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GIR Test 1 > B5-090 CBCL: Bowel Obstruction > Flashcards

B5-090 CBCL: Bowel Obstruction Flashcards

1
Q

sudden occlusion of the SMA causes loss of what parts of intestines?

3

A

jejunum
ileum
right colon

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2
Q

watershed locations

2

A
  • Griffith’s point: junction of middle and left colic arteries
  • Sudek’s point: junction of hypogastric and left colic a.
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3
Q

what is the significance of watershed points?

A

they have low perfusion, so in hypoperfusion states it becomes critically low and these areas of bowel will become ischemic first, can cause scarring and obstruction

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4
Q

why is the small bowel more susceptible to obstruction?

A

longer
more mobile

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5
Q

can rotate on it’s axis to obstruct

A

colon

cecal or sigmoid volvulus

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6
Q

the blood supply for the anorectum originates from

A

iliac arteries

rectum usually preserved despite blockage of other vessels

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7
Q

is the deep external spinchter under voluntary or involuntary control?

A

voluntary

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8
Q

is the internal spinchter under voluntary or involuntary control?

A

involuntary

normally contracted

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9
Q

most common sites of obstruction from foreign bodies

4

A
  • esophagogastric junction
  • pylorus
  • ileocecal valve
  • rectosigmoid junction

narrowest points

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10
Q

a foreign object that passes through the […] will almost always pass into the stool

which site of obstruction

A

ileocecal valve

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11
Q

physiologic impacts of GI obstruction

6 (general)

A

volume related: AKI, acute renal failure
alteration of blood flow: perforation, sepsis
aspiration: respiratory compromise, sepsis, MOF

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12
Q

what causes hypovolemia in obstructed patients?

2

A
  • inability to ingest sufficient fluid to maintain volume
  • sequestration of fluid within the bowel lumen and wall
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13
Q

a patient with a high obstruction can develop a volume deficit of […] liters within 24 hours

A

4-8 L

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14
Q

a patient with a low obstruction can develop a 10 liter volume deficit in […]

timespan

A

2 days

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15
Q

volume must be corrected prior to […] to prevent cardiac collapse

A

induction of anesthesia

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16
Q

very high obstructions result in the loss of what electrolytes?

A

K, Cl

cause alkalosis

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17
Q

reason for urgency in treating volume/electrolyte imbalances

A

to avoid acute kidney injury

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18
Q

increases the mortality of obstruction 10x

A

perforation

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19
Q

most common cause of performation

A

ischemia causing infarction, bowel disintegrates and leaks

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20
Q

how does bowel ischemia develop in close loop obstructions?

A

venous hypertension -> occlusion -> arterial occlusion

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21
Q

how does ischemia develop in rotational obstructions?

A

physical twisting of venous or arterial supply

more commonly venous

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22
Q

crucial aspects of ischemic pain

3

A
  • constant pain
  • out of proportion to physical findings
  • may develop hours after initial findings

indicates surgical emergency

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23
Q
  • drooling
  • pain on swallowing
  • chest pain
  • no bile in emesis
  • dry heaves
A

esophageal obstruction

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24
Q
  • projectile vomiting
  • epigastric pain
  • non-bilious vomitus
A

gastric obstruction

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25
Q
  • nausea and vomiting
  • intermittent cramping pain
  • relief of pain with vomiting
  • loud borborgmi with pain
A

proximal small bowel obstruction

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26
Q
  • less vomiting
  • distension more likely
A

distal small bowel obstruction

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27
Q
  • distention very common
  • intermittent cramping
  • little or no vomiting
A

colonic obstruction

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28
Q

signs of late mechanical obstruction

2

A
  • silent abdomen
  • development of ischemic pain
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29
Q

what type of obstruction?

  • non-surgical
  • post operative after laparotomy,severe stress states, vertebral fractures
  • hypoactive to silent bowel sounds
  • mild pain to palpation
  • large and small diffuse gas pattern on xray
A

ileus

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30
Q

treatment for ileus

A

supportive: fluids, NG, K+

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31
Q

hypokalemia from GI loss or overuse of diuretics is a common cause of […] in a non-surgical patient

A

ileus

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32
Q

what type of obstruction?

  • seen in elderly, bedridden patients
  • distension in right colon and cecum
A

pseudo-obstruction (Ogilivie’s)

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33
Q

neurogenic causes of obstruction

A

ileus
pseudo-obstruction (Ogilivie’s)
toxic megacolon

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34
Q

treatment of pseudo obstruction (Ogilivie’s)

A
  • pro-cholingeric (prostigmine)
  • if bowel diameter >12 cm may require surgery
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35
Q

what type of obstruction?

  • confined to colon
  • associated with ulcerative colitis, c. diff
  • distension, signs of SIRS are common
A

toxic megacolon

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36
Q

treatment of toxic megacolon

A

emergent total colectomy

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37
Q

causes of congenital obstructions

5

A
  • congenital hernias
  • malrotation
  • hypoplasia/atresia
  • Hirschsprung’s
  • imperforate anus
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38
Q

most common pediatric hernias causing obstruction

A

inguinal
umbilical

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39
Q

signs of strangulation of hernias

2

A
  • erythema
  • extremely painful mass

requires emergent surgery

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40
Q

treatment of hernias without evidence of ischemia

A

manual reduction

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41
Q

what type of obstruction?

  • chronic obstruction of pylorus
  • high GI obstruction with profuse projectile vomiting
  • hypokalemia, hypochloremia, metabolic alkalosis

2- differentiate children v adults

A
  • pyloric stenosis (children)
  • pyloric stricture from peptic ulcer (adults)
42
Q

treatment for pyloric stenosis/stricture

A
  • correct volume deficit
  • correct hypokalemia
  • surgery
43
Q

result of failure in utero for gut to attach properly to retroperitoneum

A

malrotation

44
Q

a whirl sign on CT indicates

A

obstruction of rotational cause

emergency

45
Q

ulcerative colitis can cause obstruction in the

A

colon

46
Q

leading malignant cause of small bowel obstruction

A

lymphoma

47
Q

adenocarcinoma and NET requires resection of […] bearing area

A

lymph node

48
Q

most common malignant cause of colon obstruction

A

adenocarcinoma

sigmoid most common

49
Q

benign causes of colonic obstructions

3

A
  • diverticular disease
  • IBD
  • ischemic stricture
50
Q

in patients with a competent […] distension and ischemia is more likely to occur, more rapidly resulting in perforation

A

ileocecal valve

51
Q

why does gastric outlet obstruction classically result in hypokalemia, hypochloremia, and alkalosis?

A
  • loss of H+ in vomitus
  • kidneys try to compensate by wasting K+ to retain H+
52
Q

what order should these be done to treat gastric outlet obstruction?
* relief of obstruction
* volume replacement
* K+ replacement

A
  1. volume replacement
  2. K+ replacement
  3. relief of obstruction
53
Q

in a young child with intermittent obstructive episodes without vomiting, what diagnosis should you think of primarily?

A

malrotation

54
Q

hallmark of pyloric stenosis

A

vomiting

55
Q

Why does the presence of a compentent ileocecal valve increase risk of perforation?

A

prevents venting of colonic gas

56
Q

by the law of LaPlace, what part of the colon takes the least pressure to expand?

A

the cecum, the widest part

57
Q

junction of SMA and IMA

A

Griffith’s point

58
Q

treatment of choice for pseudo obstructions

A

prostigmine

59
Q

ileus is caused by loss of peristalsis originating in

A

Auerbach’s plexus

60
Q

has a characteristic diffuse gas bowel pattern

A

ileus

61
Q

closed loop obstructions which result in rapid development of ischemia and constant pain

A

volvuli

62
Q

why are elderly people with chronic constipation at higher risk of volvulus?

A

chronic constipation elongates the sigmoid colon over time

63
Q

why is spinal anesthesia better than general anesthesia for rectal foreign body removal?

A

paralyzes internal spinchter

64
Q

the internal spinchter is in a chronic state of […] normally

A

contraction

65
Q

procholinergic agent used to treat pseudo obstructions

A

neostigmine

66
Q

what is the primary concern of midgut volvulus due to malrotation?

A

infarction of the majority of the small bowel

67
Q

electrolyte findings typical of gastric outlet obstruction

3

A

hypochloremic
hypokalemic
metabolic alkalosis

68
Q

peptic ulcer disease is a common cause of what type of obstruction?

A

gastric outlet

69
Q

early satiety, vomiting, electrolyte disturbances

A

gastric outlet obstruction

70
Q

most common places for ischemia to occur due to hypotension

A
  • splenic flexure
  • rectal-sigmoidal junction
71
Q

where the IMA and branches of iliac artery meet

A

recto-sigmoidal junction

72
Q

where middle colic and left colic arteries meet

A

splenic flexure

73
Q

watershed zones

A
  • splenic flexure
  • recto-sigmoidal junction
74
Q

best fluid solution for an issue affecting the small bowel

A

Lactated Ringers

75
Q

which electrolyte is associated with ileus?

A

potassium

may also need magnesisum

76
Q

best next step for bowel perforation and developing sepsis

A

antibiotics

before OR

77
Q

what can mitigate the risk of aspiration prior to the induction of anesthesia?

A

placement of NG tube

78
Q

cutting the vagus nerve would result in what level of bowel obstruction?

A

gastric

79
Q

what vital sign is the most sensitive indicator of adequate volume replacement?

A

pulse rate

80
Q

what is the next best step for a bowel obstruction with no bowel sounds?

A

exploratory laparatomy

bowel is dying and perforation is imminent

81
Q

in a patient with an obstruction and the esophageal level, what is the best protection against aspiration during EGD?

A

ET tube

82
Q

decreased stool passage

A

constipation

83
Q

absence of passage of gas or stool per rectum

A

obstipation

84
Q

caused by failure of the bowel to roate and attach properly during gestation

A

malrotation

associated with midgut volvulus

85
Q

which has a worse prognosis: colon or rectal cancer?

A

rectal

86
Q

what is the last segment of the GI tract to restart normal peristalsis after ileus?

A

colon

87
Q

what is the first segment of the GI tract to restart normal peristalsis after ileus?

A

small bowel

88
Q

vascular obstruction of the 3rd portion of the duodenum can result from compression of which vessel?

A

SMA

89
Q

to correc the alkalosis of gastric outlet obstruction, what electrolyte must be replaced?

A

K+

90
Q

all obstructed patients have some form of

A

hypovolemia

91
Q

a normal 70 kg patient typically injests up to […] liters of fluid a day

A

2

if the question inlcudes an amount lost through NG tube, be sure to add

92
Q

LaPlace’s law

A

wall tension = intraluminal pressure x radius

93
Q

the […] has the largest diameter of the colon and requires the least pressure to distend

A

cecum

94
Q

increased bowel wall pressure first compromises […] flow

venous or arterial

A

venous

95
Q

is venous or arterial pressure first affected by increased bowel wall tension?

A

venous

96
Q

constant pain is

A

ischemic pain

97
Q

leads to necrosis and bowel perforation

A

ischemia

98
Q

leads to volume depletion and renal failure

A

obstruction

99
Q

common point of obstruction in newborns due to hypertrophy

A

pylorus

100
Q

a child, 0-5, with sudden onset of life-threatening small bowel obstruction involving the midgut likely has?

A

malrotation

GIR Test 1 (16 decks)

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