Bowel obstruction

Question 1

What are the symptoms of bowel obstruction?

Answer 1

vomiting
constipation
abdominal distension 
abdominal pain 
gastric splash (gastric outlet obstruction)

Question 2

Name three types of bowel obstruction

Answer 2

1. Gastric outlet
2. small bowel
3. large bowel
4. acute/chronic

Question 3

How is bowel obstruction diagnosed?

Answer 3

AXR, CT scan, contrast studies (enema of follow through study), endo/colonoscopy, biopsy

Question 4

What is the general management plan for bowel obstruction?

Answer 4

decompression- NG tube on suction or regular aspiration
IV fluids
surgical treatment
conservative treatment

Question 5

What are the treatment options for gastric outlet obstruction?

Answer 5

benign- PPI, endoscopic dilatation

Malignant- gastrectomy, gastric bypass

Question 6

What is the main symptom in gastric outlet obstruction?

Answer 6

vomiting

Question 7

Name four causes of small bowel obstruction

Answer 7

1. adhesions from prev surgery
2. incarcerated hernias
3. crohn’s disease
4. gallstone ileus
5. malignancy
6. ileus

Question 8

What are the symptoms of small bowel obstruction?

Answer 8

abdo pain
vomiting
abdo distension
electrolyte imbalances due to prolonged vomiting 
renal failure

Question 9

Why do you get renal failure in small bowel obstruction?

Answer 9

fluid loss into bowel and vomiting

Question 10

What is the nature of abdo pain in small bowel obstruction?

Answer 10

colicky central

Question 11

Name four causes of large bowel obstruction

Answer 11

colonic carcinoma
sigmoid volvulus 
constipation 
benign stricture e.g. diverticular 
ileus

Question 12

What are the symptoms of large bowel obstruction?

Answer 12

constipation
vomiting
abdo distention
lower abdo pain

Question 13

At what stage does vomiting arise in large bowel obstruction?

Answer 13

late

Question 14

What are the five classic signs of strangulation?

Answer 14

continuous pain, fever, tachy, leukocytosis, peritoneal signs (guarding, rebound tenderness)

Question 15

How can you distinguish between viable and dead bowel?

Answer 15

pink colour, peristalsis, arterial pulsations

Question 16

Name five complications associated with SBO surgery

Answer 16

wound infection, ileus, abscess, recurrent obstruction, enterotomy (surgical incision to intestine)

Question 17

List the three most common causes of bowel obstruction in order of prevalence

Answer 17

1. Adhesions
2. Hernias
3. Malignancy

Question 18

What is the conservative management of bowel obstruction?

Answer 18

fluid, NG tube, catheter

Question 19

Which is the most common point of perforation in the bowel?

Answer 19

cecum

Question 20

You suspect someone has bowel obstruction. What is your rationale for requesting CT?

Answer 20

To determine cause, as well as whether there is any gas in the bowel wall as this is a sign of impending perforation

Question 21

What is the most common cause of strictures in the small bowel?

Answer 21

crohn’s

Question 22

What is the most common cause of strictures in the large bowel?

Answer 22

diverticular disease

Question 23

How can causes of intestinal obstruction be divided?

Answer 23

Mechanical vs Adynamic

Mechanical: 1. Intraluminal 2. Intramural 3. Extramural

Question 24

Name three intraluminal causes of bowel obstruction

Answer 24

impaction, foreign body, gall stones

Question 25

Name two causes of intramural bowel obstruction

Answer 25

stricture, malignancy

Question 26

Name two causes of extramural causes of bowel obstruction

Answer 26

hernia, volvulus, bands/adhesions

Question 27

List two causes of adynamic bowel obstruction

Answer 27

paralytic ileus pseudo obstruction mesenteric vascular occlusion

Question 28

If you see faeces in the small bowel on CT, what is this a sign of?

Answer 28

faecalisation, acute on chronic obstruction, suggests that there has been obstruction for a while

Question 29

List a couple of ways in which you can determine the level of the bowel when you are looking at CT

Answer 29

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

Question 30

Will pyrexia be present in bowel obstruction?

Answer 30

only if perforation or gangrene has occurred

Question 31

What are the four primary symptoms of intestinal obstruction?

Answer 31

pain, distension, vomiting, absolute constipation | !!!

Question 32

Patient presents acutely with bowel obstruction. Where is the likely site of the obstruction?

Answer 32

small bowel

Question 33

What is Whipple's procedure?

Answer 33

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.

Question 34

What is hartmann's?

Answer 34

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.

Question 35

What are the indications for hartmann's?

Answer 35

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

Question 36

Does pain arise in paralytic ileus obstruction?

Answer 36

no

Question 37

Patient with suspected bowel obstruction suddenly develops severe pain. What are you worried about?

Answer 37

bowel strangulation

Question 38

If someone vomits faeculant material, what are you worried about?

Answer 38

progression of obstruction

Question 39

What are the three classifications of bowel obstruction? (not small/large)

Answer 39

Simple Closed loop Strangulated

Question 40

Name three findings you might observe on clinical examination of patient with bowel obstruction

Answer 40

Surgical scars Hernia Bowel sounds- tinkling= mechanical, absent= ileus PR- rectal mass, impacted stool, empty rectum, blood

Question 41

Four aspects of management for bowel obstruction?

Answer 41

``` NBM IV fluids NG tube- decompression, stop vomiting Catheter Analgesia Abx ```