Bowel Obstruction Flashcards
Define Intestinal obstruction
is the inability of the intestinal tract to allow for regular passage of food and bowel contents secondary to mechanical obstruction or adynamic ileus.
True or false
Adynamic ileus (paralytic ileus) is usually self- limiting and does not require surgical intervention.
True
True or false
 Intestinal pseudo-obstruction (Ogilvie’s syndrome) may mimic bowel obstruction
True
Distention is due to the
accumulation of fluids in the bowel lumen, an increase in intraluminal pressure with enhanced peristaltic contractions, and air swallowing.
Examples of closed-loop obstruction include an
incarcerated hernia and complete colon obstruction in the presence of a closed ileo- cecal valve
The most common cause of small bowel obstruction is
adhesions after abdominal surgery
The second most common cause of small bowel obstruction is
incarceration of a hernia
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
gallstone ileus
Bezoars are most commonly composed of
vegetable matter or pulp from persimmons
Those  who have undergone __ are most susceptible to intraluminal obstruction by bezoars
GI pyloroplasty or pyloric resection
are by far the most common cause of large bowel obstruction, especially in the elderly
Neoplasms
next most frequent cause of large bowel obstruction after cancer and diverticulitis is
sigmoid volvulus
Who are most at risk for volvulus
Elderly,
bedridden, or
psychiatric patients who are taking anticholinergic medication
Differentiate the quality and character of the vomitus in proximal compared to distal or large bowel obstruction
Vomitus is usually bilious in proximal obstruction but is feculent in distal ileal or large bowel obstruction.
True or false
Partial bowel obstruction, however, is often associated with regular passage of stool and flatus.
True
Extreme leukocytosis (>40,000/mm3) suggests
mesenteric vascular occlusion
leukocytosis of >20,000/mm3 or left shift should make one suspect
bowel gangrene, intra-abdominal abscess, or peritonitis ‘
True or false
the ED, flat and upright abdominal radiographs with an upright chest radiograph or a lateral decubitus view are of little utility.
True
greatest value of the plain radiograph is in
demonstrating free air secondary to rupture and expediting surgical management.
What is the imaging method of choice in the ED
CT scan with oral and IV contrast
For colonic obstruction due to malignancy,_________ is the gold standard treatment.
tumor resection
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.
 True
Monitor adequacy of fluid resuscitation by the response of
blood pressure, heart rate, and urine output.
Vigorous IV fluid replacement is needed because of
loss of absorptive capacity, decreased oral intake, and vomiting.
are surgical emergencies.
Closed-loop obstruction, bowel necrosis, and cecal volvulus
Monotherapy could be
tazobactam-piperacillin, 3.375 grams IV every 6 hours, ticarcillin-clavulanate, 3.1 grams IV every 6 hours, or a carbapenem.
What is the disposition of adynamic Ileus and bowel obstruction
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.
