bowel obstruction

Question 1

Intussusception

Answer 1

segment of the bowel wall becomes telescoped into the segment distal to it

Question 2

Intussusception stools

Answer 2

currant jelly

Question 3

Intussusception US

Answer 3

bullseye appearance

Question 4

who is Intussusception common in

Answer 4

children

Question 5

what is the most common cause of Intussusception in children

Answer 5

lymphoid hyperplasia due to rotavirus

Question 6

what is the most common cause of Intussusception in adults

Answer 6

tumours

Question 7

who does volvulus normally occur in and what are the clinical features

Answer 7

in the elderly in the sigmoid colon

Presents with abdominal pain, distension and constipation

Question 8

common locations of volvulus in YP

Answer 8

caecum

Question 9

volvulus diagnosis

Answer 9

AXR

Question 10

volvulus treatment

Answer 10

flatus tube or surgical resection

Question 11

causes of small bowel obstruction

Answer 11

adhesions

hernias

Question 12

causes of large bowel obstruction

Answer 12

colonic cancer
volvulus
face impaction
diverticular disease

Question 13

rarer causes of obstruction

Answer 13

crohn stricture 
gallstone ileus
intussusception 
TB 
foreign body

Question 14

CF

Answer 14

vomiting
constipation
distension
colicky pain

Question 15

compare vomiting timing

Answer 15

the more proximal the obstruction the earlier it occurs

Question 16

compare vomiting

Answer 16

semi digested food - gastric outlet obstruction
bile stained fluid (green) - upper small bowel obstruction
faeculent (thick, brown, foul smelling) - distal obstruction

Question 17

compare pain

Answer 17

more constant in large bowel obstruction

Question 18

compare distension

Answer 18

less in small bowel obstruction

Question 19

other CF

Answer 19

dehydration

relative lack of abdominal tenderness

Question 20

percussion

Answer 20

centre of abdomen resonant often

Question 21

auscultation

Answer 21

tinkling and high pitched bowel sounds

Question 22

investigations

Answer 22

AXR supine

CT

Question 23

treatment

Answer 23

NBM
insert IV cannula and give IV fluids
NG tube to decompress stomach (remove contents)

Question 24

Paralytic ileus

Answer 24

absence of normal peristaltic contractions

Question 25

Paralytic ileus CF

Answer 25

similar to obstruction although pain and high pitched bowel sounds less common

Question 26

pseudo obstruction

Answer 26

mechanical GI obstruction but with no causes for obstruction found

Question 27

pseudo obstruction acute is called

Answer 27

Ogilvie’s syndrome

Question 28

pseudo obstruction associated with

Answer 28

hip replacement, CABG, spinal anaesthesia, pneumonia -

all associated with frail/elderly patients

Question 29

strangulation pain

Answer 29

sharper and more localised

Question 30

strangulation CF

Answer 30

signs of sepsis 
acutely unwell 
shock 
multisystem organ failure 
death

Question 31

strangulation treatment

Answer 31

urgent surgery