Diseases of the small and large intestine
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| What are the primary causes of intestinal obstruction? | Post-operative adhesions, malignancy, Crohn's disease, hernia, foreign bodies, congenital conditions
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| What response is there when the bowel dilates? | Increased digestive fluids
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| Presentation of early small bowel obstruction | Diarrhea due to incr digestive fluids
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| Distention leads to compression of mucusal lymphatics and movement of ___ into the lumen, leading to ____ | fluid, dehydration
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| What is the risk with strangulated bowel? | gangrene, rupture leading to sepsis, death
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| What is the presentation of proximal small bowel obstruction? | colicky pain leading to nausea (bile)
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| What is the presentation of distal small bowel obstruction? | Crampy pain every 4-7 minutes, progressive over days
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| What is the presentation of strangulated bowel? | Constant intense pain
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| What are the signs and symptoms of small bowel obstruction? | hyerpactive bowel sounds (early), hypoactive (late), nausea, diarrhea (early), constipation (late), fever/tachycardia (late), previous abdominal surgery, radiaition or malignancy
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| What is the treatment of small bowel obstruction? | Bowel rest, NG tube to take off fluid and gas
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| What are the aggressive factors r/t peptic ulcers? | H. pylori, NSAIDS/aspirin, cigarette smoking, alcohol, corticosteroids
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| What are the protective factors of the stomach as relates to peptic ulcer? | mucus, bicarb, blood flow, elaboration of protaglandins, epithelial regenrative capacity
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| What are the steps contributing to formation of gastric ulcer? | Ischemia, shock, stress, 2) delayed gastric emptying due to injury, 3) duodenal gastric reflux, 4) decreased retrograde motility impairs neutralization by pancreatic alkaline secretions
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| What is the pathophysiology of Crohn's disease? | Most commonly affects terminal ileum, begins as ulcerations, progresses to fistulas
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| What is the presentation of Crohn's disease? | "irritable bowel", bloody, mucus diarrhea, pain, pernicious anemia if ileum involved
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| What areas are affected by chronic ulcerative colitis? | chronic inflammation of the colon, usually rectum and sigmoid
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| What is the etiology of chronic ulcerative colitis? | genetic, infectious, immune (antibodies, cytotoxic t cells)
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| What is the pathophysiology of chronic ulcerative colitis? | antigen activates macrophages to release interleukins and tumor necrosis factor causing damage to the lining.
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| What is the term for urge to defecate without contents (like dry heaves)? | tenesmus
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| What is the presentation of chronic ulcertaive colitis? | rectal bleeding and diarrhea, rectal pain, urgency, cramps, tenesmus, wt loss, fatigue, fever, night sweats
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| How long does it take for gangrene and perforation to occur in an acute abdomen condition? | In 6 hours
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| Acute pain may require ___ | surgery
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| Chronic pain is treated ___ | medically
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| What are common causes of large bowel obstruction | infection, inflammation, cancer, mechanical obstruction (impaction or vovulus)
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| Who are high risk patients for large bowel obstruction? | chronic constipation, long term cathartic use, straining at stool, change in caliber of stool
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| What is the presentation of large bowel obstruction prior to perforation? | vague visceral abdominal cramps, peritonitis, belts/pants no longer fit
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| What is the presentation of Irritable Bowel Syndrome? | pain relieved by defecation, change in stool frequency, change in stool consistency, mucus in stool, bloating
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| What is the cause of diverticular disease? | low fiber diet, loss of collagen with age
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| What is the presentation of diverticulitis? | Abdominal pain, tenderness in LLQ, infection, performation, tears, obstruction
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| What is the presentation of polyps? | blood in stool, rectal bleeding, constipation or diarrhea, pain or obstruction
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