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Surgery final (Sabiston) > Bowel Obstruction > Flashcards

Bowel Obstruction Flashcards

1
Q

What are the two types of SBO (small bowel obstruction)?

A

functional

mechanical

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2
Q

Advanced obstruction leads to reduced ___ function ___ bowel dilation in relation to the site of obstruction, ___ of the borders, ___ of fluids to 3rd space. Fluids may also escape to the ___ space.

A 
absorption 
proximal
edema
sequestration
peritoneal
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3
Q

If significant, the obstruction leads to major dilation which in its turn may lead to ___ and __

A

necrosis

perforation

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4
Q

Closed loop obstruction is when the obstruction occurs in 2 places: __ and __. This type has higher chances for __ and __

A

proximal
distal
strangulation
perforation

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5
Q

SBO closed loop happens usually due to either ___ or ___

A

hernia

volvulus

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6
Q

Patients suffering from bowel obstruction suffer from ___ and must be treated with ___. The reason is loss to __ space.

A

hypovolemia
fluids
3rd

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7
Q 
What are the leading 5 etiologies for paralytic ileus?
\_\_ (60%)
\_\_ (20%)
\_\_ (10%)
\_\_ (5%)
\_\_ (5%)
A 
post operational adhesion 
tumors
hernias
Crohn's
abdominal abscess
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8
Q

SBO can be classified into 3 categories:
extra ___
intra ___
intra ___

A

mural
mural
luminal

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9
Q

What are the main reasons for extra mural SBO? (5)

A 
post operational adhesion 
hernias
mesenteric fibrosis (carcinoid)
tumors
intra abdominal abscess
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10
Q

What are the main reasons for intra mural SBO? (5)

A 
inflammatory strictures (Crohn's)
surgical strictures
volvulus
intussusception  
endometriosis
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11
Q

What are the main reasons for intra luminal SBO?

A

bezoar

parasites

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12
Q

What are the signs of SBO? (4)

A
  • hyperperistaltic -> constipation -> obstipation
  • hypovolemia
  • intrabdominal pressure
  • bacterial translocation
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13
Q

SBO patients will suffer from hypovolemia and vomiting, which in turn contribute to metabolic ___ and paradoxical ___

A

alkalosis

aciduria

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14
Q

Which symptoms are commonly seen in SBO patients? (4)

A

periumbilical colic pain
nausea and vomiting
distended abdomen
diarrhea/constipation/obstipation

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15
Q

SBO patients with periumbilical colic pain will

suffer every - minutes

A

4-5

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16
Q

The typical physical examination of patients with SBO will usually include: (4)

A
  • tachycardia
  • fever (strangulation?)
  • surgical scars
  • enlarged hypertympanic sensitive abdomen
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17
Q

In the first stages of SBO we may hear increased peristaltic abdomen, with typical __ like sounds = ___

A

metallic

borborygmic

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18
Q

The signs of strangulation include localized ___, more severe and __ (non colic) pain which do not pass (__ pain), tachycardia __,
and__ in the lab. If perforation occur- ___ signs and __

A 
sensitivity
stable
ischemic
fever
leukocytosis
peritoneal
sepsis
19
Q

The lab check up we should perform when dealing with an SBO patients include dehydration signs (hemo___, increased __/__), vomiting (hypo__ metabolic __ + urine __duria), hyop__.

A 
concertation
BUN/Cr
chloremia
alkalosis
acidosis
kalemia
20
Q

Imaging test is the most important tool in the diagnosis of SBO - Perform __ (__ and __ position).

A

AXR
standing
lying

21
Q

The acute AXR of an SBO patients will usually show dilated ileum ___ (___ sign). The __ will also be thickened. When standing- __-__ levels. There will be no air in the __. String of __ is also a classic image.

A 
loops
Ladder
borders
air-fluid
rectum
pearls
22
Q

When perforation occur in an SBO patients, the AXR may show free air under the ___ or over the __ in the ___ position (__ side)

A

diaphragm
liver
decubitus
left

23
Q

When the reason for the SBO is biliary (___ ileus), we may see air in the ___ tree (__)

A

gallstone
biliary
pneumobilia

24
Q

If the diagnosis is unclear in an SBO patient, and the AXR was not conclusive- perform ___. It is more suitable to diagnose ___ SBO rather than __

A

abdominal CT
full
partial

25
Q

Treating SBO patients will include: (5)

A 
NPA
fluids
NGT
catheter
ABx
26
Q

Partial SBO treatment should be __, as symptoms will resolve spontaneously in __% of cases. If the symptoms continue/increase -> ___

A

conservative
85
surgery

27
Q

Full SBO treatment should be ___ (within __ hours). Add warm ___ to regain __. Check blood flow with __. Perform ___ look.

A 
surgery
24
saline
peristaltic 
doppler
second
28
Q

Second look laparotomy within the first - hours post op should always be performed. This is when we decide if to __ or not.

A

18-24

resect

29
Q

Paralytic ileus is an example for ___ SBO

A

functional

30
Q

The clinical features of paralytic ileus include abdominal ___ without __ pain, less __, no __

A

distention
colic
vomiting
obstipation

31
Q

Treating paralytic ileus should be __: __ and __

A

conservative
NGT
hydration

32
Q 
What are the leading causes for paralytic ileus? (4)
Post \_\_
metabolic- \_\_/\_\_/\_\_/\_\_
iatrogenic- \_\_/\_\_/\_\_
inflammation- \_\_/\_\_
A

op
hypokalemia/hypomagnesemia/hyponatremia/uremia
opiates/TCA/anti-cholinergic
pancreatitic/sepsis

33
Q

What is the timeline for GI organs recovery from ileus?

A

small bowl- (few hours)
stomach- (24-48 hours)
colon (48-72 hours)

34
Q

LBO can be categorized into two classes: ___ obstruction, and _ obstruction

A

mechanical

pseudo

35
Q

Mechanical LBO is characterized by hyper___ colon.

A

peristaltic

36
Q 
What are the main reasons for mechanical SBO?
\_\_ (60%)
\_\_itis (20%)
\_\_ (5%)
\_\_
\_\_
\_\_
A 
CRC
diverticulitis
volvulus
fecal impaction
foreign bodies 
Crohn's
37
Q

The clinical features of LBO includes diffused stable abdominal pain (more __ than SBO), the rest is like SBO.

A

stable

38
Q

Sigma volvulus will be seen like ___

A

coffee bean

39
Q

In order to decide if the LBO is full or not, perform either urgent ___ ___, or __ (with __ or ___)

A

barium enema
CT
gastrografin
IV contrast

40
Q

Surgical treatment for LBO will be one of 3:
___
loop ___
___ ___

A

Hartman
colostomy
sub total

41
Q

Pseudo obstruction of colon= ___ syndrome

A

Ogilvie’s

42
Q

Ogilvie’s syndrome= distention of the colon with ___ symptoms, but no __ obstruction

A

SBO

mechanical

43
Q

The clinical image of Ogilvie’s syndrome is very __ abdomen, severe ___ pain, __+__, __+__

A

distended
abdominal
nausea+ vomiting
constipation+ diarrhea

44
Q

Primary pseudo obstruction= ___ motility disorder (Hollow visceral myopathy syndrome)

A

familial

Surgery final (Sabiston) (54 decks)

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