Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Gen surg > Bowel obstruction > Flashcards

Bowel obstruction Flashcards

1
Q

Causes of gastrointestinal perforation

A 
Diverticulitis(most common in higher-income countries) 
Peptic ulcer disease 
GI malignancy(mainly gastric or colorectal) 
Iatrogenic 
Foreign body 
Appendicitis 
Mesenteric ischaemia 
Excessive vomiting
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Clinical features of GI perforation

A 
Abdo pain(rapid onset and sharp) 
Systemically unwell(malaise, vomiting and lethargy) 
Features of peritonism
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Which blood test parameters are raised in bowel perforation

A

Raised WCC and CRP

Amylase is often mildly elevated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Gold standard for diagnosis of bowel perforation

A

CT scan confirming the presence of free air and suggesting a location of the perforation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

CXR and AXR features of bowel perforation

A

eCXR may show air under the diaphragm in cases of pneumoperitoneum, whilst an AXR may show either rigler’s sign or psoas sign

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Management of bowel perforation

A

NBM with consideration of nasogastric tube
Broad spectrum antibiotics
Adequate IV fluid resus and appropriate analgesia
Surgical intervention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Surgical intervention for GI perforation

A

Identification of underlying cause

Thorough washout

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Which patients with GI perforation may be managed conservatively

A

Localised diverticular perforation with only peritonitis and tenderness, and no evidence of generalised contamination on imaging

Patients with a sealed upper GI perforation on CT imaging without generalised peritonism

Elderly frail patients with extensive co-morbidities who would be very unlikely to survive surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Early complications of bowel perforation

A

Haemodynamic instability leading to hypoperfusion, shock, and multi-organ system failure, infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Late complications of bowel perforation

A

Delayed wound healing, postop adhesion leading to bowel obstruction, fistula formation and hernias

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Risk factors for small intestinal obstruction

A

May be due to adhesions, strangulated hernia, malignancy or volvulus(majority are due to intra-abdominal adhesions from prior operations)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Risk factors for large intestinal obstruction

A

Most often the result of colorectal malignancies

Risk of obstruction increases the further down the bowel the lesion is sited, as the contents become more solid

Tumours are often advances and there may be distant mets

Perforation can occur at the site of the tumour or in a dilated caecum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Risk factors for sigmoid and caecal volvulus

A

Describes rotation of the gut on its mesenteric acis

Usually seen in the elderly or those with psychiatric illness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the most common site of volvulus

A

Sigmoid volvulus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is paralytic ileus

A

Bowel ceases to function and there is no peristalsis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Which conditions are associated with paralytic ileus

A 
Chest infection 
Acute MI 
Stroke 
AKI 
Puerperium 
Trauma 
Severe hypothyroidism 
DKA
17
Q

Symptoms associated with bowel obstruction

A 
Nausea 
Vomiting 
Dysphagia 
Abdo pain 
Failure to pass bowel movements 
Abdo distension 
Tympany due to an air-filled stomach
High-pitched bowel sounds
18
Q

Examination findings in bowel obstruction

A 
Signs of dehydration 
Abdo distension 
Resonant distended bowel 
Palpable abdo masses 
Features of peritonism 
Potential hernias 
Active and tinkling bowel sounds
19
Q

IX for bowel obstruction

A 
Fluid charts 
Plain AXR 
CT abdomen(Non-contrast CT recommended) 
Patients with peritoneal fluid evident on CT scan are 3x more likely to require surgical intervention
MRI and ultrasound (diagnosis of small bowel obstruction)
20
Q

Management of uncomplicated bowel obstruction

A

Fluid resus
Electrolye replacement
Intestinal decompression
Bowel rest

21
Q

Purpose of endoscopy in bowel obstruction management

A

Bowel decompression
Dilation of strictures or placement of self-expandable metal stents to restore the luminal flow either as a final treatment or to allow for a delay until elective surgical therapy

22
Q

Surgical management of intestinal obstruction

A

Laparotomy(resection of bowel may be required)

Early surgery is required if there is local or generalised peritonitis

Prophylactic antibiotics for gut surgery are advised

23
Q

Non-surgical treatment for intestinal obstruction

A

Endoscopic stenting

24
Q

What is sigmoid volvulus

A

A large sigmoid loop full of faeces and distended with gas twists on its mesenteric pedicle to create a closed-loop obstruction

If uncorrected, venous infarction leads to perforation and faecal peritonitis

25
Q

Risk factors for sigmoid volvulus

A 
Elderly 
Chronic constipation 
Megacolon, large redundant sigmoid colon and excessively mobile colon 
More common in men
Pregnancy
26
Q

Presentation of sigmoid volvulus

A

Sudden-onset colicky lower abdominal pain associated with gross abdo distension and failure to pass either flatus or stool

Vomiting

History of recurrent mild attacks relieved by passage of stool

Shock and an elevation of temp if colonic perforation

27
Q

What might a delay in diagnosis and treatment of sigmoid volvulus result in

A

Colonic ischaemia with features of perforation and peritonitis

28
Q

IX for sigmoid volvulus

A

Plain AXR
Limited barium enema without bowel prep
CT scan

29
Q

Results of plain AXR in sigmoid volvulus

A

Single grossly dilated sigmoid loop commonly reaching the xiphisternum

30
Q

Management of acute sigmoid volvulus

A

Majority treated with non-operative decompression(with sigmoidoscope and flatus tube alongside allowing for rapid decompression)

Resection of the redundant sigmoid colon is gold-standard operation(indicated in failure of tube decompression or signs of bowel ischaemia)

31
Q

Complications of sigmoid volvulus

A

Recurrence
Bowel obstruction
Perforation and faecal peritonitis

32
Q

Complications of bowel obstruction

A

Perforation and ischaemia of the bowel may cause peritonitis and septicaemia

Fluid and electrolyte imbalance –> AKI

Death

33
Q

What is a sigmoid volvulus associated with

A

High fibre diet

Excessive use of laxatives

34
Q

What is gallstone ileus

A

Occurs when a gallstone passes through a fistula between gallbladder and small bowel before becoming impacted at the ileocaecal valve

Uncommon cause of small bowel obstruction

35
Q

Typical presentation of gallstone ileus

A

Recurrent right RUQ pain history
Chronic cholecystitis with repeated inflammatory events
Colicky abdominal pain and distension

36
Q

Management of gallstone ileus

A

Surgery is definitive with removal of stone and repair of fistulae accompanied by a cholecystectomy

Gen surg (24 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions