Gastrointestinal Problems
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Gastrointestinal Problems

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Gastrointestinal Problems Gastrointestinal Problems Presentation Transcript

  • Gastrointestinal Problems The Acute Abdomen Bowel Obstruction Bowel Cancer
  • The Acute Abdomen
    • Acute onset of abdominal pain
    • Many different causes
  • Causes of Acute Abdominal Pain
      • Abdo penetrating trauma
      • Bowel obstruction with perforation or necrosis
      • Acute ischaemic bowel
      • Appendicitis
      • Pelvic inflammatory disease
      • Inflammatory bowel conditions (Chron’s, ulcerative colitis)
    • - Gastroenteritis
    • Peptic Ulcer
    • Ruptured ectopic pregnancy
    • Ruptured ovarian cyst
    • Cholecystitis
    • Ruptured abdominal aneurysm
  • The Acute Abdomen
    • Signs & Symptoms
      • Pain: most common presenting symptom
      • Abdominal tenderness
      • Nausea/Vomiting
      • Diarrhoea
      • Constipation
      • Flatulence
      • General unwell/fatigue
      • Fever
      • Increased abdominal girth (distension)
  • The Acute Abdomen
    • Diagnostic
      • Complete history
      • Physical examination (including rectal & pelvic exam)
      • Blood tests (FBC, U&E’s,)
      • Urinalysis
      • Abdominal x-ray
      • ECG
      • Pregnancy test
      • Abdominal USS + - CT scan
  • Bowel Obstruction
    • Occurs when intestinal contents cannot pass through the GI tract
    • Obstruction maybe partial or complete
    • Causes classified as mechanical or non-mechanical
  • Bowel Obstruction
    • Mechanical Obstruction
      • Account for 90% of all bowel obstructions
      • Affects the lumen of the bowel
      • Caused by an occlusion of the lumen
      • Most occur in the small intestine
      • Mainly caused by adhesions, hernias or neoplasms
      • Carcinoma is the most common cause of large bowel obstruction
  • Bowel Obstruction
    • Non-Mechanical Obstruction
      • May result from neuromuscular or vascular disorders
      • Related to peristalsis
      • Paralytic ileus (lack of intestinal peristalsis) is the most common
        • Occurs after surgery
        • Electrolyte abnormalities
        • Spinal fractures
      • Vascular obstructions
        • Due to interference to blood supply to a portion of intestines
  • Pathophysiology of Bowel Obstruction
    • Normally 6-8 L of fluid enters small bowel daily
    • Approx 75% of intestinal gas is swallowed air
    • Bacterial metabolism produces methane &
    • hydrogen gases
    • Fluid, gas & intestinal contents accumulate
    • proximal to the intestinal obstruction
    • This causes distention, reduces the absorption of fluids & stimulates intestinal secretions
  • Pathophysiology (cont.)
    • The increase in fluid increases the pressure in
    • the lumen
    • Increased pressure leads to increase capillary permeability & extravasion of fluids electrolytes
    • peritoneal cavity
    • Oedema, congestion & necrosis from impaired blood supply can occur
    • Retention of fluid in the intestine & peritoneal cavity can lead to severe hypovolaemia & shock
  • Bowel Obstruction
    • Signs & Symptoms
      • Vary depending on the location of the obstruction
      • Nausea/Vomiting
      • Abdominal pain
        • Small bowel: colicky, cramp-like & intermittent
        • Large bowel: low grade cramp
      • Abdominal distension (greater in large bowel)
      • Bowel Sounds
        • Rapid, high-pitched tinkling
        • Absent
      • Inability to pass flatus
      • Constipation
  • Bowel Obstruction
    • Treatment of Bowel Obstruction
      • Aim to decompress the intestine
        • Removal of gas & fluid
        • Use of nasogastric &/or intestinal tubes
      • Maintain fluid & electrolyte balance
        • 6-8L fluid rich in sodium, potassium & chloride moves through the bowel each day
        • Normally most of it is reabsorbed
        • Retention of fluid in intestine & peritoneal cavity
        • Dehydration & electrolyte imbalances occur rapidly in small bowel obstruction
      • Surgery
      • l
  • Bowel Cancer
    • Colorectal cancer
    • One of the most common types of cancer in NZ
    • Diagnosed & treated early survival rate of 5 years + is approx 50%
    • Often undetected in early stages as asymptomatic
    • Prevention & early screening
  • Bowel Cancer
    • Cause
    • Exact cause unknown
    • Risk factors include
    • - History of intestinal polyps, inflammatory bowel
    • disease
    • - Hereditary disposition
    • - Aged 50+
    • - Obesity, sedentary lifestyle
    • - Diet high in animal fat
    • - Smoking
  • Bowel Cancer
    • Signs & symptoms
      • Vary with anatomic location of the tumour
      • Initially may be asymptomatic
      • Fatigue
      • Weakness
      • Loss of appetite
      • Weight loss
      • Blood in stool
  • Bowel Cancer
    • Ascending colon & caecum tumours
      • Abdominal pain R) lower quandrant
      • Iron deficiency anaemia
      • Occult blood in stool
      • Palpable mass
      • Weakness
      • Weight loss
      • Tumours may be large before causing changes in bowel habit
  • Bowel Cancer
    • Transverse colon tumours
      • Including the R) & L) flexures
      • Occult blood in the stool
      • Constipation
      • Altered frequency bowel movements
      • Abdominal fullness
      • Cramp adominal pain
  • Bowel Cancer
    • Descending colon
      • Bright red rectal bleeding
      • Ribbon shaped stools
      • Colicky abdominal pain
      • Alternating constipation & diarrhoea
      • Nausea/vomiting
      • These tumours may be ulcerative & infiltrate the bowel
  • Bowel Cancer
    • Sigmoid colon & rectum
      • Dull or aching pain in sacrum or rectum
      • Feeling of rectal fullness
      • Bright red blood from rectum
      • Narrow stools
      • Tenesmus ( painful, ineffective straining to empty bowel )
      • Anaemia
  • Bowel Cancer
    • Diagnostic Studies
      • History & physical examination
      • Rectal examination (PR)
      • Sigmoidoscopy
      • Colonoscopy
      • Barium enema
      • Faecal occult blood specimen
      • Blood tests (FBC’s, U&E’s, LFT’s)
      • Abdominal x-ray
        • Show presence of gas & fluid in intestines
      • CXR
      • Abdominal USS/CT
  • Bowel Cancer
    • Diagnostic
      • History & physical examination
      • Rectal examination (PR)
      • Sigmoidoscopy
      • Colonoscopy
      • Barium enema
      • Faecal occult blood specimen
      • Blood tests (FBC’s & U&E's, LFT’s)
      • CXR
      • Abdo USS
  • Bowel Cancer
    • Duke’s modified classification & prognosis
      • Duke’s A
        • Confined to the bowel wall
        • 72% survive 5yrs
      • Duke’s B
        • Extended through bowel wall
        • 56% survive 5yrs
      • Duke’s C
        • Regional lymph node involvement
        • 35% survive 5yrs
      • Duke’s D
        • Distant metastases
        • 0% survive 5yrs
  • Bowel Cancer
    • Treatment
      • Surgery: first line
      • Type depends on the location & extent of tumour
      • R) Hemicolectomy: tumours of the caecum & ascending colon
      • L) Hemicolectomy: tumours of the descending & sigmoid colon
      • Transverse colectomy: middle or L) transverse colon
  • Bowel Cancer
    • Surgery
      • Anterior resection: proximal & mid rectal tumours
      • Anterior-posterior resection: advanced disease
      • Abdominoperineal resection: malignant tumours of the lower sigmoid colon, rectum & anus. Too low for anastomosis