Bowel Obstruction Flashcards
What are the 2 main subcategories of intestinal obstruction
Mechanical
Adynamic Ileus aka paralytic ileus
What is the difference between the mechanical and adynamic obstruction?
Mechanical: physical blockage of intestinal tract lumen
Adynamic: dysfunction of the intestinal tract
What are the 2 most common causes of small bowel obstruction in the US?
Adhesions (most common)
Hernias (second most common)
What surgery can cause adhesions that lead to small bowel obstruction
Intra-abdominal surgery
What is a hernia?
Incarceration and/or strangulation loops of small bowel
In less developed countries, what are the common causes of small bowel obstructions
Hernias (most common)
Adhesions (second most common)
Flipped due to lack of developed health care system
Less common causes of bowel movements
Intra-luminal polyps
Lymphoma
Adenocarcinoma
A patient with the urge to move and unable to find a comfortable position as if they are subconsciously trying to unobstructed their bowels likely has what condition?
Mechanical obstruction
Why would a patient with mechanical obstruction have intermittent pain?
Periotic contractions of peristalsis passing over obstructed portion of the bowel
What will the abdomen of a patient with mechanical obstruction be?
Distended
What characteristics will the vomit be of a patient with mechanical obstruction?
Bilious if obstruction is proximal
Feculent if distal ilium is proximal
Percussing the abdomen in a patient with mechanical obstruction will have what sound?
Tympany
A patient with paralytic ileus will have more of less pain than a mechanical obstruction?
Less pain but will be constant
What will the bowel sound of a patient with paralytic ileus be?
Diminished
What is the gold standard for dx small bowel obstruction?
Upright abdominal x ray
When would surgery be needed in a patient with small bowel obstruction?
Gangrene or necrosis is suspected (WBC>20,000)
Failure of conservative therapy
What is the disposition of patients with small bowel obstruction?
MEDEVAC for mechanical obstruction
MEDADVICE minimum for paralytic ileus
Gen Surg consult
What causes almost all large bowel obstructions?
Caused intrinsically with the majority being from adenocarcinoma
Why are large bowel obstructions not normally caused from hernias or adhesions?
Ascending and descending colon are embedded within the retroperitoneum
What kind of vomitus might a patient with large bowel obstruction have?
Feculent vomitus
