SU28.14 | Disorders of Small Intestine and Large Intestine — Summary & Reflection

KEY TAKEAWAYS

The intestine fails in recognisable patterns. Intestinal obstruction presents with colicky pain, vomiting, distension and absolute constipation: SBO (early vomiting; adhesions then hernia; central valvulae on AXR) versus LBO (marked distension; cancer then volvulus; peripheral haustra). The surgical emergencies are strangulation (constant pain, tenderness, tachycardia), volvulus (sigmoid, coffee-bean sign) and closed loop (caecal perforation risk by Laplace). Intussusception (infants, red-currant-jelly stool, target sign) is reduced by air enema. IBD divides into Crohn's (transmural, skip lesions, mouth-to-anus, granulomas, fistulae/strictures) and ulcerative colitis (mucosal, continuous, rectum-up, toxic megacolon, colectomy curative). Colorectal cancer arises via the adenoma–carcinoma sequence — right-sided = anaemia/mass, left-sided = obstruction/altered habit/bleeding — diagnosed by colonoscopy + biopsy, CEA for follow-up, staged by CT (± MRI rectum), treated by oncological resection. Manage with resuscitation, drip-and-suck for simple SBO, and urgent surgery whenever the blood supply is threatened; the competency also covers neonatal obstruction and short-gut syndrome.

REFLECT

Recall a patient you have seen with a distended, painful abdomen, or imagine clerking one on the acute take. Did you examine every hernial orifice and do a rectal examination, read the bowel-gas pattern as small-bowel or large-bowel, and actively look for the danger signs of strangulation — constant pain, tenderness, tachycardia? Now think of a patient with altered bowel habit and rectal bleeding: would you have recognised the red flags of colorectal cancer and arranged a colonoscopy rather than reassuring them? Reflect on how the simple discipline of resuscitate–localise–decide simple-versus-strangulating would change the safety and speed of your decisions for the next obstructed patient you meet.