Bowel obstruction Flashcards by K D

Q

Classification of bowel obstruction

A

1) Simple
2) Closed loop
3) Strangulated

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Q

Simple bowel obstruction

A

One obstructing point

No vascular compromise

Partial or complete

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Q

Closed loop bowel obstruction

A

2 obstructing points

Gross distention -> perforation

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Q

Cause of closed loop obstruction

A

volvulus

or ileocaecal valve incompetence

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Q

Common causes of small bowel obstruction

A

Adhesions

Hernia

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Q

Large bowel obstruction cause

A

CRC

Diverticular stricture

Volvulus

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Q

Non mechanical bowel obstruction

A

Paralytic ileus

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Q

Causes of paralytic ileus

A

Post op

Peritonitis

Pancreatitis

Metabolic: ↓K, ↓Na, ↓Mg, uraemia

Mesenteric ischaemia

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Q

Mechanical causes of bowel obstruction

A

Luminal

Mural

Extra-mural

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Q

Luminal causes of bowel obstruction

A

Impacted faeces

Intussusception

Gallstones

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Q

Mural causes of bowel obstruction

A

Benign stricture (IBD, colitis)

CRC

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Q

Extra-mural causes of bowel obstruction

A

Hernia

Adhesions

Volvulus

Extrinsic compression

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Q

Presentation of bowel obstruction

A

Colic abdo pain

Abdo distension

Vomiting / nausea

Absolute constipation

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Q

Bowel sounds with bowel obstruction

A

Mechanical obstruction - increased bowel sounds (“tinkling”)

Ileus - absent

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Q

Investigations for bowel obstruction

A

Increased amylase and lactate if perforated

Erect CXR - pneumoperitoneum if perf

AXR

Colonoscopy +/- stent

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Q

Small bowel AXR findings in bowel obstruction

A

Small bowel:

> 3 cm diameter
Central
Valvulae coniventes

Q

Large bowel AXR findings in bowel obstruction

A

> 6 cm
Peripheral
Haustra

Q

Valvulae coniventes

A

Lines completely across bowel on AXR

Small bowel

Q

Haustra

A

Lines partially across bowel on AXR

Large bowel

Q

Ileus AXR findings

A

Both small and large bowel may be visible

Q

Medical management of bowel obstruction

A

NBM

IV fluids

NGT

Catheter

Analgesia

Abx (cef+met)

Q

Abx for strangulation or perforation

A

Ceftriaxone + Metronidazole

Q

Indications for surgical management of bowel obstruction

A

Closed loop obstruction

Obstructing neoplasm

Strangulation / perf

Failure of medical Mx (> 72 hrs)

Q

Surgical options for bowel obstruction

A

Adhesiolysis

Hartmann’s procedure

Colectomy

Palliative stent bypass procedure

Loop ileostomy

Caecostomy

Q

Most common site of volvulus

A

Sigmoid

Q

Sigmoid volvulus AXR findings

A

Coffee bean sign

Q

Management of sigmoid volvulus

A

Sigmoidoscopy and flatus tube insertion

Sigmoid colectomy occasionally required

Often recurs - elective sigmoidectomy