The document discusses gastrointestinal problems including the acute abdomen, bowel obstruction, and bowel cancer. It provides details on causes, signs and symptoms, diagnostic tests, and treatment for each condition. The acute abdomen can result from many causes including trauma, infection, and inflammation. Bowel obstruction occurs when contents cannot pass through the GI tract and may be mechanical or non-mechanical. Bowel cancer is common and symptoms vary depending on location but can include bleeding, fatigue, and weight loss. Treatment involves surgery and screening is important for early detection.

1. Gastrointestinal Problems The Acute Abdomen Bowel Obstruction Bowel Cancer

2. The Acute Abdomen Acute onset of abdominal pain Many different causes

3. 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

4. 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)

5. 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

6. Bowel Obstruction Occurs when intestinal contents cannot pass through the GI tract Obstruction maybe partial or complete Causes classified as mechanical or non-mechanical

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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

22. 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

23. 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

24. 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