Bowel Obstruction Flashcards
What are the signs and symptoms of bowel obstruction?
Complete constipation
Abdominal pain - tenderness
Large quantities of vomit (bile-stained)———–> dehydration
Absent passage of meconium
Abdo distension
Auscultation - high pitched = mechanical obstruction, over time bowel sounds disappear
What are the paediactric differenitials for bowel obstruction?
Malrotation volvulus (bilious vomiting should be considered malrotation until proven otherwise)
Intususception
Incarcerated hernia
Pyloric stenosis
What is important in the management of bowel obstruction?
Correcting the cause.
Fluid and electrolyte balance as patient likely to be dehydrated.
What is pyloric stenosis?
Diffuse hypertrophy and hyperplasia of the smooth muscle of the antrum of the stomach and pylorus.
The pyloric muscle hypertrophy results in narrowing of the pyloric canal, which can then become easily obstructed.
How does pyloric stenosis present?
Presents in children at 2-8 weeks.
Presents with projectile vomiting shortly after feeding (30mins usually). Vomiting will increase in frequency and intensity.
Dehydration, hunger, lethargy and failure to thrive.
Stomach wall peristalsis may be visible.
An enlarged pylorus, classically described as an ‘olive’, may be palpated in the right upper quadrant or epigastrium. It is mostly easily felt jut after a feed.
What are the investigations which are important in a child that you suspect to have pyloric stenosis?
U/e’s as patients will often have a metabolic alkalosis and hypokalaemia.
Ultrasound to confirm the diagnosis.
How is pyloric stenosis managed?
Fluids to correct the electrolyte imbalance
Pyloromyotomy: a surge in anncision is made in the longitudinal and circular muscles of the pylorus.
What is the cause of the electrolyte imbalance seen in pyloric stenosis?
Alkalosis is due to the patient vomiting out H+ ions. Due to this the kidney tries to maintain H+ by using a K+/H+ co transporter and therefore sacrifices K+ for H+ causing hypokalaemia.
