3-Intestinal Obstruction Flashcards
Why cant the intralumenal tumor cant pass to the extralumenal area?
Bcz the colon still has living cells, unless it is ischemic and the cells die
Strangulated obstructions
Disruption of the blood circulation
Closed loop obstruction
Volvulus
simple obstruction
Presence of obstacle in the transmission of the contents of the intestine *without a problem in blood circulation
Which one is not an extraluminal mechanical obstruction ?
What are examples of extraluminal mechanical obstruction?
Adhesion
Hernia
Neoplastic tm
Small bowel and colon volvulus
Superior mesenteric artery syndrome
Hernia?
Defect in the fascia allow for the intestines to pass
What is superior mesenteric artery syndrome
Duodenum gets squeezed by two arteries
How does tubular organs heal?
With contractions
What are the transmural(between wall) mechanical obstruction examples
[CO.S.T.I.]
congenital(stenosis, Meckel’s diverticulum)
traumatic
inflammatory
strictures(restriction)
What are the intraluminal mechanical obstruction examples?
Meconium ileus
Invagination
Gallstone ileus (rare)
Feces
Bezoar
Flocculated parasites
What is the most imp physical exam for mechanical obstruction?
Mainly Ask about if they fart not if they poop(it may be diarrhea):p
during Early period ‘stage’ bowel obstruction, what do you hear on auscultation
Metalic sounds
Late period bowel sounds
No sounds
***Which is the electrolyte that is most lost during vomiting?
HCl
And later loss of potassium bcz the kidney holds on the H+ and secretes away potassium; hypochloremia+ hypokalemia+ metabolic alkalosis
Colonic obstruction causes perforation in the ……
Cecum
Proximal dilation of colon
Causes distention
Ileocecal part u wont see any
Diarrhea…?
When do u see coffee bean sign under radiograph?
In volvulus
Treatment for colonic obstruction
-For dehydration: isotonic or ringer lactate iv
-After checking for urine output,Potassium must be given
-Nasogastric tube insertion
-Broad spectrum antibiotics
In which type of intestinal obstruction do u see ischemia
In strangulated obstruction of the colon
Unless it is adhesion obstruction, you always need ….. as treatment
Emergent surgery such as in :S.C.C.S
-strangulated obstruction
-closed loop obstruction
-colonic obstruction
-simple mechanical obstruction
Does adhesions of the intestines reoccur
Yes it may occur again,
No colic style abdominal pain and bowel sounds are reduced in which are of the GIS obstruction?
Ileus obstruction
Hypothyroidism, spinal cord injury,electrolyte disorders,pancreatitis,Surgical stress, retroperitoneal hematoma, may be a cause of obstruction in …..
Ileus
Which one is revesible obstruction
Ileus
Which one is irrevesible obstruction
Intestinal psodoobstruction
when do you hear metallic sounds on auscultation
during early stage of bowel obstruction
when does dehydration due to vomiting, hypochloremia, hypokalemia, and metabolic alkalosis are seen?
proximal obstruction
symptoms of intestinal obstruction
abdominal pain colic style
nausea vomiting
distension
gas-fecal inability to pass
what is the tx for adhesion?
NG tube conservative tx can be extended up to 24-48 hrs
what is the benefit of NG tube?
reduce risk of aspiration
reduces tension(to improve blood circulation)
in obstruction due to adhesion
what are the non mechanical intestinal obstruction reasons?
ileus
pseudo obstruction
is ileus treatable?
yes; by giving NG if vomiting or distension
and fluid-electrolyte therapy and TPN
which type of intestinal pseudoobstruction occurs in intestinal smooth muscle, myenteric plexus, extraintestinal nervous system?
intestinal pseudo-obstruction
definitive dx of intestinal pseudo-obstruction?
laparotomy and full thickness biopsy of intestine
which layer of the intestine is affected in the intestinal pseudo-obstruction
muscularis propria; myenteric and miessner plexus
