Bowel obstruction

Question 1

Difference between SBO and LBO on Xray?

Answer 1

Question 2

List some causes of SBO. What are the top 3 causes?

Answer 2

Top 3 causes - ABC

1. Adhesions
2. Bulge (hernias)
3. Cancer (neoplasms)

SHAVING

• Stricture
• Hernia
• Adhesions
• Volvulus
• Intussusception/IBD
• Neoplasm
• Gallstones

Question 3

Risk factors for SBO?

Answer 3

• prior abdominal or pelvic surgery
• abdominal wall or groin hernia
• history of malignancy
• prior radiation

Question 4

What are the 3 typs of SBO?

Answer 4

1. Partial
2. Complete
3. Closed loop

Question 5

Symptoms of SBO

Answer 5

• Nausea + vomiting
• Abdo pain
• Lack of bowel movements, lack of flatus
• Abdo distended
• Fevers/other symptoms consistent with sepsis – esp in the setting of perforation

Question 6

What are the top 3 causes for LBO?

Answer 6

• Cancer
• Volvulus
• Diverticulitis

Question 7

When should you consider impending perforation in a patient with LBO?

Answer 7

In a patient with clinical LBO consider impending perforation when:
• Cecum 12 cm in diameter
• Tenderness present over cecum

Question 8

List some causes of LBO

Answer 8

INTRALUMINAL

• constipation
• forgein body

INTRAMURAL

• adenocarcinoma
• diverticulitis
• IBD stricture
• radiation stricutre

EXTRAMURAL

• volvlulus
• adhesions
• hernias

Question 9

How to differentiate between bowel obstruction and paralytic ileus?

Answer 9

Question 10

Investigations for bowel obstruction

Answer 10

• Bloods
• Imaging
  
  • XRAY
  • CT
  • Gastrograffin/contrast studies

Question 11

Important things to examine in suspected bowel obstruction

Answer 11

• Vitals
• Signs of sepsis
• Abdo tenderness/peritonism
• Rectal faecal material – DRE
• Dehydration
• Bowel sounds
  
  • Functional obstruction = no bowel sounds
  • Mechanical = bowel working extra hard, tinkling sounds
• Scars
• Stigmata of malignancy

Question 12

Treatment of bowel obstruction

Answer 12

• Resuscitate: IV fluids, replace electrolytes
• Decompression: NG, rectal tube
• Strict urine output
• NBM
• Conservative vs surgical
  
  • Systemic compromise
  • Evidence of strangulation
  • Non-resolving with conservative methods
  • Closed loop (ileocaecal valve)
  • If ileus / pseudo-obstruction = mobilise, aperiants, pro-kinetics, correct electrolytes
    
    • Make sure there is no mechanical obstruction before giving pro kinetics
    • Erythromycin, metoclopramide