Bowel Obstruction

Question 1

Intestinal Obstruction is commonly referred to as:

Answer 1

bowel obstruction

Question 2

Two main subcategories of intestinal obstruction:

Answer 2

Mechanical obstruction
Adynamic Ileus aka paralytic ileus

Question 3

What main subcategory of intestinal obstruction
1) A physical blockage of the intestinal tract lumen disabling to passage of food and bowel contents.
a) Both intrinsic and extrinsic causes

Answer 3

Mechanical obstruction

Question 4

What main subcategory of intestinal obstruction
Not caused by a physical blockage, but rather a dysfunction of the intestinal tracts ability to move bowel contents through its lumen

Answer 4

Adynamic Ileus aka paralytic ileus

Question 5

True/False
Both large and small intestines may show signs and symptoms of obstruction due to a physical mechanical obstruction or due to paralytic ileus

Answer 5

True

Question 6

Two most common causes of small bowel obstruction in the U.S:

Answer 6

Most common: Adhesions
Second most common: Hernias

Question 7

Signs and Symptoms of what?
-Crampy, intermittent abdominal pain
-these patients will typically feel the urge to move, and typically will report a feeling of being unable to find a comfortable position.
-Intermittent pain is thought to be caused by the periotic contractions of peristalsis passing over the obstruction
-Abdominal Distention
-Vomiting
1) May be bilious in character if obstruction is proximal
2) May be feculent if the distal ilium is obstructed
-Possible Diarrhea
If the lumen is only partially obstructed and/or intermittently obstructed only
liquids may be able to pass through.
-Constipation, bloating common
-May have tympanic abdomen on percussion
-May produce active, high-pitched bowel sounds with occasional “rushes.”

Answer 7

Small Bowel Mechanical Obstruction

Question 8

What issue has similar s/s as mechanical obstruction except the patient usually has less
intense pain that is more constant.
- These patients also tend to present constipated with diminished bowel sounds.

Answer 8

Paralytic Ileus

Question 9

Labs/Rabs Small bowel obstruction

Answer 9

Labs:
(a) CBC, CMP
Radiology/Imaging:
(a)Gold Standard for Imaging: Upright abdominal X-Ray

Question 10

Upright abdominal X-Ray results in this….. What would you suspect?
1) Air fluid levels in stomach and portions of small intestine
2) Multiple dilated loops of small bowel
3) No air in large intestine, rectum

Answer 10

Small Bowel Obstruction

Question 11

Patients presents similarly to patients with paralytic ileus of the small intestine but has these associated issues. what would you suspect?
-Constant aching diffuse lower abdominal pain
-Bloating, distention
-Constipation and inability to pass flatus
-Possible feculent vomitus

Answer 11

Large Bowel Obstruction

Question 12

Almost all large bowel obstructions are caused intrinsically, with the large majority
being from _______.

Answer 12

adenocarcinoma.

Question 13

Disposition: LBO and SBO

Answer 13

(1) MEDEVAC for all patients suspected to have a mechanical obstruction.
(2) A minimum of MEDADVICE for patients suspected to have a paralytic ileus.
(3) General Surgery Consultation

Question 14

Surgery likely needed if:
(a) _____ or _____ is suspected (WBC>20,000)
(b) There is an intrinsic mechanical cause of obstruction (i.e. Carcinoma)
(c) Failure of conservative therapy
1) __% of completely obstructed SBO patients will fail conservative therapy

Answer 14

(a) Gangrene or necrosis
1) 60%

Question 15

Management and Treatment SBO and LBO

Answer 15

1) NPO to include water and oral medications
- D/C meds that inhibit bowel motility (i.e opiods)
2) Nasogastric tube insertion
-Decompress proximal GI tract
3) Two site IV access
-Aggressive fluid resuscitation
4) IV Antibiotics
5) Surgery likely needed