Bowel Obstruction Flashcards
what are the cardinal features of intestinal obstruction
vomiting, colicky pain, constipation, distension
features
vomiting, nausea, anorexia, faeculent vomiting (fermentation intestinal contents in established obstruction), colic, constipation, distension, active tinkling bowel sounds
is anything passed if the obstruction is distal
no. if it is higher up the constipation may not be complete
what is faeculent v faecal vomiting
faeculent- fermentation of intestinal contents in established obstruction. faecal- colonic fistula with the proximal gut
causes of small bowel obstruction
adhesions, herniae
causes of large bowel obstruction
colonic carcinoma, constipation, diverticular stricture, volvulus
rarer causes of obstruction
crohns stricture, gallstone ileus, TB, FB, intussusception
features small bowel obstruction
vomiting is earlier, less distension, pain is higher up in the abdomen
what does AXR show in small bowel obstruction
central gas shadows with valvulae conniventes- completely cross lumen and no gas in large bowel
features large bowel obstruction
pain is more constant
what does AXR show in large bowel obstruction
peripheral gas shadows proximal to the blockage. large bowel haustra do not cross all lumens width.
what is an ileus
functional obstruction due to decr bowel motility
features ileus
no pain and absent bowel sounds
what is a simple obstruction
one obstructing point and no vascular compromise
what is a closed loop obstruction
obstruction at 2 points forming a loop of grossly distended bowel at risk of perforation
what is a strangulated obstruction
blood supply compromised and patient more ill than you would expect. sharper more constant and localised pain. peritonism
management
strangulation and large bowel- surgery, ileus and incomplete small bowel- conservatively. immed management- drip and suck- NGT and IV fluids- rehydrate and correct electrolytes. analgesia, bloo. CTds- amylase, FBC U&E, AXR, erect CXR, catheterise
what is paralytic ileus
adynamic bowel due to absence of normal peristaltic contractions.
factors leading to paralytic ileus
abdominal surgery, pancreatitis, spinal injury, hypokalaemia, hyponatraemia, uraemia, peritoneal sepsis, drugs (TCAs)
what is a pseudo obstruction
mechanical obstruction but no cause
what is sigmoid volvulus
bowel twists on its mesentery- severe rapid strangulated obstruction. more likely in elderly, constipated, co morbid
what is the characteristic AXR for sigmoid volvulus
inverted U loop looks like a coffee bean.
management sigmoid volvulus
sigmoidoscopy, insertion flatus tube, sigmoid colectomy
what is volvulus of the stomach
rare. closed loop, incarceration and strangulation. gastro oesophageal obstruction- vomiting (then retching), pain, failed attempts to pass an NG tube.
