**ACC (Y4)** Abdominal: Small and Large bowel obstruction

Question 1

what can cause a bowel obstruction?

Answer 1

• adhesion
• tumour
• intussusception
• hernia
• Volvulus

Question 2

what is a bowel obstruction?

Answer 2

a blockage that keeps food or liquid from passing through your intestine

Question 3

what is meant by intussusception?

Answer 3

part of the bowel invaginates itself

Question 4

what is meant by volvulus?

Answer 4

twisting of the bowel

Question 5

how does a bowel obstruction result in bowel distention?

Answer 5

When there is a blockage, food builds up and is broken down by bacteria in the GI tract, this produces gas which causes bowel distention.

NB: The distention causes venous compression resulting in decreased oxygenation. This causes ischaemia and bowel cells die.

Question 6

what are the some causes of intestinal obstruction?

Answer 6

most common:

• intestinal adhesions
• colon cancer

other:

• hernia
• IBD
• diverticulitis
• twisting of colon (volvulus)
• impacted faeces
• foreign body

Question 7

what are risk factors of an intestinal obstruction?

Answer 7

• abdo/pelvic surgery
• IBD
• Cancer
• Hernia
• Diverticular disease

Question 8

what are the clinical features of an intestinal obstruction?

Answer 8

• abdo pain
• loss of appetite
• constipation
• vomiting/nausea
• anorexia
• inability to have bowel movement or pass gas
• abdo distention
• fever
• tachycardia

Question 9

with reference to an intestinal obstruction, would the signs of vomiting appear soon or later?

Answer 9

• high up in bowels (sooner)
• distal bowels (later)

NB: The more proximal the obstruction the later the constipation will be.

Question 10

what is a Pseudo-obstruction?

Answer 10

Intestinal pseudo-obstruction is a clinical syndrome caused by severe impairment in the ability of the intestines to push food through. It is characterized by the signs and symptoms of intestinal obstruction without any lesion in the intestinal lumen.

NB: Ogilvie’s syndrome

Question 11

what are the two types of bowel obstruction?

Answer 11

• mechanical: physical obstruction

- pseudo: inability of bowels to push food through but no physical blockage

Question 12

what investigations would you conduct to diagnose a bowel obstruction?

Answer 12

• physical abdo examination
• X-ray, CT or ultrasound
• barium enema

Question 13

how would you treat an intussusception?

Answer 13

A barium or air enema is used both as a diagnostic procedure and a treatment for children with intussusception. If an enema works, further treatment is usually not necessary.

Question 14

how would you treat a partial bowel obstruction?

Answer 14

• special low-fiber diet that is easier for your partially blocked intestine to process.
• If the obstruction does not clear on its own, you may need surgery to relieve the obstruction.

Question 15

how would you treat a complete bowel obstruction?

Answer 15

• Conservative management – make the patient nil by mouth and insert NG tube, IV fluids, urinary catheter, analgesia

• Surgical interventions
o Exploratory laparotomy in patients with an unclear underlying cause
o Adhesiolysis to treat adhesions (either by laparoscopy/open laparotomy)
o Repair of hernia
Emergency resection of the tumour
o Stent in bowel to keep it open
o Gastrostomy tube,

Question 16

what is a barium enema?

Answer 16

A series of x-rays of the lower gastrointestinal tract. A liquid that contains barium (a silver-white metallic compound) is put into the rectum. The barium coats the lower gastrointestinal tract and x-rays are taken. This procedure is also called a lower GI series. This test may show what part of the intestine is blocked.

Question 17

what is a gastrostomy tube?

Answer 17

A tube inserted through the wall of the abdomen directly into the stomach. The gastrostomy tube can relieve fluid and air build-up in the stomach and allow medications and liquids to be given directly into the stomach by pouring them down the tube. A drainage bag with a valve may also be attached to the gastrostomy tube. When the valve is open, the patient may be able to eat or drink by mouth and the food drains directly into the bag. This gives the patient the experience of tasting the food and keeping the mouth moist. Solid food is avoided because it may block the tubing to the drainage bag.

Question 18

what are the complications if a intestinal blockage is left untreated?

Answer 18

• tissue death (can lead to perforation, which can lead to infection)
• Infection (peritonitis).