bowel obstruction Flashcards

1
Q

what

A

passage of food, fluid, gas through intestines becomes blocked

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2
Q

what kind of bowel obstruction is most common

A

small bowel obstruction is more common than large bowel

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3
Q

what does bowel obstruction result in

A

back pressure –> vomit and dilation of proximal intestine

gastrointestinal tract fluid can’t reach colon to be reabsorbed –> fluid loss from intravascular space to GIT and so hypovolaemia and shock (3rd spacing)

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4
Q

causes: the big 3

A

adhesions (small bowel)
hernias (small bowel)
malignancy (large bowel)

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5
Q

causes: other

A

volvulus
diverticular disease
strictures e.g. Crohn’s
intussuseption

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6
Q

adhesions

A

peices of scar tissue that bind abdo contents together

can cause kinking or squeezing of bowel , causing obstruction

more often small boewl

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7
Q

main causes of intestinal adhesions

A

abdo/pelvic surgery
peritonitis
abdo/pelvic infection
endometriosis

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8
Q

closed loop obstruction

A

there are 2 points of obstruction , meaning there is a middle section sandwhiched between

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9
Q

what might closed lop obsturction happen with

A

adhesions
hernias
volvulus
single point of obstruction of large bowel and incompetent ileocaecal valce

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10
Q

key features of bowel obstruction

A
vomit (esp bilious)
abdo distension
diffuse abdo pain
absolute constipation 
tinkling bowel sounds
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11
Q

key x-ray finding

A

distended loops of bowel

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12
Q

key blood abnormalities

A
  • electrolyte imbalance
  • metabolic alkalosis (due to vomiting stomach acid)
  • bowel ischaemia: riased lactate
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13
Q

initial management

A

nil by mouth
IV fluids
NG tube with free drainage

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14
Q

Ix

A

abdo X-ray

contrast abdo CT

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15
Q

surgical options

A

exploratory surgery - cause unclear
adhesiolysis - treat adhesions
hernia repair
emergency resection - tumour

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16
Q

what should be avoided in bowel obstruction

A

metoclopramide

but may be helpful in paralytic ileus