1 / 27

Bowel Obstruction and Hernias - SLIME teaching 2013

Bowel Obstruction and Hernias - SLIME teaching 2013. Richard Marks – FY1 Orthopaedics @ Warwick. Aims. Hernias What are they? Anatomy Presentation Complications Bowel Obstruction Types Complications Investigation Management. So what is a hernia???.

zonta
Télécharger la présentation

Bowel Obstruction and Hernias - SLIME teaching 2013

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Bowel Obstruction and Hernias- SLIME teaching 2013 Richard Marks – FY1 Orthopaedics @ Warwick

  2. Aims • Hernias • What are they? • Anatomy • Presentation • Complications • Bowel Obstruction • Types • Complications • Investigation • Management

  3. So what is a hernia??? • “A hernia is the protrusion of a viscus or part of a viscus outside the cavity which normally contains it” ?

  4. What are the types?

  5. Case 1 • A 54 year old builder attends your GP clinic with a testicular mass. Its painful, mildly tender to palpation. • Differentials? • What if he’s vomiting?

  6. The inguinal canal • Split it into the four “walls” • - Anterior • - Posterior • - Roof • - Floor • Where are the deep &superficial rings?

  7. Femoral a. Anatomy...yay... Deep/internal ring

  8. The Femoral Canal • Anteriorly: inguinal lig. • Medial: lacunarlig. • Lateral: Femoral vein + illopsoas • Posterior: pectineallig. + pectineus

  9. Inguinal or Femoral? The key to remember is: • Femoral = inferior and lateral to the pubic tubercle • Inguinal = Superior and medical to the tubercle

  10. Direct or Indirect Inguinal Hernia? • Almost pointless clinically to distinguish... But loved by finals examiners • How would you do this? • What is the “gold standard” way of finding this out?

  11. Why bother repairing them? • Complications are serious, and include... • Bowel Obstruction • Incarcerate • Strangulation • Necrosis • Peritonitis • Death! • But... would you rush to repair a 95 year old man's painless, reducible inguinal hernia?

  12. So how to investigate?

  13. Management • Conservative... • Medical... Inguinal? Strangulated? • Surgical...

  14. Bowel Obstruction

  15. Causes • Intra-luminal: • Faecal impaction • Gallstone ileus • Intramural • Cancers • Strictures – IBD, diverticulitis • Extraluminal • Adhesions • Hernias • Volvulus • Foreign body... • TB (developing world)

  16. What to do? • “Drip and suck” – why? • NBM • Analgesia (IV) • Bloods: FBC, U&E, CRP, amylase • AXR • Erect CXR • Catheterise • “Gastrografin” • ?CT • ???Colonoscopy • Seniors ASAP - theatre

  17. Small or Large bowel obstruction?

  18. Small or Large?

  19. Small versus Large?

  20. “Pseudo-obstruction” • ... So don’t worry too much about it!

  21. Clinical Finals... • Clinical scenario: • A 72 year old man presents with a painful swelling in his right groin. He explains that he has ‘had a lump’ there for years and it’s never given him any trouble before. On examination he has a 4cm tender mass which is not reducible. The skin overlying is dusky coloured. It is located laterally and superior to the pubic tubercle

  22. On the spot... • What type of hernia is this likely to be, and why? • How would you investigate this man? • What is the initial management in the acute setting? • And the long term management?

  23. More questions... 5) What are the borders of the inguinal canal? • Floor? • Anterior? • Roof? • Posterior? 6) Risk factors for hernias? 7) Remind me again... What is a hernia? 8) What are the main complications of hernias?

  24. Please explain... • Please take a few minutes to explain to Mr Hunt that he needs a CT scan...

  25. Almost there... • As there’s no orthopaedic session by SLIME, make sure you at least skim the basics on #NOF’s... ... And don’t suggest exercise tolerance test as a pre-op investigation in a hip fracture like a few 2009 cohort guys did...

  26. Finally... Good luck!! • (They let me pass, so you’ll be absolutely fine!) • http://radiologymasterclass.co.uk

More Related