relaxation
  • Hiatus hernia
  • Oesophageal dysmotility
  • Increased abdominal pressure e.g. pregnancy
  • Gastric acid hypersecretion e.g. Ellison Zollinger syndrome
  • Delayed gastric emptying
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2
Q

Which drugs can increase the risk of GORD and why?

A

Tricyclic antidepressants
Anticholingergics
Nitrates
Calcium channel blockers

They all relax the tone of gastrooesophageal sphincter

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3
Q

What are some symptoms of GORD?

A
  • Heartburn - retrosternal burning pain that worsen with lying down and after eating
  • Belching
  • Acid brash (regurgitation)
  • Increased salivation
  • Odynophagia
  • Chronic cough
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4
Q

What condition is GORD often associated with?

A

Asthma

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5
Q

What investigations should be done for GORD?

A
  • Empirical therapy - if GORD is clinically suspected and there are no indications for endoscopy, start a short trial of PPIs
  • Endoscopy - if signs of complicated disease (e.g. dysphagia, odynophagia, weight loss)
  • Oesophageal pH monitoring - measured over 24h via NG tube with pH probe; sudden drops to pH < 4 = acid reflux
  • Barium swallow - to rule out hiatus hernia
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6
Q

What is the endoscopic grading of oesophagitis?

A

Savary-Miller system
Grade 1: single/multiple erosions on a single fold
Grade 2: multiple erosions on multiple folds
Grade 3: multiple circumferential erosions
Grade 4: ulcer, stenosis or oesophageal shortening
Grade 5: Barrett’s (columnar metaplasia AKA intestinal metaplasia)

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7
Q

What are the conservative, medical and surgical management optoins for GORD?

A

Conservative
• Small portions and avoid eating < 3 hours before bedtime
• Lose weight
• Avoid nicotine, alcohol, coffee

Medical

  • Antacids
  • PPIs for 2 months - omeprazole, lansoprazole

Surgical

  • Fundoplication - the gastric fundus is wrapped around the lower oesophagus and secured to form a cuff, which narrows the distal oesophagus and GOJ to prevent reflux
  • Laparoscopic insertion of magnetic bead band
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8
Q

What are some side effects of PPIs?

A

Headache
GI upset
Increased risk of C. difficile
Low magnesium - tetany, ventricular tachycardia

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9
Q

What is a contra indication of PPIs?

A

Osteoporosis

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10
Q

What drugs do PPIs interact with?

A

They are CYP450 inhibitors so they increase concentration of drugs metabolised by CYP450 system

Drugs metabolised by CYP450 system:

  • Warfarin
  • COCP
  • Theophylline - methylxanthine for COPD
  • Corticosteroids
  • Tricyclic antidepressants
  • SSRIs
  • Pethidine - analgesia
  • Statins
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11
Q

When are H2 receptor antagonists used over PPIs?

A

Pregnancy

Pre-op - quicker onset than PPIs

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12
Q

What are some red flag symptoms for upper GI cancer?

A
  • Dysphagia
  • Dyspepsia with weight loss, anaemia or vomiting
  • Family history
  • Barrett’s oesophagus
  • Upper abdominal mass
  • Jaundice
  • Pernicious anaemia
  • Peptic ulcer surgery
  • > 55 years
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13
Q

How do antacids interact with other drugs?

A 
Decrease absorption of gastric protected drugs e.g. metformin
Increase excretion of aspirin + lithium
Decrease serum concentrations of:
- ACE inhibitors
- Cephalosporins
- Ciprofloxacin
- Tetracyclines
- Digoxin
- PPIs
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14
Q

What is the pathophysiology of the main cause of peptic ulcers?

A

H. Pylori infection
It produces ammonia in order to neutralise the acid of the stomach.
The ammonia is directly toxic to epithelial cells, leading to inflammation
The inflammation causes depletion of the alkaline mucus and atrophy of the lining, leading to ulcers

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15
Q

What is the 2nd most common cause of peptic ulcers and why?

A

NSAID use - they inhibit prostaglandin synthesis which reduces the production of the protective alkaline mucus

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16
Q

What shape is H Pylori and what gram stain is it?

A

Spiral shaped bacteria

Gram-negative

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17
Q

What are the alarm symptoms of peptic ulcer?

A

ALARMS

Anaemia (iron deficiency)
Loss of weight
Anorexia
Recent onset
Melaena/haematemesis
Swallowing difficulty
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18
Q

How do stomach/duodenal ulcers present?

A

Stomach

  • Pain worse on eating
  • Haematemesis

Duodenal

  • Pain relieved by eating
  • Pain wakes patient up in the night
  • Melaena
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19
Q

Which type of peptic ulcer is more common?

A

Duodenal ulcers are 4x more common

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20
Q

What tests can you do for H Pylori?

A

Stool antigen test = diagnostic

Carbon-13 urea breath test = to check if eradication was successful

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21
Q

What is the treatment for H Pylori?

A

Triple therapy

Amoxicillin 1g + clarithromycin 500mg + PPI (all taken twice daily for 1 week)

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22
Q

What are the main complications of peptic ulcers?

A

Bleeding
Perforation
Malignancy
Decreased gastric outflow

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23
Q

Who must get an endoscopy?

A

Anyone with dysphagia

> 55 years and persistent symptoms or ALARM symptoms

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24
Q

If H. Pylori test is negative, how do you treat a peptic ulcer?

A

PPIs for 2 months

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25
What are the most common causes of acute GI bleeds?
1. Peptic ulcer = 50% 2. Oesophago-gastric varices (due to portal hypertension e.g. liver cirrhosis) = 10-20% Others: - Mallory-Weiss tear (due to severe vomiting e.g. alcoholism or bulimia) - Malignancy - Gastritis/oesophagitis
26
What are the risk factors for poor prognosis/re-bleeding?
``` Age > 60 Cardiovascular disease Respiratory disease Hepatic impairment Coagulopathy Malignancy ``` 1. Is the patient more susceptible to the effects of anaemia, such as coronary artery disease? 2. Is the patient at risk of fluid overload with aggressive resuscitation (such as renal disease)? 3. Will the bleeding be harder to control, owing to anticoagulation, liver disease or thrombocytopaenia?
27
What scores are used to assess risk of mortality in Upper GI bleeds
Rockall score Glasgow-Blatchford score
28
What is Boerhaave's syndrome? What sign can be found on examination
Oesophageal perforation Sign - subcutaneous/surgical emphysema
29
What blood levels would indicate a GI bleed?
Low Hb | High urea out of proportion to creatinine indicates large blood meal
30
What is the acute management of an upper GI bleed?
- 2 wide bore cannulae in antecubital fossae - Take bloods - U+Es, FBC, group + save, coagulation screen, LFTs, VBG - 500ml 0.9% sodium chloride in 15 min - Activate 'Major Haemorrhage' protocol - FFP + 4 units of RBCs - Prescribe terlipressin + prophylactic antibiotics - Call GI reg to organise endoscopy
31
What are some causes of portal hypertension?
Pre-hepatic - thrombosis (portal or splenic vein) Hepatic - Cirrhosis (most common in UK) - Schistosomiasis (most common worldwide) - Sarcoidosis Post-hepatic - Right heart failure - Constrictive pericarditis
32
What is the prevalence of IBS?
10-20% of UK population
33
What is the criteria used to diagnose IBS and what does it consist of?
Manning Criteria Abdominal discomfort or pain that is relieved by defecation OR associated with altered bowel frequency or stool form AND at least 2 of: - Altered stool passage (e.g. straining or urgency) - Abdominal bloating - Symptoms made worse by eating - Passage of mucus
34
What are some exacerbating factors of IBS?
Stress Menstruation Gastroenteritis = post-infectious IBS
35
What tests should be done in IBS?
- FBC to check for anaemia - CRP - Coeliac screening - Faecal calprotectin for potential IBD
36
What advice can be given for constipation in IBS?
- Increase water and fibre intake - Physical activity - Simple laxatives but avoid lactulose which can aggravate bloating when it ferments
37
What advice can be given for diarrhoea in IBS?
Avoid: - Sweeteners - Alcohol - Caffeine - Fibre Loperamide after each loose stool
38
What are the main risk factors for Crohn's disease?
- Family history - NOD2 gene | - Smoking increases risk by 3-4x
39
What causes Crohn's disease?
Autoimmune response against gut flora
40
What is the macroscopic and microscopic histopathology of Crohn's?
``` Macroscopic • Cobblestone appearance • Pinpoint lesions - small, aphthous haemorrhagic mucosal defects • Thickened bowel wall • Fistulae and abscesses ``` Microscopic • Skip lesions present • Transmural inflammation -> fibrosis and stenosis -> fistulae and abscesses • Creeping fat • Non-caseating granulomas - lots of cells clumped together • Lots of lymphocytes (lots of purple) = autoimmune
41
How does Crohn's present?
- Aphthous ulcers - Chronic diarrhoea - Colicky abdominal pain, worse after eating - Weight loss - Anal fistula/abscess - Malnourished due to decreased absorption
42
What are some extra-intestinal manifestations of Crohn's?
* Pyoderma gangrenosum * Episcleritis (painless red eye) * Anterior uveitis * Erythema nodosum * Ankylosing spondylitis * Calcium oxalate kidney stones * Gallstones
43
What investigations are done for IBD?
- Stool culture to exclude infection if first presentation - Faecal calprotectin tests for GI inflammation - Colonoscopy + biopsy - MRI to detect fistulae - FBC, CRP, ESR, B12, folate
44
How do you treat a flare of Crohn's?
Prednisolone 40mg per day for 1 week then taper by 5mg each week for 7 weeks - first line Mesalazine - second line
45
How do you induce or maintain remission for someone suffering frequent exacerbations of Crohn's?
Azathioprine - first line (always check TPMT activity first Mercaptopurine - second line Methotrexate - possible add on therapy to either Infliximab in refractory or fistulating disease
46
What is the histolopathology of ulcerative colitis? | What is the defining lesion?
- Crypt abscesses = defining lesion - Micro ulcers - Inflammatory polyps - Inflammation is NOT transmural
47
What does ulcerative colitis most commonly affect?
The rectum (proctitis)
48
How does ulcerative colitis present?
- Diarrhoea with blood + mucus - Cramping abdominal discomfort - Tenesmus (proctitis)
49
What is an acute complication of ulcerative colitis?
Toxic megacolon = fulminant colitis - Acute colonic dilatation so transverse colon is > 6cm diameter - Extension of inflammation beyond mucosa - Loss of contractility leads to accumulation of gas and fluid - Risk of perforation
50
What signs would be seen on examination in toxic megacolon?
- Firm, distended abdomen - Rebound tenderness + guarding - Absent bowel sounds
51
In ulcerative colitis: a) What is used to induce remission? b) What is used to maintain remission?
Steroids to induce remission - prednisolone 40mg OD with tapering dose Mesalazine = 5-aminosalicylate OD to maintain remission Surgery if failing to respond to medical therapy
52
What are the main poultry-associated causes of gastroenteritis? How can you distinguish between them?
Salmonella Campylobacter Incubation period - Salmonella = 12-36 hours - Campylobacter = 1-10 days Campylobacter is more likely to cause bloody stools
53
Which viruses commonly cause gastroenteritis?
``` Norovirus = most common Adenovirus Rotavirus Sapovirus CMV ```
54
What usually causes Listeria gastroenteritis?
Cold meats Soft cheeses Pâté Avoid these foods in pregnancy due to risk of miscarriage
55
What causes E. Coli gastroenteritis?
Under-cooked beef | Unpasteurised milk
56
How does E. Coli gastroenteritis present?
``` Bloody diarrhoea (E Coli 0157 is haemolytic) Risk of developing haemolytic uraemic syndrome ```
57
Name some intestinal parasites that can cause gastroenteritis
Giardia Cryptosporidium Entamoeba histolytica
58
What is the incubation period for viruses, bacteria and parasites?
``` Viruses = 1-3 days Bacteria = < 1 week (can be hours) Parasites = weeks ```
59
What are the main causes of dysentery?
- E. Coli - Shigella - Campylobacter (25%) - Salmonella - C. Difficile - CMV - Entamoebic histolytica - Trichuriasis = whipworm
60
What is the definition of diarrhoea?
> 3 episodes of loose stools per day
61
What investigation should be done in gastroenteritis?
Stool MC&S - Toxins - Culture of bacteria - PCR - Oocytes in cyclospora and cryptosporidium
62
How do you treat gastroenteritis?
Hydration - oral rehydration solution | Antimotility agents e.g. loperamide (do not give in dysentery because need to get rid of the infection)
63
Why should you not give antibiotics in food poisoning?
If it is E. Coli, there is risk of haemolytic uraemic syndrome
64
How do you treat C. Difficile?
Metronidazole | Vancomycin if metronidazole didn't work
65
What is the mechanism of loperamide?
Opioid receptor agonist and non-selective calcium channel blocker This reduces peristalsis This increases the time substances stay in the intestine so more water can be absorbed
66
What are the contraindications of loperamide?
Acute IBD - risk of perforation | C. difficile + other dysentery
67
What is the mechanism of laxatives?
They increase water and electrolyte secretion from the mucosa to increase peristalsis
68
What are the side effects of laxatives?
Diarrhoea Melanosis coli Tolerance (often abused in anorexia)
69
What are the contraindications of laxatives?
Bowel obstruction - risk of perforation Diabetes - senna is high in sugar Haemorrhoids
70
What does mesalazine interact with?
PPIs - they increase the pH so the gastric protection is broken down in the stomach Lactulose - decreases the pH of stools so it prevents release in the colon
71
When is mesalazine contraindicated?
Aspirin hypersensitivity
72
What are some important side effects of mesalazine?
Oligospermia | Leucopenia
73
What are the 2 types of oesophageal carcinoma? Where is each more common?
Adenocarcinoma - developed world | Squamous cell carcinoma - developing world
74
What are the risk factors for adenocarcinoma of the oesophagus?
``` Barrett's oesophagus Cured meats, low fruit and veg High fat intake GORD Obesity ```
75
What are the risk factors for squamous cell carcinoma of oesophagus?
``` Thermal injury - hot drinks Smoking Excessive alcohol HPV virus Achalasia ```
76
Which parts of the oesophagus is affected in each type of oesophageal carcinoma?
Adenocarcinoma - lower third | Squamous cell carcinoma - upper and middle thirds
77
What is the treatment for oesophageal carcinoma?
Adenocarcinoma - neoadjuvant chemotherapy then oesophagectomy Squamous cell - definitive chemo-radiotherapy (SCCs are difficult to operate on)
78
Where are rates of gastric carcinoma particularly high?
Japan China South America
79
What are some risk factors for gastric carcinoma?
- H. Pylori infection - Smoking - Atrophic gastritis - Pernicious anaemia - Nitrosamines - cured meats - High salt, pickling - High alcohol intake
80
What signs might be found on examination of gastric cancer?
Epigastric mass Virchow's node Acanthosis nigricans Hepatomegaly, jaundice, ascites if metastatic disease
81
Explain an endoscopy procedure to a patient
1. Check the patient's understanding 2. Endoscopy = a tube that is only the size of your middle finger with a camera at the end will go down your gullet to look at your stomach and the first bit of your bowel 3. Why they need it 4. Pre-procedure - fast for at least 6 hours before and have no fluids 3 hours before. If you are being sedated, make sure you have someone to take you home. 5. How it's performed - lie on the bed on your side; some anaesthetic spray will be sprayed in your mouth; the tube is inserted and gas is used to inflate the bowel 6. Risks - you may get some bloating and pain. Rare risks include perforation, infection, bleeding
82
How might gastric cancer present?
Dyspepsia - not responsive to PPIs and worse when eating Early satiety Vomiting Melaena Non-specific cancer sx: weight loss, anaemia
83
What are some risk factors for colorectal cancer?
- IBD - Family history - FAP, HNPCC - Diet low in fibre, high is processed meat - Smoking - Alcohol
84
What drug can be used to prevent colorectal cancer?
Apirin 75mg daily
85
How does left sided colorectal cancer present?
- Rectal bleeding with mucus - Early change in bowel habit - Tenesmus - Mass in LIF - Obstruction (left colon is narrower and doesn't expand as easily)
86
How does right sided colorectal cancer present?
- Weight loss - Anaemia - Abdominal pain - Mass in RIF - More advanced at presentation
87
What investigations are done for colorectal cancer?
Colonoscopy + biopsy - diagnostic FBC - microcytic anaemia Faecal occult blood CEA tumour marker - used to monitor disease progression
88
What is the screening programme for colorectal cancer?
1. All 55+ years are invited for a one off flexible sigmoidoscopy 2. All 60-74 year olds are invited to do a home test every 2 years 3. Over 75s can ask for a home test kit every 2 years
89
What is the classification of colorectal cancer?
``` Duke's criteria A - limited to muscularis mucosae B - extension through muscularis mucosae C - involvement of regional lymph nodes D - distant metastasis ```
90
What genes are linked to coeliac disease?
HLA-DQ2 (95%) | HLA-DQ8
91
When should coeliac disease be suspected?
Anaemia (iron or B12 deficiency) Weight loss Diarrhoea (steatorrhoea)
92
What is seen on histology of coeliac disease?
Villous atrophy Crypt hyperplasia Stages • Stage 1 - increased intraepithelial lymphocytes • Stage 2 - increased inflammatory cells and crypt hyperplasia • Stage 3 - all the above + villous atrophy
93
What are some extra-intestinal manifestations of coeliac disease?
B12 deficiency - peripheral neuropathy, ataxia Iron deficiency - angular stomatitis, anaemia Aphthous ulcers Osteoporosis Dermatitis herpetiformis
94
What is the first line investigation for coeliac disease? What investigation is the gold-standard for diagnosis of coeliac disease?
All tests must be done whilst eating a gluten-containing diet 1. Total IgA and IgA tissue transglutaminase = 1st choice 2. If the first test was only weakly positive, test IgA EMA (endomysial antibodies) 3. If IgA is deficient, test IgG Duodenal/jejunal biopsy = gold-standard diagnostic
95
What causes appendicitis?
Lumen of appendix becomes obstructed with: - Faecolith = hard mass of faecal matter - Lymphoid hyperplasia - Filarial worms Then gut organisms invade the appendix wall
96
What are some complications of acute appendicitis?
Increased intraluminal pressure -> ischaemia -> necrosis -> perforation -> peritonitis Electrolyte imbalance from vomiting Pelvic abscess
97
What signs might be found on examination of appendicitis?
- Tachycardia, tachypnoea, pyrexia - Tenderness at McBurney's point (2/3rds umbilicus to ASIS) - Guarding due to peritonitis - Rovsing's sign - pain in RIF on pressing over LIF - Psoas sign - pain on extending thigh - Cope sign - pain on flexion and internal rotation of R thigh
98
How is appendicitis diagnosed? What tests must be done?
Clinical diagnosis Bloods - raised WCC, CRP, ESR Urinalysis to rule out UTI Pregnancy test to rule out ectopic
99
What is the management of appendicitis?
Nil by mouth IV fluids IV analgesia + anti-emetics IV Abx (cefuroxime 1.5g/8hr plus metronidazole 500mg/8hr) Laparoscopic appendectomy = curative gold-standard treatment (usually booked electively a few weeks after IV abx and fluids unless acute peritonitis)
100
What are the causes of small bowel mechanical obstruction?
Adhesions (most common) e.g. prior abdo surgery, abdominal TB Incarcerated hernias Crohn's disease
101
How does small bowel obstruction present?
- Early bilious vomiting - Less abdominal distention - Colicky pain high up in abdomen
102
What are the causes of large bowel obstruction?
Tumours e.g. colon carcinoma - most common cause especially in elderly (typically sigmoid carcinoma) Constipation Volvulus Diverticular stricture
103
How does large bowel obstruction present?
- More constant pain - Absolute constipation (no faeces or flatus) - Distention - Feculent vomiting - but this is a late sign
104
What are the 2 categories of intestinal obstruction? How can you distinguish between them clinically?
Mechanical - High-pitched tinkling bowel sounds - Colicky abdominal pain - Vomiting Functional - Bowel sounds absent - Less pain - but it is more diffuse and continuous - Marked abdominal distention - Absolute constipation
105
What can cause paralytic ileus?
* Recent abdominal surgery * Abdominal infections or inflammatory conditions * Medications - opioids, anticholinergics, antiparkinsonian drugs * Electrolyte disturbances classic is someone on IV morphine post-operatively
106
What would an abdominal X-ray of bowel obstruction look like depending on which bowel is affected?
Dilated bowel - Small bowel dilatation if >3cm - Large bowel dilatation if >6cm - Cecal dilatation if > 9cm Small bowel obstruction - valvulae conniventes are visible (lines completely cross the bowel) Large bowel obstruction - haustral lines visible Rigler's sign = pneumoperitoneum due to perforated bowel (both sides of bowel wall can be seen)
107
What is the pathophysiology of Barrett's oesophagus?
* Intestinal metaplasia - Stomach acid damages the squamous epithelium, then it becomes replaced by columnar epithelium and goblet cells * The physiological transformation zone (Z-line) between squamous and columnar epithium is shifted upwards * If there is >3cm of columnar epithelium between Z-line and GOJ, there is a higher cancer risk
108
What is the management of low-grade dysplasia in Barrett's oesophagus?
High dose PPI and followed up with endoscopic surveillance at six monthly intervals
109
What is the management of high-grade dysplasia in Barrett's oesophagus?
Endoscopic resection of the abnormal areas (radiofrequency ablation, photodynamic ablation, or laser)
110
What is the most common presenting symptom in oesophageal cancer?
Dysphagia ○ Progressive in nature - starts with solids only, before affecting liquids ○ Any patient with dysphagia should be assumed to have oesophageal cancer until proven otherwise
111
What is the initial investigation in suspected oesophageal carcinoma?
Endoscopy (OGD) within 2 weeks +/- biopsy if there is any malignancy to send to histology
112
What are the options for palliative management of oesophageal cancer?
* Oesophageal stent * Radiotherapy + chemotherapy to reduce tumour size * Nutritional support - thickened fluid, nutritional supplements * Radiologically-Inserted Gastrostomy (RIG) - can be inserted to bypass the obstruction if dysphagia becomes too severe
113
How are gastric cancers treated?
* Peri-operative chemotherapy - 3 cycles of neoadjuvant + 3 cycles of adjuvant * Proximal gastric cancers - total gastrectomy * Distal gastric cancers - subtotal gastrectomy
114
What are the NICE guidelines for referral for urgent investigation for colorectal cancer?
* ≥40yrs with unexplained weight loss and abdominal pain * ≥50yrs with unexplained rectal bleeding * ≥60yrs with iron‑deficiency anaemia or change in bowel habit * Positive occult blood screening test
115
What signs can be seen on imaging of sigmoid volvulus?
CT abdo-pelvis with IV contrast - dilated sigmoid colon with 'whirl sign' AXR - coffee-bean sign arising from LIF
116
What are the management options for bowel obstruction?
Remove the cause e.g. medications, do enema for impaction, correct electrolytes Conservative - for patients that are haemodynamically stable - Bowel rest - NG tube insertion - IV fluids and electrolytes Surgical (exploratory laparotomy) - for patients that are haemodynamically unstable or have signs of ischaemia/necrosis
117
What signs are seen on AXR in Crohn's and UC?
Thumb-printing = Crohn's Lead-piping = Ulcerative colitis
118
What side of the abdomen would an ileostomy and a colostomy be on?
Ileostomy = right Colostomy = left
119
What is the hallmark electrolyte abnormality in refeeding syndrome?
Low phosphate
120
What is the pathophysiology behind achalasia?
Idiopathic degeneration of the myenteric plexus causes failure of relaxation of oesophageal sphincter
121
How does achalasia present?
* Difficulty swallowing both liquids and solids * Regurgitation of food * Retrosternal chest pain
122
What investigation is done to diagnose achalasia and what is seen?
Barium swallow - bird's beak appearance of distal oesophagus
123
What are the different management options for achalasia depending on the patient?
Heller's cardiomyotomy - for patients that are fit and can undergo surgery - Fibres of the lower oesophagus are cut longitudinally to relieve pressure Endoscopic balloon dilatation - for older, less fit patients Injection of botox Calcium channel blockers (e.g. nifedipine) and nitrates - Often ineffective - Reserved for unfit patients who are unable to tolerate other therapies
124
What are the indications for surgery in ulcerative colitis?
Acute fulminant UC Toxic megacolon with little improvement after 48-72 h of IV steroids Symptoms worsening despite IV steroids
125
What is a severe side effect of mesalazine?
Agranulocytosis
126
What classification is used for severity of UC?
Truelove and Witts
127
What sign is seen on AXR of UC?
Lead pipe appearance
128
What is the conservative management of intestinal obstruction?
Bowel rest NG tube (Ryles tube) insertion - aspirate stomach contents with syringe then attach a bag for free drainage IV fluids and electrolytes Depending on cause: - Enema for faecal impaction - Sigmoidoscopic detorsion for sigmoid volvulus
129
Which patients is conservative management of intestinal obstruction appropriate for?
For patients with partial bowel obstruction or complete bowel obstruction but no signs of ischaemia/necrosis/clinical deterioration
130
When is surgical management of intestinal obstruction indicated?
Haemodynamic instability Signs of ischaemia/necrosis Persistent partial obstruction >3-5 days Closed-loop obstruction
131
What medications should be stopped in bowel obstruction?
Pro-kinetic medications - Metoclopramide - Erythromycin - Domperidone
YEAR 3 & 5 CORE CONDITIONS
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