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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
Q

What are the indications for surgery in pt w/ SBO?

A

Complication bowel obstruction (worsening sx, peritonitis)
Intestinal strangulation
Worsening sx or unresolved sx w/ NG tube & bowel rest

26
Q

Pt presents with significant pain w/ light palpation/ bumps, appears ill and lies completely still. What are you concerned about?

A

Peritonitis

27
Q

A strangulated hernia, volvulus and intussusception can all cause what?

A

Intestinal strangulation

28
Q

What is the vicious cycle associated w/ adhesions?

A

Surgery causes adhesions, adhesions cause obstructions, adhesion removal causes more adhesions

29
Q

What is obstipation?

A

Inability to pass flatus or stool (bad sign)

30
Q

What is defined as hypomotility of the GI tract in the absence of mechanical bowel obstruction?

A

Ileus

31
Q

An ileus will often occur secondary to what?

A

Postoperative abdominal surgery (can be self limited or no return of bowel function)

32
Q

Opioids, antispasmodics and anticholinergic are what type of agents? What can they cause?

A

Hypomotility agents

Can cause ileus

33
Q

3way ABD XR will should what for pt w/ ileus?

A

Dilated loops of bowel
Air is present in both small and large bowel
NO air fluid levels

34
Q

What is the tx for ileus?

A

Supportive care w/ IV fluids, lyte replacements, pain mgt (avoid narcotics, use NSAIDs), bowel rest, bowel decompression w/ NG tube

35
Q

What is the most common cause of a LBO?

A

Adenocarcinoma (commonly of colon and rectum)

  • Also: stricture, volvulus, IBD, fecal impaction, FB
36
Q

The following questions are part of the hx for SBO or LBO?

Have LLQ pain w/ diarrhea?
Chronic opioid use or chronic constipation?

A

LBO

37
Q

What will XR show for pt w/ complete colonic obstruction?

A

Absence of air distally in the rectum or sigmoid

38
Q

What is the tx for partial LBO?

A

Trial of conservative therapy (surgery consult, NPO. IV fluids, decompression)

39
Q

What is the tx for complete LBO?

A

Resection (if CA, stricture, cecal volvulus), pneumatic reduction (instussusception), enema (fecal impaction)

40
Q

What is defined as abn twisting of a portion of the GI traction which can impair blood flow?

A

Volvulus

41
Q

What are the 2 types of volvulus?

A

Sigmoid (more common), cecal

42
Q

Age, chronic constipation, redundant sigmoid colon, colonic dysmotility and hypomotility agents are RF for what?

A

Sigmoid volvulus

43
Q

What is the managements for sigmoid volvulus?

A

Flex sig to decompress and de-rotate, surgery to resect and prevent recurrence

44
Q

What is the average age for sigmoid volvulus?

A

70 y/o

45
Q

What is the avg age for cecal volvulus?

A

33-53 yrs

46
Q

What is the tx for ceal volvulus?

A

Surgery

Also: volume resuscitation, lyte replacement, NPO

47
Q

What will an upright ABD XR show for cecal volvulus?

A

Dilated cecum typically displaced medially and superiorly

48
Q

What imaging is dx for cecal volvulus?

A

CT

49
Q

What imagaing study is diagnostic and therapeutic for w/ sigmoid volvulus?

A

Contrast enema

1. Clin Med III (29 decks)

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