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1. Clin Med III > 2- Bowel Obstruction > Flashcards

2- Bowel Obstruction Flashcards

1
Q

What is defined as a blockage of the bowel that occurs when normal flow of intraluminal contents is interrupted due to functional or mechanical process?

A

Bowel obstruction

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2
Q

What is considered a partial bowel obstruction?

A

Fluid/air continue to pass

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3
Q

What is considered a complete bowel obstruction?

A

Cessation of passage of stool or flatus

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4
Q

What are the 3 major causes of a bowel obstruction?

A
  • Extrinsic/Extra-luminal (external to bowel)
  • Intrinsic (within wall of bowel)
  • Intraluminal (defect that prevents passage of GI contents)
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5
Q

What effect does a bowel obstruction have on the lumen of proximal and distal to obstruction?

A

Proximal: bowel dilation and retention of fluid
Distal: Bowel compression

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6
Q

What two things contribute to distention sx during a bowel obstruction?

A

Swallowed air and gas fermentation

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7
Q

What is the pathophys of a bowel obstruction?

A

Excessive dilation → poor perfusion → ischemia → necrosis → perforation

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8
Q

Is a small or large bowel obstruction more common?

A

SBO

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9
Q

Adhesions, hernia, and neoplasms are RFs for SBO or LBO?

A

SBO

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10
Q

What is the most common cause of SBO?

A

Adhesions from prior abdominal/pelvic surgery (can develop YEARS after procedure)

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11
Q

Pt presents w/ hx of intermittent periumbilical cramping that is now constant focal abd pain, worse after food and w/ distention and obstipation. What are you concerned about?

A

SBO

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12
Q

SX of shock, laying flat/motionless and + peritoneal signs are RF for what?

A

SBO

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13
Q

If on auscultation you hear high pitched tinkling in pt w/ suspected SBO. Is this an early or late stage finding?

A

Early

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14
Q

If on auscultation you hear hypoactive/absent bowel sounds in pt w/ suspected SBO. Is this an early or late stage finding?

A

Late

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15
Q

What should be included on PE for pt w/ suspected SBO?

A

DRE

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16
Q

If pt presents w/ hx of vomiting before onset of pain is this more a medical condition or surgical condition?

A

Medical

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17
Q

If pt presents w/ hx of pain followed by onset of vomiting is this more a medical condition or surgical condition?

A

Surgical

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18
Q

An increased H/H on CBC for pt w/ SBO will indicate what?

A

Hemoconcentration, most likely due to dehydration

Elevated BUN/Cr and specific gravity on UA will also indicate dehydration

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19
Q

What is the benefit of ordering a CT for pt w/ suspected SBO?

A

ID location, severity, etiology, and complications

dilated proximal bowel w/ distal collapse, wall thickening > 3 mm, submucosal edema

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20
Q

What imaging will show dilated loops of bowel w/ air fluid levels?

A

Supine and upright Abd XR (respectively)

21
Q

What finding on CXR is consistent w/ perforation?

A

Free air under diaphragm

22
Q

If you have a VERY HIGH suspicion of SBO what is your next step?

A

Consult surgery to have them decide on what imaging they prefer

23
Q

What is the tx for SBO?

A
  1. Admit
  2. Consult surgery or GI
  3. Trial of non-operative management (NPO, IV fluids, bowel decompression w/ NG tube, anti-emetic)
  4. Serial clinical monitoring for 2-5 days (improvement if decreased in distention, passage of stool, decreased NG output
24
Q

What tx for SBO is diagnostic and therapeutic?

A

Gastrograffin

25
What are the indications for surgery in pt w/ SBO?
Complication bowel obstruction (worsening sx, peritonitis) Intestinal strangulation Worsening sx or unresolved sx w/ NG tube & bowel rest
26
Pt presents with significant pain w/ light palpation/ bumps, appears ill and lies completely still. What are you concerned about?
Peritonitis
27
A strangulated hernia, volvulus and intussusception can all cause what?
Intestinal strangulation
28
What is the vicious cycle associated w/ adhesions?
Surgery causes adhesions, adhesions cause obstructions, adhesion removal causes more adhesions
29
What is obstipation?
Inability to pass flatus or stool (bad sign)
30
What is defined as hypomotility of the GI tract in the absence of mechanical bowel obstruction?
Ileus
31
An ileus will often occur secondary to what?
Postoperative abdominal surgery (can be self limited or no return of bowel function)
32
Opioids, antispasmodics and anticholinergic are what type of agents? What can they cause?
Hypomotility agents | Can cause ileus
33
3way ABD XR will should what for pt w/ ileus?
Dilated loops of bowel Air is present in both small and large bowel NO air fluid levels
34
What is the tx for ileus?
Supportive care w/ IV fluids, lyte replacements, pain mgt (avoid narcotics, use NSAIDs), bowel rest, bowel decompression w/ NG tube
35
What is the most common cause of a LBO?
Adenocarcinoma (commonly of colon and rectum) - Also: stricture, volvulus, IBD, fecal impaction, FB
36
The following questions are part of the hx for SBO or LBO? Have LLQ pain w/ diarrhea? Chronic opioid use or chronic constipation?
LBO
37
What will XR show for pt w/ complete colonic obstruction?
Absence of air distally in the rectum or sigmoid
38
What is the tx for partial LBO?
Trial of conservative therapy (surgery consult, NPO. IV fluids, decompression)
39
What is the tx for complete LBO?
Resection (if CA, stricture, cecal volvulus), pneumatic reduction (instussusception), enema (fecal impaction)
40
What is defined as abn twisting of a portion of the GI traction which can impair blood flow?
Volvulus
41
What are the 2 types of volvulus?
Sigmoid (more common), cecal
42
Age, chronic constipation, redundant sigmoid colon, colonic dysmotility and hypomotility agents are RF for what?
Sigmoid volvulus
43
What is the managements for sigmoid volvulus?
Flex sig to decompress and de-rotate, surgery to resect and prevent recurrence
44
What is the average age for sigmoid volvulus?
70 y/o
45
What is the avg age for cecal volvulus?
33-53 yrs
46
What is the tx for ceal volvulus?
Surgery Also: volume resuscitation, lyte replacement, NPO
47
What will an upright ABD XR show for cecal volvulus?
Dilated cecum typically displaced medially and superiorly
48
What imaging is dx for cecal volvulus?
CT
49
What imagaing study is diagnostic and therapeutic for w/ sigmoid volvulus?
Contrast enema

1. Clin Med III (29 decks)

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