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Surgery block > Bowel Obstruction > Flashcards

Bowel Obstruction Flashcards

1
Q

Define bowel obstruction.

A

Partial or complete blockage of the bowel that results in failure of the intestinal contents to pass

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2
Q

What are the three different groupings of classification of bowel obstruction?

A

Small bowel vs large bowel
Complete vs partial (complete no gas or faeces)
Acute vs chronic

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3
Q

What classification of bowel obsruction is always an acute situation?

A

Complete obstruction

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4
Q

What are the three main causes of bowel obstruction?

A

Adhesions
Hernias
Malignancy.

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5
Q

What are all potential causes of bowel obstruction?

A

Three main: adhesions, hernias, malignancy
Other causes:
Volvulus
Stricture - 2 to Crohns or diverticular disease

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6
Q

What background questions are important to ask a patient to help determine the cause of a bowel obstruction?

A

Hernias
Change in bowel habit, weight loss, PR bleeding
Previous abdominal surgery may have resulted in adhesions.

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7
Q

What are the three different classifications of bowel obstructions based on the location relative to the bowel wall?

A

Intraluminal - in the lumen - ingestion of a foreign body
Intramural - in the wall - cancers,
Extramural - outside the wall - hernias, cancer, adhesions

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8
Q

What is the difference between a dynamic (mechanical) and adynamic bowel obstruction?

A

Dynamic - physical blockage aka foreign body
Adynamic - failure of peristalsis, muscular or neurogenic.

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9
Q

What is the difference between a simple and a strangulated bowel obstruction?

A

Simple - blood flow is not compromised manage conservativly
Strangulated - blood flow is compromised is a surgical emergency

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10
Q

What are some common causes of obstructed bowel by age group?

A

Neonates - atresia, meconium, hirschsprung,
Infants - introsusception, pyloric stenosis, meckles diverticulum,
YA - adhesions, strangulated hernia
Adult - hernia, adhesion, inflammation, carcinoma
Elderly - CA, inflammation, sigmoid volvulus, impacted faeces.

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11
Q

What is a volvulus?

A

When the intestines twist around itself and its supplying mesentery - results in cut of blood supply to this section of bowel.

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12
Q

What is intussusception?

A

When the bowel folds into the section next to it, telescopes - cause of bowel obstruction.

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13
Q

What are the key signs and symptoms of a bowel obstruction?

A

Nausea and vomiting (green bilious vomiting)
Absolute constipation (no stool or wind)
Abdominal pain - generalised
Abdominal distention
‘Tinkling’ bowel sounds
Dehydrated - colon responsible for reabsorbing fluid/water

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14
Q

What are the cardinal symptoms of bowel obstruction?

A

Colicky abdominal pain
Vomiting
Distention
Obstipation/constipation

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15
Q

How do the symptoms differ between a high/low small bowel obstruction and a large bowel obstruction?

A

High - early vomiting
Low SI - distention and vomiting
Large - constipation, vomiting is later to develop

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16
Q

What investigation are important for suspected bowel obstruction?

A

Bloods - lactate (bowel ischemia), U&Es (electrolyte imbalances e.g hypokalemia), venous blood gas (metabolic alkalosis from vomiting)
Bedside - PR exam for impacted foecal matter, VBG for metabolic acidosis (ischemia, severe hypovolemia anaerobic metabolism) or metabolic alkalosis (excess vomiting - loss of hydrogen)
Imaging - CT abdomen (confirm location, perforation is present) , AXR (confirm presence of), Erect CXR (look for perforation)

17
Q

What is a radiological sign of perforated bowel obstruction?

A

Pneumoperitoneum - air under the diaphragm

18
Q

What is the initial non surgical management in all patients with a bowel obstruction?

A

NBM
“Suck and Drip” - NG tube - Ryle’s tube - to decompress the stomach/bowel, IV fluids rehydrate and address electrolyte abnormalities
Analgesia.

19
Q

What are the surgical management options for a bowel obstruction?

A
  1. Do-nothing - uncomplicated obstruction, stable patient, secondary to adhesion
  2. Adhesiolysis - laparoscopic surgery to cut adhesion
  3. Hernia repair
  4. Colonic stenting - 2 to cancer, performed via colonoscopy
  5. Bowel resection
20
Q

What is the difference between a low and high anterior resection of the bowel?

A

High - upper rectum (1/3) and sigmoid/lower left colon
Low - lower rectum and sigmoid colon

21
Q

what is the surgical procedure where the sigmoid colon is removed called?

A

Sigmoid colectomy

22
Q

What are the different types of hemicolectomy?

A

Left hemi - distal transverse and descending
Right hemi - - caecum, ascending and up to mid transverse
Extended right hemi -same as above but up to transverse colon at the splenic flexure

23
Q

What is a total abdominal colectomy?

A

Remove entire large colon

24
Q

What is a subtotal colectomy?

A

Removes all of large intestins except the sigmoid colon

25
Q

What is a total proctocolectomy?

A

Surgical removal of the colon and the rectum

26
Q

What is an abdominal-perineal resection?

A

Surgical procedures to remove the anus, rectum and sigmoid colon.

27
Q

What is a Hartmans procedure?

A

Type of colectomy - removes part of the sigmoid colon, remaining rectum is sealied, creating Hartmans pouch, remains colon is redirect to a colostomy
Majority of large bowel obstructions occur in the sigmoid colon.

28
Q

In the case of bowel obstruction what are the indications for emergency surgery?

A

Clinically unstable patients with a life-threatening condition.
Includes evidence of confirmed or pending - perforation, ischaemia, necrosis.

29
Q

What is the most common cause of small bowel obstruction?

A

Adhesions (90%) - most likley in patients with a history of previous abdominal surgery.
Hernias also common

30
Q

How does the management plan for bowel obstruction tend to change based on the cause of the obstruction?

A

If adhesive SBO’s -try conservative - most resolve on own, surgery would inc risk of further adhesions
Non-adhesive - tend to require surgery.

31
Q

What is more common small or large bowel obstruction?

A

Small bowel

32
Q

What are the features of a small bowel obstruction on an x-ray?

A

Central positions of gas-filled and distended loops of bowel
Valvulae conniventes - white lines passing full width of bowel - muscoal foldings.

33
Q

What are the main causes of large bowel (colorectal) obstruction?

A

Colon cancer - 60% - is the presenting complaint in 30% of colon cancer diagnosis
Volvulus
Severely impacted constipation.

34
Q

What is the surgical management required for large bowel (colorectal) obstruction?

A

75% of cases require surgical intervention
Colorectal resections are common.

35
Q

What are the features shown on the x-ray?
What diagnosis do they suggest?

A

Suggest a large bowel obstruction
Dilated transverse and sigmoid colon
Abrupt cut-off at point of obstruction
Haustra - pouches formed by mucosa, do not extend full width of the bowel.

36
Q

What are some potential complications of a bowel obstruction and its management?

A

Surgical treatment - increase risk of adhesion and repeat obstruction, short bowel syndrome
Perforated bowel - peritonitis
Aspiration - pneumonia
Strangulated bowel and ischemia/necrosis - sepsis

37
Q

What is meant by a closed loop obstruction?

A

When the section of the bowel is obstructed at both sides, so content can not drain proximally or distally
Can be caused be two adhesion, hernias (with a loop of bowel out), large bowel obstruction + a competent ileocaecal valve.
Is an emergency, more likely to continue to expand leading to ischemia and necrosis.

38
Q

What is the epidemiology of bowel obstruction?

A

80% small bowel obstructions
SI obstruction - Found in around 10% of over 65yrs presenting to A&E with abdominal pain
6% mortality rate, increasing to over 10% when surgery is required.

Surgery block (14 decks)

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