Bowel Obstruction Flashcards
0
Q
Causes of adhesions?
A
Ischemia
Mechanical trauma
Prolonged ileus
1
Q
What are causes of bowel obstruction?
A
Top 3
Adhesions
Hernias
Carcinoma
Other causes Diverticulitis Crohn's disease Intussusception Volvulus Gallstone ileus
2
Q
Presentation?
A
ABDO distension Colicky generalized ABDO pain Vomiting (unless LBO due to competent illeocaecal valve) Altered bowel motions Dehydration
3
Q
Evidence of complicated obstruction?
A
Pain becomes constant
Pain Localizes
Fever, tacky, leukocytosis
4
Q
Ix for rad?
A
Abdominal xray
- paucity of colonic gas for SBO
- air fluid levels on erect
Complete obstruction if gas is absent in distal intestine.
Sigmoid volvulus - coffee bean sign
CT most commonly to differentiate
- partial from complete
- level of obstruction
- identify possible tumour masses
- differentiate LBO from pseudo-obstruction
5
Q
When are you worried about perforation?
A
Small bowel > 3cm
Large vowel > 6cm
Caecum > 9cm
6
Q
Which is more dangerous SBO or LBO?
A
LBO because there is a closed loop
7
Q
Rx?
A
SBO
- complete: stabilize IV FLUIDS triples then laparotomy
- if partial/surgery contraindicated: NGT decompression and IV fluids
- if partial SBO does not resolve then laparotomy
- SBO obstructions secondary to oedema should resolve spontaneously
LBO: laparotomy due to closed loop
