Uper

1. Dr.Aditya Raghav.G

2. At the end of this lecture students will be able to describe:
 The clinical presentation and Management of Small
bowel obstruction.
 The clinical features and Management of Crohn’s
disease.
 Presentation and Management of Small bowel tumors.
 Clinical features and Management of Small bowel
ischemia.
 Short bowel syndrome , causes and management.
 Meckel’s Diverticulum, presentation and management.

6. CLASSIFICATION
 MECHANICAL (Dynamic) vs ILEUS
(Adynamic)
 ACUTE vs CHRONIC
 SMALL vs LARGE INTESTINAL

10. CLINICAL FEATURES
 Colicky central abdominal pain
 Vomiting
 Abdominal distension
 Constipation

11.  Complete Blood Count
 Blood Chemistry
 Abdominal X Ray, erect and supine films
 CT abdomen with oral and I/V contrast
 Investigations required for GA fitness if
surgery is planned

17.  This may be defined as a state in which there is
failure of transmission of peristaltic waves
secondary to neuromuscular failure.
 The resultant stasis leads to accumulation of
fluid and gas within the bowel, with associated
distension, vomiting, absence of bowel sounds
and constipation.

18. Post open cholecystectomy paralytic ileus

19.  Arterial or Venous
 Acute or Chronic
 Symptoms: Acute: Sudden abdominal pain,
passage of altered blood, shock.
Chronic: Abdominal angina, weight loss or
diarrhoea.
 Investigations: AXR, CT angiography
 Treatment: Resuscitation, Gut Resection,
Embolectomy, Vascular bypass or
Endarterectomy.

23.  A disease of uncertain aetiology, but thought to
be result of inflammation caused by an unusual
strains of mycobacteria.
 It is characterized by full thickness
inflammatory process of any part of GIT from
lips to anal margin.
 Pathological features include full thickness
inflammation, edema, fissures/ulceration,
non- caseating foci of epithelioid and giant
cells.

27.  ACUTE
 Pain right iliac fossa
with tenderness
mimicking acute
appendicitis.
 Features of low small
bowel obstruction
 Rarely perforation of
small intestine
causing peritonitis.
 CHRONIC
 Colicky abdominal
pain with diarrhoea
 Weight loss
 Perianal fistulas
 Fistulation into
adjacent organs like
bladder, colon,
vagina.

28. INVESTIGATIONS
 Barium meal and follow through
 CT abdomen with oral and I/V contrast
 Blood : Anemia, high C- reactive protein and
low Vit-B12 levels
 Colonoscopy/ Enteroscopy with biopsy

29. Barium follow through showing “String sign of Kantor”

30. TREATMENT
Corticosteroids
Aminosalicylates
Immunomodulators e.g. azathioprine
Monoclonal antibodies
Antibiotics for perianal disease
Surgery: Resections, strictureplasty or
colectomies.

32.  Uncommon in developed countries except
when associated with AIDS.
 Both human and bovine strains of
mycobacterium can affect.
 Starts when ingested from infected source or
from swallowed sputum from open pulmonary
tuberculosis.
 Pathology: Ulceration, stricture formation and
lymph node enlargement.

34.  General: Weight loss, low grade fever, fatigue.
 Abdominal: Vague lower abdominal pain,
distension, borborygmi, diarrhoea, constipation
and ulceration leading to lower GI blood loss.
Palpable mass in right iliac fossa.
 Blood / Serum: CBC, ESR, PCR, Culture.
 Radiological: CXR, CT abdomen, Barium
follow through.
 Endoscopy

35.  Course of Anti-tuberculosis drugs
 Surgery for complications like:
 Stricture formation
 Perforation
 Haemorrhage

36.  Embryological remnant of Vitello-intestinal duct.
 Occurs in 2% population, 2 feet from ileocecal
valve and 2 inches long and 2 times common in
men.
 Presents as :
o Persistent vitello-intestinal fistula
o Acute diverticulitis
o Perforation and peritonitis
o Intestinal obstruction
o Bleeding due to ectopic gastric mucosa.

39. Asymptomatic and incidentally
discovered Meckel’s diverticulum are
left as such.
Narrow necked, inflamed or symptomatic
diverticulum is excised.

40. Primary tumours of small gut are uncommon
and form only 5% of the GIT neoplasms.
Aetiological factors include:
A. Inherited Conditions: Polyposis coli, Peutz-Jegherz
Syndrome, Gardner's syndrome.
B. Immunocompromised states: Coeliac disease, AIDS,
transplant recipients.
C. Geographical Areas: Lymphomas more common in
Middle East.

41. Benign
 Adenomas
 GIST (Gastrointestinal
Stromal tumours)
 Lipomas
 Neurofibromas
Malignant
 Lymphomas
both primary and part of
generalised disease.
 Adenocarcinomas
 Carcinoids
 Secondary tumours
from lung, breast or
malignant melanoma.

43.  It can be Acute or Chronic
 Acute presentation is with intestinal
obstruction, GI bleeding or perforation leading
to peritonitis.
 Chronic symptoms include malaise,
abdominal pain, weight loss, diarrhoea and
anaemia.

44.  Blood : Anemia and high ESR, Tumour
markers, high 5-HIAA levels in Carcinoids.
 Radiological: CT or MRI abdomen with oral
and intravenous contrast.
 Endoscopy: Upper GI endoscopy, Enteroscopy,
Colonoscopy.
TREATMENT: This depends upon presentation,
stage and type of the tumour.

45.  Short gut syndrome has been arbitrarily
defined as the presence of less than 200 cm of
residual small bowel in adult patients.
OR
 A functional definition, in which insufficient
intestinal absorptive capacity results in the
clinical manifestations of diarrhoea,
dehydration and malnutrition.

46.  Crohn's disease;
 Mesenteric infarction
 Radiation enteritis
 Midgut volvulus
 Multiple fistulae
 Small-bowel tumours

48.  Nutritional Support including TPN.
 Gut lengthening procedures
 Intestinal Transplantation