Bowel Obstruction Flashcards
What are the two types of SBO (small bowel obstruction)?
functional
mechanical
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.
absorption proximal edema sequestration peritoneal
If significant, the obstruction leads to major dilation which in its turn may lead to ___ and __
necrosis
perforation
Closed loop obstruction is when the obstruction occurs in 2 places: __ and __. This type has higher chances for __ and __
proximal
distal
strangulation
perforation
SBO closed loop happens usually due to either ___ or ___
hernia
volvulus
Patients suffering from bowel obstruction suffer from ___ and must be treated with ___. The reason is loss to __ space.
hypovolemia
fluids
3rd
What are the leading 5 etiologies for paralytic ileus? \_\_ (60%) \_\_ (20%) \_\_ (10%) \_\_ (5%) \_\_ (5%)
post operational adhesion tumors hernias Crohn's abdominal abscess
SBO can be classified into 3 categories:
extra ___
intra ___
intra ___
mural
mural
luminal
What are the main reasons for extra mural SBO? (5)
post operational adhesion hernias mesenteric fibrosis (carcinoid) tumors intra abdominal abscess
What are the main reasons for intra mural SBO? (5)
inflammatory strictures (Crohn's) surgical strictures volvulus intussusception endometriosis
What are the main reasons for intra luminal SBO?
bezoar
parasites
What are the signs of SBO? (4)
- hyperperistaltic -> constipation -> obstipation
- hypovolemia
- intrabdominal pressure
- bacterial translocation
SBO patients will suffer from hypovolemia and vomiting, which in turn contribute to metabolic ___ and paradoxical ___
alkalosis
aciduria
Which symptoms are commonly seen in SBO patients? (4)
periumbilical colic pain
nausea and vomiting
distended abdomen
diarrhea/constipation/obstipation
SBO patients with periumbilical colic pain will
suffer every - minutes
4-5
The typical physical examination of patients with SBO will usually include: (4)
- tachycardia
- fever (strangulation?)
- surgical scars
- enlarged hypertympanic sensitive abdomen
In the first stages of SBO we may hear increased peristaltic abdomen, with typical __ like sounds = ___
metallic
borborygmic
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 __
sensitivity stable ischemic fever leukocytosis peritoneal sepsis
The lab check up we should perform when dealing with an SBO patients include dehydration signs (hemo___, increased __/__), vomiting (hypo__ metabolic __ + urine __duria), hyop__.
concertation BUN/Cr chloremia alkalosis acidosis kalemia
Imaging test is the most important tool in the diagnosis of SBO - Perform __ (__ and __ position).
AXR
standing
lying
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.
loops Ladder borders air-fluid rectum pearls
When perforation occur in an SBO patients, the AXR may show free air under the ___ or over the __ in the ___ position (__ side)
diaphragm
liver
decubitus
left
When the reason for the SBO is biliary (___ ileus), we may see air in the ___ tree (__)
gallstone
biliary
pneumobilia
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 __
abdominal CT
full
partial
Treating SBO patients will include: (5)
NPA fluids NGT catheter ABx
Partial SBO treatment should be __, as symptoms will resolve spontaneously in __% of cases. If the symptoms continue/increase -> ___
conservative
85
surgery
Full SBO treatment should be ___ (within __ hours). Add warm ___ to regain __. Check blood flow with __. Perform ___ look.
surgery 24 saline peristaltic doppler second
Second look laparotomy within the first - hours post op should always be performed. This is when we decide if to __ or not.
18-24
resect
Paralytic ileus is an example for ___ SBO
functional
The clinical features of paralytic ileus include abdominal ___ without __ pain, less __, no __
distention
colic
vomiting
obstipation
Treating paralytic ileus should be __: __ and __
conservative
NGT
hydration
What are the leading causes for paralytic ileus? (4) Post \_\_ metabolic- \_\_/\_\_/\_\_/\_\_ iatrogenic- \_\_/\_\_/\_\_ inflammation- \_\_/\_\_
op
hypokalemia/hypomagnesemia/hyponatremia/uremia
opiates/TCA/anti-cholinergic
pancreatitic/sepsis
What is the timeline for GI organs recovery from ileus?
small bowl- (few hours)
stomach- (24-48 hours)
colon (48-72 hours)
LBO can be categorized into two classes: ___ obstruction, and _ obstruction
mechanical
pseudo
Mechanical LBO is characterized by hyper___ colon.
peristaltic
What are the main reasons for mechanical SBO? \_\_ (60%) \_\_itis (20%) \_\_ (5%) \_\_ \_\_ \_\_
CRC diverticulitis volvulus fecal impaction foreign bodies Crohn's
The clinical features of LBO includes diffused stable abdominal pain (more __ than SBO), the rest is like SBO.
stable
Sigma volvulus will be seen like ___
coffee bean
In order to decide if the LBO is full or not, perform either urgent ___ ___, or __ (with __ or ___)
barium enema
CT
gastrografin
IV contrast
Surgical treatment for LBO will be one of 3:
___
loop ___
___ ___
Hartman
colostomy
sub total
Pseudo obstruction of colon= ___ syndrome
Ogilvie’s
Ogilvie’s syndrome= distention of the colon with ___ symptoms, but no __ obstruction
SBO
mechanical
The clinical image of Ogilvie’s syndrome is very __ abdomen, severe ___ pain, __+__, __+__
distended
abdominal
nausea+ vomiting
constipation+ diarrhea
Primary pseudo obstruction= ___ motility disorder (Hollow visceral myopathy syndrome)
familial
