Bowel Obstruction Flashcards
Define bowel obstruction.
Partial or complete blockage of the bowel that results in failure of the intestinal contents to pass
What are the three different groupings of classification of bowel obstruction?
Small bowel vs large bowel
Complete vs partial (complete no gas or faeces)
Acute vs chronic
What classification of bowel obsruction is always an acute situation?
Complete obstruction
What are the three main causes of bowel obstruction?
Adhesions
Hernias
Malignancy.
What are all potential causes of bowel obstruction?
Three main: adhesions, hernias, malignancy
Other causes:
Volvulus
Stricture - 2 to Crohns or diverticular disease
What background questions are important to ask a patient to help determine the cause of a bowel obstruction?
Hernias
Change in bowel habit, weight loss, PR bleeding
Previous abdominal surgery may have resulted in adhesions.
What are the three different classifications of bowel obstructions based on the location relative to the bowel wall?
Intraluminal - in the lumen - ingestion of a foreign body
Intramural - in the wall - cancers,
Extramural - outside the wall - hernias, cancer, adhesions
What is the difference between a dynamic (mechanical) and adynamic bowel obstruction?
Dynamic - physical blockage aka foreign body
Adynamic - failure of peristalsis, muscular or neurogenic.
What is the difference between a simple and a strangulated bowel obstruction?
Simple - blood flow is not compromised manage conservativly
Strangulated - blood flow is compromised is a surgical emergency
What are some common causes of obstructed bowel by age group?
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.
What is a volvulus?
When the intestines twist around itself and its supplying mesentery - results in cut of blood supply to this section of bowel.
What is intussusception?
When the bowel folds into the section next to it, telescopes - cause of bowel obstruction.
What are the key signs and symptoms of a bowel obstruction?
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
What are the cardinal symptoms of bowel obstruction?
Colicky abdominal pain
Vomiting
Distention
Obstipation/constipation
How do the symptoms differ between a high/low small bowel obstruction and a large bowel obstruction?
High - early vomiting
Low SI - distention and vomiting
Large - constipation, vomiting is later to develop