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What are the four types of intestinal obstruction? Hernias Adhesions Volvulus Intussusception
What are the most common causes of intestinal obstruction? Post-operative adhesions and hernias
What happens both proximal and distal to the obstruction? Proximal: dilation Distal: decompression
What are the tumours which can arise in the small intestine? Benign: adenoma; connective tissue
tumours (eg. GIST); angiomas; lipomas Malignant: adenocarcinomas; carcinoid
tumours; lymphoma; GIST
Describe the pathophysiology of colorectal cancer
Describe the staging and prognosis of colorectal cancer A: limited to mucosa 5 year survival
>85% B: through m. propria 5 year survival
70-80% C: LN metastases 5 year survival 40-
60% D: distant mets/irresectable local
disease 5 year survival < 5%
Name some options for screening of colorectal cancer FOBT but ALL positives must be
followed up with colonoscopy Flexible sigmoidoscopy more
acceptable than colonoscopy, but detects 50-55% of cancers
Colonoscopy but acceptability and resource issues
Define primary, secondary and tertiary peritonitis. Give an example of each Primary = haematogenous dissemination
in the setting of an immunocompromised state eg. translocation of bacteria; cirrhosis
Secondary = pathological process in a visceral organ eg. perforation, trauma
Tertiary = persistent/recurrent infection after adequate initial therapy eg. immunocompromised patients
What four factors affect the likelihood of developing peritonitis? Fibrinolysis alterations Bacterial load Bacterial virulence Abscess formation
What factors must be considered in peritonitis treatment? Control of the infectious source Elimination of the bacteria and toxins Maintenance of organ function Control of inflammation
What three pathologies can lead to abdominal pain? Inflammation constant pain,
worsens with local/general disturbance, still patient
Obstruction ‘colicky’, wriggling patient
Perforation more sudden increase in intensity to maximal
List some pre-operative and post-operative considerations
What symptoms can you get with hypokalemia?
Weakness, hypotonicity, depression, constipation, ileus, ventilatory failure, ventricular tachycardia, atrial tachycardia, coma
Name some causes and possible treatments for hypercalcemia Causes: hyperparathyroidism;
thyrotoxicosis; thiazide diuretics; immobilisation
Treatments: iv saline; bisphosphonates
Where is the majority of fluid reabsorbed within the GIT? Small intestine – absorbs ~8.3L/day
What is absorbed from/secreted into the SI? Absorbed: K+, Na+, H2O, Cl- Secreted: H2O, Cl-, HCO3- Both water and Cl- are absorbed > secreted
A patient presents with abdominal pain
Colicky abdominal pain Has nausea and vomiting Constipated, no flatus Underwent an appendicectomy a few years ago
1. What questions would you ask the patient?
What would you be looking for on examination? General: obvious pain, dehydrated BP and PR normal Abdomen: mildly distended, soft,
tenderness in right iliac fossa, no guarding/rigidity, no masses palpable
What investigation would you perform?
Report this x-ray
Diagnosis is intestinal obstruction secondary to adhesion.Describe the pathophysiology of this diagnosis.What treatment/management would you consider?