Abdominal Obstructive Issues Flashcards
LBO are caused by?
mechanical of functional obstruction of large bowel
interruption of normal function
LBO Etiology
60% are d/t what?
Other causes?
malignancy
diverticular dz
colonic volvulus
endometriosis
LBO Prevention/Screening inlcudes?
colonoscopy per guidelines
High-fiber diet
low-fat diet
endometriosis management
Colonic Volvulus:
usually involves what?
may involve what?
who is @ greatest risk?
Risk factors that may contribute?
sigmoid colon
cecum & transverse colon
elderly
constipation, laxative use, psychotropic meds
Colonic Volvulus Etiology
twisting of colon on its mesentery
Colonic Volvulus Clinical Manifestations
acute abdominal distention
chronic constipation
colicky, crampy pain possibly in either lateral aspect of abdomen
Pain aggravated by food, relieved with narcs, NGT decompression
anorexia, N/V
Increased bowel sounds
Colonic Volvulus Differential Dx includes?
constipation
diverticular dz
SBO
Cancer
Colonic Volvulus can be diagnosed by?
abdominal radiographs: dilated colon, may lack haustral folds
Upright CXR to assess for perforation
CT Scan
Labs to obtain when suspicion of colonic volvulus is present?
CBC
Lactate
BMP
Coags
T&C
Colonic Volvulus Management includes?
fluid resuscitation
emergency laparotomy if signs of peritonitis or ischemia
Sigmoidoscopy may be performed if sigmoid volvulus suspected & absence of complete obstruction
Colonic Volvulus Complications include?
Bowel necrosis
Acidosis
Perforation
Death
Olgilvie Syndrome
Has S&S of what? AKA what?
obstruction, but no actual obstruction
Pseudo-obstruction
Olgilvie Syndrome may be d/t what?
What promotes gut motility?
What stim results in decreased motility?
may be an interruption in what that feed the L colon & rectum?
What is usually the site of largest dilation?
Generally a dz of who?
autonomic innervation
PNS
SNS
sacral parasympathetic nerves (S2-S5)
cecum
elderly
Olgilvie Syndrome Etiology can be from?
Recent surgery
severe pulm dz
severe electrolyte disturbances (hyponatremia, kalemia, calcemia, magnesium/hypercalcemia)
Severe CV dz
Severe constipation
Malignancy
systemic infection
meds (narcs, anticholinergics, clonidine, steroids)
Olgilvie Syndrome Clinical Manifestations
Abdominal Pain (80%)
N/V (80%)
Obstipation (40%)
Fever (37%)
abdominal distention (90-100%)
abdominal tenderness (64%)
Bowel sounds: Normal or hyperactive (40%)
Hypoactive, high pitched, or absent (60%)
Differentials for Olgilvie Syndrome include?
acute/chronic mesenteric ischemia
cancer
obstruction
constipation
diverticulitis
intestinal perforation
megacolon (acute, chronic, toxic)
Pseudomembranous colitis
Olgilvie Syndrome labst to draw include?
CBC (leukocytosis may indicate perforation)
Electrolytes
LFTs
Olgilvie Syndrome Imaging includes?
plain/upright abdominal films that will show:
dilated colon from cecum to splenic flexure
Haustral markings normal
repeat films necessary to follow progression/response to tx
dilation > 10cm increases risk of perforation
Olgilvie Syndrome Management includes?
R/O mechanical obstruction, ischemia, perforation
tx underlying problems
hydrate
NGT/rectal tube for decrompression
DC predisposing meds
Olgilvie Syndrome Colonoscopy used for what?
Success rate?
Watch out for what?
Decompression (can use decompression tube
70-85%
perforation
Olgilvie Syndrome Surgical intervention may be needed for who?
What surgical intervention done via what approaches?
What should be done if perforation is present?
small # of patients
tube cecostomy via open approach vs perc
colectomy
SBO:
Most common cause?
Proximal distention of bowel d/t what?
Fluid accumulation & increased peristalsis above and below resulting in what?
adhesions
accumulation of GI secretions & air
freq loose stools, flatus early on
SBO Etiology includes?
prior surgery
malignancy
hernia
constipation
increased risk in those with inta-abdominal infections, ischemia, foreign bodies
will develop in ~5-10% of those undergoing laparotomy
can occur in early post-op period or several years later
SBO Clinical Manifestations
Crampy abd pain
N/V
Abd distention
no stool or flatus if complete obstruction
dehydration
tinkling bowel sounds
SBO Diagnosis can be done with?
abd radiograph will show:
dilated loops of small bowel, air-fluid levels, decreased air distal to obstruction (absent gas in distal bowel if complete obstruction)
CT
SBO labs to obtain
CBC
amylase
BMP
SBO Management includes?
fluid resuscitation
urgent laparotomy
NGT for decompression
non-op management if partial obstruction
NPO
NGT (20-30% of pts can be managed medically)
Ileus is d/t what?
there is no what?
Involves what structures?
hypomotility of GI tract
mechanical obstruction
both small & large bowel
Ileus Etiology
post-op (most common - occurs in ~50% of pt who undergo major abd surgery)
sepsis
trauma
pneumonia
metabolic (hypokalemia, magnesium, sodium)
Meds (opiates)
Ileus Clinical Manifestations
vague abd pain
distention
+/- N/V, tenderness, flatus or stool
tympanic upon percussion
absent or decreased bowel sounds
Differential Dx of Ileus includes?
Olgilvie syndrome
Mechanical obstruction
Ileus Diagnosis can be done with?
plain abd radiograph: gaseous distention of small & large bowel
Ileus labs to get include?
CBC
BMP
Ileus Management includes?
time
supportive care
hydration
+/- NGT
correction of electrolytes
minimize narcs
gum chewing
Meds to use with Ileus
what meds have no proven benefit?
what may have some benefit?
what blocks inhibitory reflexes, reduces amt of narc needed?
Peripherally selective opioid antagonists include what meds? have what effect? has no effect on what due to what?
reglan; erythromycin
dulcolax
thoracic epidural
entereg & relistor; inhibit peripheral mu-opioid receptors; do not cross blood-brain barrier, so no effect on analgesia
