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ms3 - gi > Bowel obstruction > Flashcards

Bowel obstruction Flashcards

1
Q

Classification of bowel obstruction

A

1) Simple
2) Closed loop
3) Strangulated

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2
Q

Simple bowel obstruction

A

One obstructing point
No vascular compromise
Partial or complete

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3
Q

Closed loop bowel obstruction

A

2 obstructing points - usually due to competent ileocaecal valve or volvulus
Gross distention -> perforation

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4
Q

Common causes of small bowel obstruction

A

Adhesions

Hernia

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5
Q

Large bowel obstruction

A

CRC
Diverticular stricture
Volvulus

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6
Q

Non mechanical bowel obstruction

A

Paralytic ileus

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7
Q

Causes of paralytic ileus

A 
Post op
Peritonitis
Pancreatitis
Metabolic: ↓K, ↓Na, ↓Mg, uraemia
Mesenteric ischaemia
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8
Q

Mechanical causes of bowel obstruction

A

Luminal
Mural
Extra-mural

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9
Q

Luminal causes of bowel obstruction

A

Impacted faeces
Intussusception
Gallstones

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10
Q

Mural causes of bowel obstruction

A 
Benign stricture (IBD, colitis)
CRC
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11
Q

Extra-mural causes of bowel obstruction

A

Hernia
Adhesions
Volvulus
Extrinsic compression

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12
Q

Presentation of bowel obstruction

A

Colic abdo pain
Abdo distension
Vomiting / nausea
Absolute constipation

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13
Q

Bowel sounds with bowel obstruction

A

Mechanical obstruction - increased bowel sounds (“tinkling”)

Ileus - absent

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14
Q

Investigations for bowel obstruction

A

Increased amylase and lactate if perforated
Erect CXR - pneumoperitoneum if perf
AXR
Colonoscopy +/- stent

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15
Q

AXR findings in bowel obstruction

A

Small bowel:

  • > 3 cm diameter
  • Central
  • Valvulae coniventes

Large bowel:

  • > 6 cm
  • Peripheral
  • Haustra
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16
Q

Valvulae coniventes

A

Lines completely across bowel on AXR

Small bowel

17
Q

Haustra

A

Lines partially across bowel on AXR

Large bowel

18
Q

Ileus AXR findings

A

Both small and large bowel may be visible

19
Q

Medical management of bowel obstruction

A 
NBM
IV fluids
NGT
Catheter
Analgesia
Abx (cef+met)
20
Q

Abx for strangulation or perforation

A

Ceftriaxone + Metronidazole

21
Q

Indications for surgical management of bowel obstruction

A

Closed loop obstruction
Obstructing neoplasm
Strangulation / perf
Failure of medical Mx (> 72 hrs)

22
Q

Surgical options for bowel obstruction

A 
Adhesiolysis
Hartmann's procedure
Colectomy
Palliative stent bypass procedure
Loop ileostomy
Caecostomy
23
Q

Most common site of volvulus

A

Sigmoid

24
Q

Sigmoid volvulus AXR findings

A

Coffee bean sign

25
Q

Management of sigmoid volvulus

A

Sigmoidoscopy and flatus tube insertion
Sigmoid colectomy occasionally required
Often recurs - elective sigmoidectomy

ms3 - gi (16 decks)

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