Bowel Obstruction Flashcards
Where can bowel obstruction occur
Any part of GI tract
Presentation of upper small bowel obstruction
Acute presentation, within hours of onset, large volumes vomited
Presentation of small/large bowel obstruction
Colicky abdominal pain and distension
Vomiting - Possibly faeculant
Can vomiting occur in the absence of food
Yes, as GI secretions can be vomited up
Semi-digested food eaten a day or two previously (no bile) suggests
Gastric outflow obstruction
Copious bile-stained fluid vomit suggests
Small bowel obstruction
Thicker, brown, foul-smelling vomitus (‘faeculent’)
Large bowel obstruction
Closed loop obstruction and the caecum
Thin walled caecum may progressively distend and eventually rupture
Vomiting pattern in partial obstruction of the intestine
Vomiting may be intermittent and bowel habit erratic
Chronic incomplete obstruction leads to what change in muscles of bowel wall proximally
Hypertrophy which is responsible for colicky pain
Signs of intestinal obstruction
Dehydration
Abdominal distension
Visible peristalsis
Abdominal mass may be palpable
On percussion, centre of abdomen tends to be gaseous due to gaseous distension
Groins must be examined for obstructing hernia
High pitched and tinkling bowel sound
Intestinal obstruction
Investigating bowel obstruction
Supine abdominal x-ray
Bowel proximal to obstruction is distended with gas
CT scan in investigating bowel obstruction
Confirm diagnosis and look for a cause. Transition point on CT is often seen with distended proximal bowel and collapsed bowel distal to site of obstruction
Management of intestinal obstruction
Nothing by mouth
Insert IV cannulae and take bloods
Resuscitate with IV fluids, replacing electrolyte loss
Pass a NG tube to decompress stomach
Adhesions or band bowel obstruction common cause
Surgery but can be congenital
Femoral vs Inguinal hernia
Inguinal hernia is superior and medial to pubic tubercle whereas femoral is inferior and lateral to pubic tubercle
Coffee bean shape on erect abdominal x-ray
Caecal volvulus
Inflammatory mechanical causes of bowel obstruction
Inflammatory strictures such as Crohns disease or diverticular disease
These obstructions are usually incomplete
What is bowel strangulation
Segment of bowel becomes trapped
Venous return is obstructed. This leads to a rising ntra vascular pressure conpromising arterial inflow. If strangulation is not relieved, infarction and perforation occurs
Pain over hernia is a sign on
Bowel strangulation, requires urgent surgery
What is paralytic ileus
Distruption of normal propulsive activity of GI tract due to failure of peristalsis
Risk factors for paralytic ileus
Recent GI surgery
Inflammation with peritonitis
Diabetic keto acidosis
Treatment for paralytic ileus
Drip and suck -
Insert NG tube to decompress bowel (suck)
Start IV fluids and correct any electrolyte imbalance (drip)
