Bowel Obstruction Flashcards
What are the risk factors for small bowel obstruction
- Previous abdominal surgery
- Hernias
- Crohn’s disease (due to fibrotic strictures)
- Intestinal malignancy
- Appendicitis
- Volvulus
- Galltone ileus
- Paeds: Malrotation of gut, intersusseption
what are the symptoms of small bowel obstruction
- Abdominal pain and distention
- Absolute constipation
- No flatulence
- Vomiting (green bilious)
- Tinkling bowel sounds
- Can also present with fever or peritonism
What are the investigations for small bowel obstruction?
- Abdominal X-ray (quick)
- CT scan (if unsure or recurrent obstruction)
- Bloods including G&S and amylase
- ABG (look at lactate which will indicate poor tissue perfusion/generally unwell)
- Erect chest X ray if suspect perforation
What is the management of a small bowel obstruction?
- A-E
- IV Fluids
- NG tube to drip and suck
- Analgesia
- Anti-emetics
- Can use gastrografin in partial obstruction
- Surgery
What are the abdominal X ray findings of bowel obstruction?
3:6:9 rule: Upper limits of normal diameter for small bowel;colon:caecumm respectively.
Valvulae conniventes in normal small bowel
Haustra seen in normal large bowel
What are the complications of small bowel obstruction?
Intestinal necrosis, sepsis, organ failure, intra-abdominal abscess, interstinal perforation
What are some causes of large bowel obstruction?
- Colonic tumours,
- Strictures (secondary to diverticular disease, IBD or post surgical)
- Volvulus
- Hernia
- Adhesion
What are the signs and symptoms of large bowel obstruction?
Cramping abdominal pain
bloating
absolute constipation and inability to pass wind
Potential nausea and vomiting (more common in SBO)
What are the investigations for LBO?
- Abdominal X-ray
- CT scan
- Bloods including G&S and amylase
- Erect CXR to exclude perforation
What is the management of large bowel obstruction?
- A-E,
- IV fluids
- NG tube to drip and suck,
- Analgesia
- Anti-emetics
- Surgical intervention
