Bowel Obstruction

Question 1

what are the cardinal features of intestinal obstruction

Answer 1

vomiting, colicky pain, constipation, distension

Question 2

features

Answer 2

vomiting, nausea, anorexia, faeculent vomiting (fermentation intestinal contents in established obstruction), colic, constipation, distension, active tinkling bowel sounds

Question 3

is anything passed if the obstruction is distal

Answer 3

no. if it is higher up the constipation may not be complete

Question 4

what is faeculent v faecal vomiting

Answer 4

faeculent- fermentation of intestinal contents in established obstruction. faecal- colonic fistula with the proximal gut

Question 5

causes of small bowel obstruction

Answer 5

adhesions, herniae

Question 6

causes of large bowel obstruction

Answer 6

colonic carcinoma, constipation, diverticular stricture, volvulus

Question 7

rarer causes of obstruction

Answer 7

crohns stricture, gallstone ileus, TB, FB, intussusception

Question 8

features small bowel obstruction

Answer 8

vomiting is earlier, less distension, pain is higher up in the abdomen

Question 9

what does AXR show in small bowel obstruction

Answer 9

central gas shadows with valvulae conniventes- completely cross lumen and no gas in large bowel

Question 10

features large bowel obstruction

Answer 10

pain is more constant

Question 11

what does AXR show in large bowel obstruction

Answer 11

peripheral gas shadows proximal to the blockage. large bowel haustra do not cross all lumens width.

Question 12

what is an ileus

Answer 12

functional obstruction due to decr bowel motility

Question 13

features ileus

Answer 13

no pain and absent bowel sounds

Question 14

what is a simple obstruction

Answer 14

one obstructing point and no vascular compromise

Question 15

what is a closed loop obstruction

Answer 15

obstruction at 2 points forming a loop of grossly distended bowel at risk of perforation

Question 16

what is a strangulated obstruction

Answer 16

blood supply compromised and patient more ill than you would expect. sharper more constant and localised pain. peritonism

Question 17

management

Answer 17

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

Question 18

what is paralytic ileus

Answer 18

adynamic bowel due to absence of normal peristaltic contractions.

Question 19

factors leading to paralytic ileus

Answer 19

abdominal surgery, pancreatitis, spinal injury, hypokalaemia, hyponatraemia, uraemia, peritoneal sepsis, drugs (TCAs)

Question 20

what is a pseudo obstruction

Answer 20

mechanical obstruction but no cause

Question 21

what is sigmoid volvulus

Answer 21

bowel twists on its mesentery- severe rapid strangulated obstruction. more likely in elderly, constipated, co morbid

Question 22

what is the characteristic AXR for sigmoid volvulus

Answer 22

inverted U loop looks like a coffee bean.

Question 23

management sigmoid volvulus

Answer 23

sigmoidoscopy, insertion flatus tube, sigmoid colectomy

Question 24

what is volvulus of the stomach

Answer 24

rare. closed loop, incarceration and strangulation. gastro oesophageal obstruction- vomiting (then retching), pain, failed attempts to pass an NG tube.

Question 25

treat volvulus of stomach

Answer 25

prompt resus and laparotomy