bowel obstruction Flashcards
Intussusception
segment of the bowel wall becomes telescoped into the segment distal to it
Intussusception stools
currant jelly
Intussusception US
bullseye appearance
who is Intussusception common in
children
what is the most common cause of Intussusception in children
lymphoid hyperplasia due to rotavirus
what is the most common cause of Intussusception in adults
tumours
who does volvulus normally occur in and what are the clinical features
in the elderly in the sigmoid colon
Presents with abdominal pain, distension and constipation
common locations of volvulus in YP
caecum
volvulus diagnosis
AXR
volvulus treatment
flatus tube or surgical resection
causes of small bowel obstruction
adhesions
hernias
causes of large bowel obstruction
colonic cancer
volvulus
face impaction
diverticular disease
rarer causes of obstruction
crohn stricture gallstone ileus intussusception TB foreign body
CF
vomiting
constipation
distension
colicky pain
compare vomiting timing
the more proximal the obstruction the earlier it occurs
compare vomiting
semi digested food - gastric outlet obstruction
bile stained fluid (green) - upper small bowel obstruction
faeculent (thick, brown, foul smelling) - distal obstruction
compare pain
more constant in large bowel obstruction
compare distension
less in small bowel obstruction
other CF
dehydration
relative lack of abdominal tenderness
percussion
centre of abdomen resonant often
auscultation
tinkling and high pitched bowel sounds
investigations
AXR supine
CT
treatment
NBM
insert IV cannula and give IV fluids
NG tube to decompress stomach (remove contents)
Paralytic ileus
absence of normal peristaltic contractions
Paralytic ileus CF
similar to obstruction although pain and high pitched bowel sounds less common
pseudo obstruction
mechanical GI obstruction but with no causes for obstruction found
pseudo obstruction acute is called
Ogilvie’s syndrome
pseudo obstruction associated with
hip replacement, CABG, spinal anaesthesia, pneumonia -
all associated with frail/elderly patients
strangulation pain
sharper and more localised
strangulation CF
signs of sepsis acutely unwell shock multisystem organ failure death
strangulation treatment
urgent surgery
