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GI > Bowel Obstruction > Flashcards

Bowel Obstruction Flashcards

1
Q

what happens to the bowel proximal to an obstruction

A

dilatation with air and fluid

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2
Q

how can an upper small bowel obstruction present

A

acutely, hours of onset, large volumes (of gastric, pancreatic and biliary secretions) vomited

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3
Q

how does a distal/ large bowel obstruction present

A

colicky abdominal pain and distention, vomiting (possibly faeculent)

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4
Q

what are the symptoms of intestinal obstruction

A

vomiting, pain (colicky), constipation, distention, complete/ incomplete obstruction

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5
Q

what determines when vomiting develops

A

hoe proximal the obstructions- the more proximal the earlier the vomiting

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6
Q

what causes vomiting when nothing is taken by mouth

A

GI secretions- saliva, gastric, pancreatic, bile, small intestine

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7
Q

what about the vomitus gives clues to the level of obstruction

A

nature of vomitus

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8
Q

vomitus: what does semi digested food eaten a day/ two before suggest

A

no bile, obstruction in gastric outlet

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9
Q

vomitus: what does copious bile stained fluid suggest

A

upper small bowel obstruction

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10
Q

vomitus: what does thicker, brown, foul-smelling vomitus suggest

A

faeculent vomiting, a more distal obstruction

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11
Q

what causes pain in bowel obstruction

A

distention of the bowel, intermittent episodes of colicky pain ( as peristalsis tries to overcome the obstruction)

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12
Q

what causes distention of the bowel

A

swallowed air and intestinal fluid secreted proximal to an obstruction

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13
Q

describe the onset of symptoms in large bowel obstructions

A

more gradually as large bowel has more capacity and absorptive capacity

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14
Q

what is prevented in large bowel obstruction if the ileocaecal valve is competent

A

backflow of accumulated contents

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15
Q

what is a closed loop obstruction and what can is cause

A

when thin walled caecum progressively distends and eventually may rupture

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16
Q

why is the caecum at most risk of rupturing

A

thin walls

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17
Q

what happens if the ileoceacal valve becomes incompetent

A

small bowel distends and the onset of symptoms is delayed

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18
Q

what are the symptoms of incomplete bowel obstruction

A

intermittent vomiting and erratic bowel habit

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19
Q

what does chronic incomplete obstruction leads to

A

gradual hypertrophy of the muscle of the bowel proximally- creates pain during peristalsis in this area

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20
Q

what are the physical signs of intestinal obstruction

A

dehydration, abdominal distention, visible peristalsis, relative lack of abdominal tenderness, possible palpable mass, resonant to percussion, possible hernia, high pitched- tinkling bowel sounds

21
Q

what investigations should be done initially

A

supine abdo x ray- bowel proximal will be distended with gas

22
Q

what do erect x rays show

A

air fluid levels- not done now

23
Q

what does distended bowel look like on x ray

A

black with air, in anatomical position, has haustra coli

24
Q

what is a CT used for

A

to look for cause and find transition site between distended bowel proximal and collapsed bowel distal

25
Q

how is an intestinal obstruction initially managed

A

nil by mouth, IV cannula, fluid resus, replace electrolytes, NG tube to decompress the stomach

26
Q

what are the mechanical causes of bowel obstruction

A 
adhesions or bands (congenital or post op or peritonitis),
hernia abdo wall or internal),
volvulus, 
tumour,
inflammatory strictures,
bolus obstruction,
intussusception
27
Q

how are adhesions or bands treated

A

drip and suck

28
Q

what are the types of abdo all hernias that can become incarcinated and cause bowel obstruction

A

inguinal, femoral, umbilical, paraumbilical, ventral, incisional

29
Q

what part of the bowel is most likely to get a volvulus

A

sigmoid

30
Q

how is a volvulus treated

A

colonscope

31
Q

what can happen when the bowel perforates

A

peritonitis

32
Q

what can cause inflammatory strictures

A

crohns disease, diverticular disease

33
Q

where are inflammatory strictures most common

A

in small bowel

34
Q

what can cause bolus obstruction

A

food bolus, impacted faeces, gallstone ileus, tichobezor (hairball)

35
Q

how does a gall stone get into the ileum

A

fistula

36
Q

what is intussusception

A

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

37
Q

what initiates intussusception

A

mass- enlargement of lymphatic tissue or tumour

38
Q

what happens to blood flow when bowel become obstructed

A

venous return is obstructed, rises local intra vascular pressure, arterial flow is compromised

39
Q

what happens if strangulation is not relieved

A

infarction and perforation

40
Q

what is the venous pressure of the gut

A

14 mmHg

41
Q

what does pain over a hernia suggest

A

bowel stangulation, required urgent surgical intervention

42
Q

what is adynamic bowel obstruction

A

paralytic ileus (post op) or pseudo-obstruction, failure of peristalsis

43
Q

what can cause a aparalytic ileus

A

recent GI surgery, inflammation with peritonitis, diabetic keto acidosis

44
Q

why dont you get colick in paralytic ileus

A

bowel is paralytic

45
Q

how do you treat a paralytic ileus

A

drip and suck

46
Q

what is ogilvies syndrome

A

pseudo-obstruction acute dilatation of the colon in the abscence of colonic obstruction (disruption of autonomic activity of the bowel)

47
Q

what is pseudo-obstruction associated with

A

hip replacement, CABG, spinal fracture, pneumonia, frail, eldery

48
Q

how do relieve pseudo-obstruction

A

colonoscopic depression

GI (64 decks)

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