Bowel Obstruction

Question 1

Define Intestinal obstruction

Answer 1

is the inability of the intestinal tract to allow for regular passage of food and bowel contents secondary to mechanical obstruction or adynamic ileus.

Question 2

True or false

Adynamic ileus (paralytic ileus) is usually self- limiting and does not require surgical intervention.

Answer 2

True

Question 3

True or false

 Intestinal pseudo-obstruction (Ogilvie’s syndrome) may mimic bowel obstruction

Answer 3

True

Question 4

Distention is due to the

Answer 4

accumulation of fluids in the bowel lumen, an increase in intraluminal pressure with enhanced peristaltic contractions, and air swallowing.

Question 5

Examples of closed-loop obstruction include an

Answer 5

incarcerated hernia and complete colon obstruction in the presence of a closed ileo- cecal valve

Question 6

The most common cause of small bowel obstruction is

Answer 6

adhesions after abdominal surgery

Question 7

The second most common cause of small bowel obstruction is

Answer 7

incarceration of a hernia

Question 8

unusual cause of intraluminal obstruction is __________ , in which a gallstone has eroded from the gallbladder through the bowel wall and causes obstruction at the ileocecal valve. Signs of gallstone ileus include bowel obstruction and pneumobilia

Answer 8

gallstone ileus

Question 9

Bezoars are most commonly composed of

Answer 9

vegetable matter or pulp from persimmons

Question 10

Those  who have undergone __ are most susceptible to intraluminal obstruction by bezoars

Answer 10

GI pyloroplasty or pyloric resection

Question 11

are by far the most common cause of large bowel obstruction, especially in the elderly

Answer 11

Neoplasms

Question 12

next most frequent cause of large bowel obstruction after cancer and diverticulitis is

Answer 12

sigmoid volvulus

Question 13

Who are most at risk for volvulus

Answer 13

Elderly,
bedridden, or
psychiatric patients who are taking anticholinergic medication

Question 14

Differentiate the quality and character of the vomitus in proximal compared to distal or large bowel obstruction

Answer 14

Vomitus is usually bilious in proximal obstruction but is feculent in distal ileal or large bowel obstruction.

Question 15

True or false

Partial bowel obstruction, however, is often associated with regular passage of stool and flatus.

Answer 15

True

Question 16

Extreme leukocytosis (>40,000/mm3) suggests

Answer 16

mesenteric vascular occlusion

Question 17

leukocytosis of >20,000/mm3 or left shift should make one suspect

Answer 17

bowel gangrene, intra-abdominal abscess, or peritonitis ‘

Question 18

True or false

the ED, flat and upright abdominal radiographs with an upright chest radiograph or a lateral decubitus view are of little utility.

Answer 18

True

Question 19

greatest value of the plain radiograph is in

Answer 19

demonstrating free air secondary to rupture and expediting surgical management.

Question 20

What is the imaging method of choice in the ED

Answer 20

CT scan with oral and IV contrast

Question 21

For colonic obstruction due to malignancy,_________ is the gold standard treatment.

Answer 21

tumor resection

Question 22

True or false

 Use of a nasogastric tube is often unnecessary, but should be considered in the presence of severe distention and vomiting. Local surgeon preference continues to dictate local practice with regard to nasogastric tube use.

Answer 22

 True

Question 23

Monitor adequacy of fluid resuscitation by the response of

Answer 23

blood pressure, heart rate, and urine output.

Question 24

Vigorous IV fluid replacement is needed because of

Answer 24

loss of absorptive capacity, decreased oral intake, and vomiting.

Question 25

are surgical emergencies.

Answer 25

Closed-loop obstruction, bowel necrosis, and cecal volvulus

Question 26

Monotherapy could be

Answer 26

tazobactam-piperacillin, 3.375 grams IV every 6 hours, ticarcillin-clavulanate, 3.1 grams IV every 6 hours, or a carbapenem.

Question 27

What is the disposition of adynamic Ileus and bowel obstruction

Answer 27

If adynamic ileus is suspected or the diagnosis is uncertain, conserva- tive inpatient management, including IV fluids and observation, gener- ally is effective in allowing the bowel to resume normal activity and function. Discontinue medications that inhibit bowel mobility.
Admit patients with bowel obstruction to the hospital. Surgical consultation should generally be obtained in the ED or at the time of admission. Patients with adynamic ileus should also be admitted for the treatment of the underlying cause and until resolution of the ileus.