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Year 3 Lower GI Surgery > Bowel obstruction > Flashcards

Bowel obstruction Flashcards

1
Q

Small Bowel Tumour presentation

A

Often non-specific symptoms so present late

  • N/V - obstruction
  • Wt. loss and abdominal pain
  • rectal bleeding
  • Jaundice from biliary obstruction or liver mets
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2
Q

Investigations of small bowel CA

A 
Imaging
• AXR: SBO
• CT
Endoscopy
• Push enteroscopy
• Wireless capsule endoscopy
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3
Q

Classification of bowel obstruction

A
  • Simple
  • Closed Loop
  • Strangulated
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4
Q

Simple bowel obstruction

A
  • 1 obstructing point + no vascular compromise

- May be partial or complete

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5
Q

Closed loop bowel obstruction

A
  • Bowel obstructed at two points
  • Left CRC with competent ileocaecal valve
  • Volvulus
  • Gross distension can cause perforation
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6
Q

Strangulated bowel obstruction

A
  • Compromised blood supply
  • Localised, constant pain + peritonism
  • Fever + ↑WCC
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7
Q

Causes of bowel obstruction

A

SBO
• Adhesions
• Hernia

LBO
• Colorectal Neoplasia:
• Diverticular stricture
• Volvulus

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8
Q

Presentation of bowel obstruction

A

• Abdominal Pain

  • Colicky
  • Central but level depends on gut region
  • Constant / localised pain suggests strangulation or impending perforation

• Distension
- lower obstructions

• Vomiting

  • Early in high obstruction
  • Late or absent in low obstructions

• Absolute Constipation: flatus and faeces

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9
Q

Examination for bowel obstruction

A 
Examination:
• ↑HR: hypovolaemia, strangulation
• Dehydration, hypovolaemia
• Fever: inflammatory disease or strangulation
• Surgical scars
• Hernias
• Mass: neoplastic or inflammatory
• Bowel sounds
- ↑: mechanical obstruction
- ↓: ileus

• PR

  • Empty rectum
  • Rectal mass
  • Hard impacted stool
  • Blood from higher pathology
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10
Q

Investigations for bowel obstruction

A

• Bloods

  • FBC: ↑WCC
  • U+E: dehydration, electrolyte abnormalities
  • Amylase: ↑↑ if strangulation/perforation
  • VBG: ↑ lactate in strangulation
  • G+S, clotting: may need surgery
• Imaging
- Erect CXR
- AXR: ± erect film for fluid levels
-  CT: can show transition point
• Follow through or enema
• Colonoscopy
- Can be used in some cases but risk of perforation
- May be used therapeutically to stent
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11
Q

Small bowel obstruction of AXR

A

Dilated > 3 cm
Central
Valvulae coniventes
Many loops

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12
Q

Large bowel obstruction on AXR

A 
Dilated > 6cm 
(caecum > 9cm) 
Peripheral 
Haustra 
Few loops
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13
Q

General bowel obstruction management

A

Resuscitate: “Drip and Suck”

Therapy:
• Analgesia: may require strong opioid
• Antibiotics: cef+met if strangulation or perforation
• Gastrograffin study (contrast)
• Consider need for parenteral nutrition
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14
Q

Drip and suck

A

• NBM
• IV fluids: aggressive as pt. may be v. dehydrated
• NGT: decompress upper GIT, stops vomiting,
prevents aspiration
• Catheterise: monitor UO

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15
Q

Indications for surgery

A
  • Closed loop obstruction
  • Obstructing neoplasm
  • Strangulation/perforation → sepsis, peritonitis
  • Failure of conservative Mx (up to 72h)
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16
Q

Monitoring of bowel obstruction

A

• Regular clinical examination

  • ↑ distension
  • ↑ pain or tenderness
  • ↑ HR/ ↑RR
  • Repeat imaging and bloods
  • Pts. with LBO are more likely to need surgery
17
Q

Surgical procedures

A

Consent pt. for possible resection ± stoma

  • SBO: adhesiolysis
  • LBO
  • Hartmann’s
  • Colectomy + 1O anastomosis + on table lavage
  • Palliative bypass procedure
  • Transverse loop colostomy or loop ileostomy
  • Caecostomy
18
Q

Triad of gastro-oesophageal obstruction

A
  • Vomiting → retching with regurgitation of saliva
  • Pain
  • Failed attempts to pass an NGT
19
Q

Paralytic ileus presentation

A

Adynamic bowel secondary to the absence of normal peristalsis

  • Usually SBO
  • Reduced or absent bowel sounds
  • Mild abdominal pain: not colicky
20
Q

Causes of paralytic ileus

A
  • Post-op
  • Peritonitis
  • Pancreatitis
  • Drugs: antimuscarinics (e.g. TCAs)
  • Pseudo-obstruction
  • Mesenteric ischaemia
21
Q

How to prevent paralytic ileus

A
  • ↓ bowel handling
  • Laparoscopic approach
  • Peritoneal lavage after peritonitis
22
Q

Management of paralytic ileus

A
  • Conservative “drip and suck” Mx
  • Correct any underlying causes
  • Consider need for parenteral nutrition
  • Exclude mechanical cause if protracted

Year 3 Lower GI Surgery (10 decks)

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