6. Diseases of the Small Intestines - Sarm

• mechanical obstruction of the lumen - extrinsic factor

  • adhesion
  • hernias
• simple obstruction - is at one point only
• closed loop obstruction - presents at 2 points of the intestines
• strangulation of the bowel segment will cause vessel compression
• Clinical manifestation of SBO

  • acidosis
  • hemoconcentration
  • electrolyte imbalance
• Diagnosis for SBO

  • X- ray - plain abdominal upright and supine
  • chest - upright
• SBO - most common is adhesion

  • ask pts if they had surgery
• triad finding indicative of SBO

  • air fluid levels
  • dilated bowel segment - > 3 cm
  • paucity of colonic gas
• SBO - there is increase hematocrit due to dehydration
• Distension for large bowel is > 6 cm
• SBO due to post-operative adhesion treatment?

  conservative - can resolve spontaneously
• Most common type of hernia for both female and male?

  indirect
• intussusception - when one portion of the intestinal tract invaginates into the immediate adjacent segment (telescoping)
• ** intussusception - "lead point" can be present or usual suspect
• intussusception is proximal to distal
• ** Intussusception - most common area

  • pediatric - ileocecal
  • adult - colocolic
• Intussusception diagnosis

  • x-ray of abdomen
  • upright
  • supine
• Treatment of Intussusception

  • enema
• Intussusception clinical manifestation

  • ** currant jelly stool
  • Dance's sign
  • palpable mass at left upper quadrant
  • empty right lower quadrant
• SBO caused by gallstone impacted at the ileo-cecal valve
• CT scan of the abdomen is the best diagnostic tool to differentiate ileus from mechanical obstruction
• Early post-operative mechanical bowel obstruction is?

  adhesion
• Crohn disease is a type of Inflammatory Bowel Disease
• Crohn's disease symptoms - joint pain