Bowel obstruction Flashcards
Functional bowel obstruction (ileus)
- 5 reasons?
Mechanical bowel obstruction
- Most common cause for small intestinal obstruction?
- Most common cause for large intestine obstruction?
SBO: post operative adhesions
LBO: colorectal cancer
Small bowel obstruction
- Other causes?
Post operative adhesions
Hernias
Crohn’s - strictures
Appendicitis - obstruction by abscess/phlegmon
Cancers
Large bowel obstruction
- Other causes?
Colorectal cancer?
Diverticulitis - strictures
Volvulus
Intussusception - usually <2
Foreign bodies
Pathophysiology
- Describe the initial pathology caused by bowel obstruction
Complications
- Describe how bowel obstruction can lead to transmural infarction, perforation, and sepsis/shock?
Pathophysiology
- How can bowel obstructions cause localised infection?
History
- Cramping/abdominal pain
- Vomiting (bilious if small, faeculent if large)
- Constipation
- Abdominal distention
Exam
- Vitals?
- Abdomen general inspection
- Abdomen palpation
- Abdomen percussion
- Bowel sounds (mechanical and functional)
- DRE
Investigations
- Labs?
Investigation
- Initial imaging?
Investigation
- Definitive imaging?
CT AP with contrast — confirms diagnosis, cause, site and perforation
Management
- Overview?
Initial supportive management
Emergency surgery (some cases)
Treat the underlying cause
Management
- Initial supportive management?
Bowel decompression - with nasogastric tube
Fluid resuscitation - for severe dehydration or shock
Analgesia - eg. IV morphine
Management
- When is emergency surgery indicated?
May be indicated for complete small bowel obstruction, ischemia, strangulation, perforated bowel, peritonitis
