What are the four types of intestinal obstruction?  Hernias  Adhesions  Volvulus  Intussusception

What are the most common causes of intestinal obstruction?  Post-operative adhesions and hernias What happens both proximal and distal to the obstruction?  Proximal: dilation  Distal: decompression

What are the tumours which can arise in the small intestine?  Benign: adenoma; connective tissue tumours (eg. GIST); angiomas; lipomas  Malignant: adenocarcinomas; carcinoid tumours; lymphoma; GIST

Describe the pathophysiology of colorectal cancer

Describe the staging and prognosis of colorectal cancer  A: limited to mucosa  5 year survival >85%  B: through m. propria  5 year survival 70-80%  C: LN metastases  5 year survival 40-60%  D: distant mets/irresectable local disease  5 year survival < 5%

Name some options for screening of colorectal cancer  FOBT  but ALL positives must be followed up with colonoscopy  Flexible sigmoidoscopy  more acceptable than colonoscopy, but detects 50-55% of cancers  Colonoscopy  but acceptability and resource issues

Define primary, secondary and tertiary peritonitis. Give an example of each  Primary = haematogenous dissemination in the setting of an immunocompromised state  eg. translocation of bacteria; cirrhosis  Secondary = pathological process in a visceral organ  eg. perforation, trauma  Tertiary = persistent/recurrent infection after adequate initial therapy  eg. immunocompromised patients

What four factors affect the likelihood of developing peritonitis?  Fibrinolysis alterations  Bacterial load  Bacterial virulence  Abscess formation

What factors must be considered in peritonitis treatment?  Control of the infectious source  Elimination of the bacteria and toxins  Maintenance of organ function  Control of inflammation

What three pathologies can lead to abdominal pain?  Inflammation  constant pain, worsens with local/general disturbance, still patient  Obstruction  ‘colicky’, wriggling patient  Perforation  more sudden increase in intensity to maximal

List some pre-operative and post-operative considerations

What symptoms can you get with hypokalemia?  Weakness, hypotonicity, depression, constipation, ileus, ventilatory failure, ventricular tachycardia, atrial tachycardia, coma

Name some causes and possible treatments for hypercalcemia  Causes: hyperparathyroidism; thyrotoxicosis; thiazide diuretics; immobilisation  Treatments: iv saline; bisphosphonates

Where is the majority of fluid reabsorbed within the GIT?  Small intestine – absorbs ~8.3L/day What is absorbed from/secreted into the SI?  Absorbed: K+, Na+, H2O, Cl-  Secreted: H2O, Cl-, HCO3-  Both water and Cl- are absorbed > secreted

A patient presents with abdominal pain  Colicky abdominal pain  Has nausea and vomiting  Constipated, no flatus  Underwent an appendicectomy a few years ago 1. What questions would you ask the patient?

What would you be looking for on examination?  General: obvious pain, dehydrated  BP and PR normal  Abdomen: mildly distended, soft, tenderness in right iliac fossa, no guarding/rigidity, no masses palpable

What investigation would you perform? Report this x-ray

Diagnosis is intestinal obstruction secondary to adhesion. Describe the pathophysiology of this diagnosis. What treatment/management would you consider?