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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?