Bowel obstruction Flashcards
Presentation of bowel obstruction
Colicky pain (periumbilical or suprapubic) Abdo distension Absolute constipation Faeculant vomiting
Clinical signs of bowel obstruction
Visible peristalsis Abdo distension Borborygymi Fever Signs of dehydration Hypotension Tachycardia
Causes of SBO
Adhesions Hernia Tumours - most commonly affecting ileocaecal valve Strictures Foreign bodies
Causes of LBO
Tumour Diverticular disease Volvulus Interception - more common in children (bowel drawn in and distal portion dilated) Obturator hernia
Describe obturator hernias
Seen in frail, elderly women
Referred knee pain
X-ray shows gas below inferior pubic rami
Management for bowel obstruction
NBM Analgesia Antiemetics Fluids Start TPN on diagnosis of small bowel obstruction SURGERY
Specific management for adhesional SBO
Drip and suck
Give fluids + put in NG tube at least 45cm in for suction
Specific management for sigmoid volvulus
Try endoscopic decompression with a rigid sigmoidoscope
Features of a strangulated hernia
Tender, non reducible lump at hernia orifice
Skin erythema
Bowel obstruction
Systemically unwell
Consequences of LBO with competent ileocaecal valve
No vomiting
Caecum likely to perforate
Describe pseudo obstruction
Sigmoid colon and rectum dilation but can’t pass wind due to poor colonic tone with good anal tone
Risk factors for pseudo obstruction
Parkinson’s disease drugs
Immobility
Hypernatraemia
Chronic constipation
Treatment for pseudo obstruction
Flatus decompression - can be done by DRE or proctoscope/sigmoidoscope
Prokinetic drugs - macrolides, neostigmine
Treatment for colon carcinoma causing LBO
Hartmann’s - proctosigmoidectomy with end ileostomy
