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Colorectal surgery > Bowel obstruction > Flashcards

Bowel obstruction Flashcards

1
Q

What are the symptoms of bowel obstruction?

A 
vomiting
constipation
abdominal distension 
abdominal pain 
gastric splash (gastric outlet obstruction)
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2
Q

Name three types of bowel obstruction

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

How is bowel obstruction diagnosed?

A

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

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4
Q

What is the general management plan for bowel obstruction?

A

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

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5
Q

What are the treatment options for gastric outlet obstruction?

A

benign- PPI, endoscopic dilatation

Malignant- gastrectomy, gastric bypass

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6
Q

What is the main symptom in gastric outlet obstruction?

A

vomiting

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7
Q

Name four causes of small bowel obstruction

A
  1. adhesions from prev surgery
  2. incarcerated hernias
  3. crohn’s disease
  4. gallstone ileus
  5. malignancy
  6. ileus
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8
Q

What are the symptoms of small bowel obstruction?

A 
abdo pain
vomiting
abdo distension
electrolyte imbalances due to prolonged vomiting 
renal failure
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9
Q

Why do you get renal failure in small bowel obstruction?

A

fluid loss into bowel and vomiting

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10
Q

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

A

colicky central

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11
Q

Name four causes of large bowel obstruction

A 
colonic carcinoma
sigmoid volvulus 
constipation 
benign stricture e.g. diverticular 
ileus
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12
Q

What are the symptoms of large bowel obstruction?

A

constipation
vomiting
abdo distention
lower abdo pain

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13
Q

At what stage does vomiting arise in large bowel obstruction?

A

late

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14
Q

What are the five classic signs of strangulation?

A

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

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15
Q

How can you distinguish between viable and dead bowel?

A

pink colour, peristalsis, arterial pulsations

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16
Q

Name five complications associated with SBO surgery

A

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

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17
Q

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

A
  1. Adhesions
  2. Hernias
  3. Malignancy
18
Q

What is the conservative management of bowel obstruction?

A

fluid, NG tube, catheter

19
Q

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

A

cecum

20
Q

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

A

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

21
Q

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

A

crohn’s

22
Q

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

A

diverticular disease

23
Q

How can causes of intestinal obstruction be divided?

A

Mechanical vs Adynamic

Mechanical: 1. Intraluminal 2. Intramural 3. Extramural

24
Q

Name three intraluminal causes of bowel obstruction

A

impaction, foreign body, gall stones

25
Q

Name two causes of intramural bowel obstruction

A

stricture, malignancy

26
Q

Name two causes of extramural causes of bowel obstruction

A

hernia, volvulus, bands/adhesions

27
Q

List two causes of adynamic bowel obstruction

A

paralytic ileus
pseudo obstruction
mesenteric vascular occlusion

28
Q

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

A

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

29
Q

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

A

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

30
Q

Will pyrexia be present in bowel obstruction?

A

only if perforation or gangrene has occurred

31
Q

What are the four primary symptoms of intestinal obstruction?

A

pain, distension, vomiting, absolute constipation

!!!

32
Q

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

A

small bowel

33
Q

What is Whipple’s procedure?

A

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.

34
Q

What is hartmann’s?

A

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.

35
Q

What are the indications for hartmann’s?

A

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

36
Q

Does pain arise in paralytic ileus obstruction?

A

no

37
Q

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

A

bowel strangulation

38
Q

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

A

progression of obstruction

39
Q

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

A

Simple
Closed loop
Strangulated

40
Q

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

A

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

41
Q

Four aspects of management for bowel obstruction?

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

Colorectal surgery (11 decks)

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