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Gastroenterology > 323 Obstruction > Flashcards

323 Obstruction Flashcards

1
Q

Types of intestinal obstruction

A

mechanical from blockage or functional from intestinal dysmotility

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2
Q

most common causes of intestinal obstruction

A

postoperative adhesions, carcinomatosis, herniation of the abdominal wall

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3
Q

most common origin of carcinomatosis

A

ovary, pancreas, stomach or colon

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4
Q

responsible for majority of easly postoperative obstruction

A

adhesions

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5
Q

Most common causes of acute intestinal obstruction

A

extrinsic, intrinsic diseases and intraluminal abnormalities

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6
Q

Examples of extrinsic disease

A

adhesions, hernias, neoplasms, etc

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7
Q

Examples of intrinsic disease

A

congenital malrotation, atresia, stenosis, duplication, congenital bands; IBD, radiation, TB, traumatic, intussusception, volvulus

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8
Q

Example of luminal abnormalities

A

bezoars, feces, foreign bodies

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9
Q

Operations that are most likely to create adhesions that can cause bowel obstruction

A

Open operations of the lower abdomen such as appendectomy and colorectal and gynecologic procedures

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10
Q

commonly affected part of volvulus

A

sigmoid

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11
Q

True or false. It is rare for adhesions or hernias to obstruct the colon

A

True.

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12
Q

Responsible for most cases of chronic volvulus

A

Cancer of ascending colon and rectum

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13
Q

Other names of functional obstruction

A

ileus and pseudo obstruction

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14
Q

Most common identified form of functional bowel obstruction

A

ileus that occurs after intraabdominal surgery

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15
Q

Relatively rare where patient have chronic dysmotility due to abnormalities of their autonomic nervous system that may be inherited

A

Ogilvies syndrome

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16
Q

Primary contributor to intestinal obstruction

A

swallowed air

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17
Q

How early can epithelial necrosis can be identified in intestinal obstruction

A

Within 12 hours of obstruction

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18
Q

What is the mechanism of dehydration in intestinal obstruction

A

loss of normal intestinal absorptive capacity as well as fluid accumulation in the gastric or intestinal wall and intraperitoneally

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19
Q

What type of obstruction does nausea and vomiting occur

A

high grade distal obstruction

20
Q

How does intestinal obstruction lead to dyspnea and vascular instability

A

Intraperitoneal fluid increase the intraabdominal pressure enough to elevate the diaphragm inhibiting respiration and to impede systemic venous return leading to vascular instability

21
Q

Refers to when the proximal and distal openings of a given bowel segment are both occluded like due to a volvulus or a hernia

A

closed loop obstruction

22
Q

Most common precursor for strangulation

A

closed loop obstruction

23
Q

True or false. All closed loop obstruction leads to strangulation

A

False. Not every one

24
Q

At what diameter is the cecum most likely to perforate

A

Cecal diameter exceed 10-12 cm

25
Q

What type of patient will present with close loop obstruction early and warrant early intervention

A

patient with high grade distal obstruction competent ileocecal valuve and prone to close loop obstructon earlier than those with imcompetent ileocecal valves

26
Q

Cardinal signs of intestinal obstruction

A

colicky abdominal pain, abdominal distention, emesis and obstipation

27
Q

In intestinal obstruction which part will be dilated and which part will be collapse

A

Proximal to the obstruction there is bowel dilatation and the distal part is collapse

28
Q

Differentiate distal from proximal intestinal bowel obstruction

A

distal intestinal bowel obstruction greater distention, more discomfort, delayed feculent emesis when there is bacterial overgrowth; proximal intestinal bowel obstruction present with less abdominal distention but more pronounced vomiting

29
Q

Bowel sounds of early small bowel obstruction

A

high pitched, musical, tinkling bowel sounds

30
Q

Differential bowels sounds of intestinal obstruction versus ileus or pseudo obstruction

A

in intestinal obstruction there is high pitched tinkling bowel sounds in the beginning before becoming absent or hypoactive while in ileus it is hypoactive or absent bowel sounds right at the beginning
in intestinal obstruction there is high pitched tinkling bowel sounds in the beginning before becoming absent or hypoactive while in ileus it is hypoactive or absent bowel sounds right at the beginning

31
Q

Typical presentation of patient with colonic volvulus

A

severe abdominal pain, vomiting, obstipation and asymmetrical abdominal distention and a tympanic mass may be evident

32
Q

classical findings in intestinal obstruction

A

staircasing pattern of dilated air and fluid filled small loops more than 2.5 cm in diameter with little or no air seen in the colon

33
Q

When can small bowel air fluid levels not be obvious on abdominal radiograph of intestinal obstruction

A

air fluid levels may not be obvious if the ileocecal valve is competent

34
Q

What is the sensitivity of CT scan in detecting bowel obstruction

A

About 95%; specificity of 96% and accuracy of more than 95%

35
Q

CT scan imaging of volvulus

A

birds beak or c-loop or whorl deformity on CT scan show where the twisting obstruct the lumen in volvulus

36
Q

Most specific early finding of bowel ischemia

A

altered bowel wall enhancement

37
Q

Late CT scan findings of bowel ischemia

A

mesenteric venous gas, pneumoperitonium and pneumatosis intestinalis

38
Q

True or false. Barium studies are part in the workup of intestinal obstruction for better visibility

A

False. Barium studies are contraindicated esp in patients with firm evidence of complete or high grade obstruction as it may develop into barium concretions causing additional source of blockage

39
Q

May be given to patients with ileus to accelerate gastrointestinal recovery

A

u opioid receptor antagonist such as alvimopan and mehtylnatrexone

40
Q

An acetylcholinesterase inhibitor that increase cholinergic activity and stimulate colonic motility in patient with Ogilvie’s

A

neostigmine

41
Q

True or false. 60-80% of patients with mechanical bowel obstruction can be managed successfully with conservative measures

A

True.

42
Q

Done to decompress the stomach, minimize further distention and improve patient comfort

A

nasogastric tube suction

43
Q

Most common site of intestinal obstruction in patients with gallstone

A

ileum in 60% of patients

44
Q

How early can postoperative mechanical obstruction occurs

A

as early as the first 6 weeks of operation

45
Q

true or false. In postoperative bowel obstruction, the longer it tales for the obstructive symptoms to resolve after hospitalization, the more likely is the patient to require surgical intervention

A

True.

Gastroenterology (13 decks)

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