NMS. Casos Clínicos

8 Chapter

Lower Gastrointestinal Disorders Bruce E. Jarrell • Molly Buzdon • Eric D. Strauch

Cutting to the Chase Small Intestinal Disorders

• Many small bowel obstructions are due to adhesions and will resolve with bowel rest, correction of fluid and electrolytes, and time. Surgery is usually indicated if the obstruction fails to resolve or if certain clinical findings are present, such as localized abdominal tenderness, a hernia, fever, markedly elevated white blood cells (WBCs), acidosis, large fluid requirements, or a closed loop obstruction on radiograph. Tumors of the small bowel such as carcinoid tumor can present with obstruction. • Acutely ischemic bowel is a difficult diagnosis and should be suspected when atrial fibrillation, acute myocardial infarction (MI), hypercoagulable state, low- flow states, or an abdominal bruit is present with severe abdominal pain. Inflammatory Bowel Disease

• The common complications of inflammatory bowel disease (IBD) that may lead to surgical intervention include obstruction, bleeding, fistula formation, perforation, toxic megacolon (typically ulcerative colitis), and failure of medical therapy. Disorders of the Colon • Ulcerative colitis poses an increased risk for dysplasia and colonic malignancy in active disease over 10 years. Lower Abdominal Pain • A retrocecal appendix may not exhibit the usual clinical course of right lower quadrant (RLQ) pain. Malignant Disorders of the Colon, Rectum, and Anus • Adjuvant chemotherapy (postoperatively) improves survival in stage III colon cancer. • Rectal cancer has a high risk of local recurrence at the site of resection. SAMPLE

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