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2010-07-14 #1.4

Small & Large bowel obstruction

MCC of SB obstruction: MCC? adhesion; previous surgery
full-thickness inflammation of bowel wall > narrowing of lumen in terminal ileum: Dx? Crohn's disease
associated with down syndrome; history of maternal polyhydramnios; vomiting of bile-stained fluid at birth: Dx? further characteristics? duodenal atresia; distal to common bile duct; double bubble sign (air in sotmach & proximal duodenum)
underlying disease: chronic cholecystitis & cholelithiasis; air in biliary tree: Dx? pathogenesis? gallstone ileus in elderly women; fistual between gallbladder & SB > stone into SB & lodges at ileocecal valve > obstruction
absence of ganglion cells in Meissner's submucosal plexus & Auerbach's myenteric plexus; X sympathetic neurons in aganglionic segment; constant contraction without relaxation = aperistalsis > obstruction: Dx? Ax? hirschsprung's disease; chagas's > amastigotes > destruction of ganglion & down syndrome
Ax: down syndrome hirschsprung's disease; duodenal atresia
chronic constipation without large stools of retentive encopresis in early life; absent stool on examining finger: Dx? hirschsprung's disease
dilated portion of colon proximal to aganglionic segment, resulting in a 'transition zone': Dx? MC site? hirschsprung's disease; distal sigmoid & rectum
2nd MCC of SB obstruction indirect inguinal hernia; bowel in inguinal canal
highest rate of bowel incarceration femoral hernia
complication of newborn with CF; content lacking NaCl & obstructing the bowel lumen meconium ileus
what is volvulus? bowel twists around mesenteric root producing obstruction & "strangulation"
MC site of volvulus in elder, young adults sigmoid colon (senile); cecum
MC risk factors for volvulus chronic constipation
oblong mass palpated in midepigastrium (Dance's sign); rotavirus oral vaccine-related (Adenovirus); compromising blood supply: Dx? intussusception; common in children; "telescoping" of 1 bowel segment into distal segment causing obstruction
risk factors for intrassusception in adults polyp or cancer
Created by: mataos