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Party hard

Party hard. 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

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Party hard

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  1. Party hard

  2. What are the four types of intestinal obstruction? • Hernias • Adhesions • Volvulus • Intussusception

  3. 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

  4. 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

  5. Describe the pathophysiology of colorectal cancer

  6. 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%

  7. 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

  8. 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

  9. What four factors affect the likelihood of developing peritonitis? • Fibrinolysis alterations • Bacterial load • Bacterial virulence • Abscess formation

  10. 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

  11. 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

  12. List some pre-operative and post-operative considerations

  13. What symptoms can you get with hypokalemia? • Weakness, hypotonicity, depression, constipation, ileus, ventilatory failure, ventricular tachycardia, atrial tachycardia, coma

  14. Name some causes and possible treatments for hypercalcemia • Causes: hyperparathyroidism; thyrotoxicosis; thiazide diuretics; immobilisation • Treatments: iv saline; bisphosphonates

  15. 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

  16. 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?

  17. 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

  18. What investigation would you perform? Report this x-ray

  19. Diagnosis is intestinal obstruction secondary to adhesion. Describe the pathophysiology of this diagnosis. What treatment/management would you consider?

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