Bowel Obstruction

Question 1

Where can bowel obstruction occur

Answer 1

Any part of GI tract

Question 2

Presentation of upper small bowel obstruction

Answer 2

Acute presentation, within hours of onset, large volumes vomited

Question 3

Presentation of small/large bowel obstruction

Answer 3

Colicky abdominal pain and distension

Vomiting - Possibly faeculant

Question 4

Can vomiting occur in the absence of food

Answer 4

Yes, as GI secretions can be vomited up

Question 5

Semi-digested food eaten a day or two previously (no bile) suggests

Answer 5

Gastric outflow obstruction

Question 6

Copious bile-stained fluid vomit suggests

Answer 6

Small bowel obstruction

Question 7

Thicker, brown, foul-smelling vomitus (‘faeculent’)

Answer 7

Large bowel obstruction

Question 8

Closed loop obstruction and the caecum

Answer 8

Thin walled caecum may progressively distend and eventually rupture

Question 9

Vomiting pattern in partial obstruction of the intestine

Answer 9

Vomiting may be intermittent and bowel habit erratic

Question 10

Chronic incomplete obstruction leads to what change in muscles of bowel wall proximally

Answer 10

Hypertrophy which is responsible for colicky pain

Question 11

Signs of intestinal obstruction

Answer 11

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

Question 12

High pitched and tinkling bowel sound

Answer 12

Intestinal obstruction

Question 13

Investigating bowel obstruction

Answer 13

Supine abdominal x-ray

Bowel proximal to obstruction is distended with gas

Question 14

CT scan in investigating bowel obstruction

Answer 14

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

Question 15

Management of intestinal obstruction

Answer 15

Nothing by mouth
Insert IV cannulae and take bloods
Resuscitate with IV fluids, replacing electrolyte loss
Pass a NG tube to decompress stomach

Question 16

Adhesions or band bowel obstruction common cause

Answer 16

Surgery but can be congenital

Question 17

Femoral vs Inguinal hernia

Answer 17

Inguinal hernia is superior and medial to pubic tubercle whereas femoral is inferior and lateral to pubic tubercle

Question 18

Coffee bean shape on erect abdominal x-ray

Answer 18

Caecal volvulus

Question 19

Inflammatory mechanical causes of bowel obstruction

Answer 19

Inflammatory strictures such as Crohns disease or diverticular disease
These obstructions are usually incomplete

Question 20

What is bowel strangulation

Answer 20

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

Question 21

Pain over hernia is a sign on

Answer 21

Bowel strangulation, requires urgent surgery

Question 22

What is paralytic ileus

Answer 22

Distruption of normal propulsive activity of GI tract due to failure of peristalsis

Question 23

Risk factors for paralytic ileus

Answer 23

Recent GI surgery
Inflammation with peritonitis
Diabetic keto acidosis

Question 24

Treatment for paralytic ileus

Answer 24

Drip and suck -
Insert NG tube to decompress bowel (suck)
Start IV fluids and correct any electrolyte imbalance (drip)

Question 25

What is Oglivie’s syndrome

Answer 25

Pseudo-obstruction.

Acute dilation of the colon in the absence of colonic obstruction in acutely unwell patients

Question 26

Oglivie’s syndrome is associated wtih

Answer 26

Hip replacement surgery
CABG
Pneumonia
Frail/elderly patients

Question 27

Treatment for Oglivie’s syndrome

Answer 27

Colonoscopic decompression if distention is causing pain or respiratory discomfort