Bowel obstruction Flashcards
What are the symptoms of bowel obstruction?
vomiting constipation abdominal distension abdominal pain gastric splash (gastric outlet obstruction)
Name three types of bowel obstruction
- Gastric outlet
- small bowel
- large bowel
- acute/chronic
How is bowel obstruction diagnosed?
AXR, CT scan, contrast studies (enema of follow through study), endo/colonoscopy, biopsy
What is the general management plan for bowel obstruction?
decompression- NG tube on suction or regular aspiration
IV fluids
surgical treatment
conservative treatment
What are the treatment options for gastric outlet obstruction?
benign- PPI, endoscopic dilatation
Malignant- gastrectomy, gastric bypass
What is the main symptom in gastric outlet obstruction?
vomiting
Name four causes of small bowel obstruction
- adhesions from prev surgery
- incarcerated hernias
- crohn’s disease
- gallstone ileus
- malignancy
- ileus
What are the symptoms of small bowel obstruction?
abdo pain vomiting abdo distension electrolyte imbalances due to prolonged vomiting renal failure
Why do you get renal failure in small bowel obstruction?
fluid loss into bowel and vomiting
What is the nature of abdo pain in small bowel obstruction?
colicky central
Name four causes of large bowel obstruction
colonic carcinoma sigmoid volvulus constipation benign stricture e.g. diverticular ileus
What are the symptoms of large bowel obstruction?
constipation
vomiting
abdo distention
lower abdo pain
At what stage does vomiting arise in large bowel obstruction?
late
What are the five classic signs of strangulation?
continuous pain, fever, tachy, leukocytosis, peritoneal signs (guarding, rebound tenderness)
How can you distinguish between viable and dead bowel?
pink colour, peristalsis, arterial pulsations
Name five complications associated with SBO surgery
wound infection, ileus, abscess, recurrent obstruction, enterotomy (surgical incision to intestine)
List the three most common causes of bowel obstruction in order of prevalence
- Adhesions
- Hernias
- Malignancy
What is the conservative management of bowel obstruction?
fluid, NG tube, catheter
Which is the most common point of perforation in the bowel?
cecum
You suspect someone has bowel obstruction. What is your rationale for requesting CT?
To determine cause, as well as whether there is any gas in the bowel wall as this is a sign of impending perforation
What is the most common cause of strictures in the small bowel?
crohn’s
What is the most common cause of strictures in the large bowel?
diverticular disease
How can causes of intestinal obstruction be divided?
Mechanical vs Adynamic
Mechanical: 1. Intraluminal 2. Intramural 3. Extramural
Name three intraluminal causes of bowel obstruction
impaction, foreign body, gall stones
Name two causes of intramural bowel obstruction
stricture, malignancy
Name two causes of extramural causes of bowel obstruction
hernia, volvulus, bands/adhesions
List two causes of adynamic bowel obstruction
paralytic ileus
pseudo obstruction
mesenteric vascular occlusion
If you see faeces in the small bowel on CT, what is this a sign of?
faecalisation, acute on chronic obstruction, suggests that there has been obstruction for a while
List a couple of ways in which you can determine the level of the bowel when you are looking at CT
If you can’t see liver, kidneys, you observe lumbar vertebrae, the IVC and aorta haven’t split yet, then you are in a lower quadrant
Will pyrexia be present in bowel obstruction?
only if perforation or gangrene has occurred
What are the four primary symptoms of intestinal obstruction?
pain, distension, vomiting, absolute constipation
!!!
Patient presents acutely with bowel obstruction. Where is the likely site of the obstruction?
small bowel
What is Whipple’s procedure?
A Whipple procedure — also known as a pancreaticoduodenectomy — is a complex operation to remove the head of the pancreas, the first part of the small intestine (duodenum), the gallbladder and the bile duct. The Whipple procedure is used to treat tumors and other disorders of the pancreas, intestine and bile duct.
What is hartmann’s?
the surgical resection of the rectosigmoid colon with closure of the anorectal stump and formation of an end colostomy. is the most common operation carried out by general surgeons for management of malignant obstruction of the distal colon. During this procedure, the lesion is removed, the distal bowel closed intraperitoneally, and the proximal bowel diverted with a stoma.
What are the indications for hartmann’s?
a. Localized or generalized peritonitis caused by perforation of the bowel secondary to the cancer
b. Viable but injured proximal bowel that, in the opinion of the operating surgeon, precludes safe anastomosis
c. Complicated diverticulitis
Does pain arise in paralytic ileus obstruction?
no
Patient with suspected bowel obstruction suddenly develops severe pain. What are you worried about?
bowel strangulation
If someone vomits faeculant material, what are you worried about?
progression of obstruction
What are the three classifications of bowel obstruction? (not small/large)
Simple
Closed loop
Strangulated
Name three findings you might observe on clinical examination of patient with bowel obstruction
Surgical scars
Hernia
Bowel sounds- tinkling= mechanical, absent= ileus
PR- rectal mass, impacted stool, empty rectum, blood
Four aspects of management for bowel obstruction?
NBM IV fluids NG tube- decompression, stop vomiting Catheter Analgesia Abx
