Bowel Obstruction Flashcards
What are the three types of bowel obstruction?
Small bowel, large bowel, psuedo-obstruction
Which type of obstruction is most common?
Small bowel
What can cause small bowel obstruction?
Adhesions, hernias, malignancy, Crohn’s disease
What happens during a small bowel obstruction?
Distension above blockage, build-up, increased pressure pushes on blood vessels, ischaemia and necrosis, eventually perforation
How does small bowel obstruction present?
Pain that’s initially colicky but then diffuse and higher than in LBO, vomiting following pain that’s earlier than in LBO, less abdominal distension than LBO, increased bowel sounds
What does tenderness suggest in SBO?
Strangulation/risk of perforation
What is the first line investigation?
Abdominal X-ray
What is the gold standard investigation?
Non-contrast CT
What will an X-ray show?
Central gas shadows that completely cross the lumen, no gas in large bowel, distended loops,
How do you manage BO?
Aggressive fluid resuscitation, decompression of the bowel, analgesia and anti-emetics, antibiotics, surgery
What can cause LBO?
Malignancy, volvulus, diverticulitis, Crohn’s disease, intussusception
What is volvulus?
Rotation or twisting of the bowel on its mesenteric axis, most common at sigmoid colon
What is intussusception?
Where the bowel roles inside of itself
How does LBO present?
More constant and diffuse pain than SBO, more abdominal distension than SBO, bowel sounds normal –> increased –> none, palpable mass, vomiting later or absent, constipation earlier then SBO
What would you find on a DRE in LBO?
Empty rectum, hard and compacted stools, might be blood
