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MET 3A > Bowel Obstruction > Flashcards

Bowel Obstruction Flashcards

1
Q

What are the 4 cardinal signs of bowel obstruction

A
  • Vomiting
  • Colicky pain
  • Absolute constipation
  • Distension
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2
Q

What would be heard in bowel obstruction

A

Tinkling bowel sounds

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3
Q

What are some common causes of small bowel obstruction

A
  • Hernias
  • Volvulus
  • Adhesions
  • Tumours
  • Crohns
  • Gallstone ileus
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4
Q

How do strictures appear

A

Strands of fibrous materials

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5
Q

What is the pain like in small bowel obstruction

A

Colicky pain often around umbilicus

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6
Q

What kind of abdominal x-ray is used

A

Supine

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7
Q

Define obstruction

A

Mechanical blockage arising from a structural abnormality that presents barrier to progression of gut contents

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8
Q

What is ileus

A

A paralytic/ functional variety of obstruction

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9
Q

What does obstruction result in?

A
  • Electrolyte imbalance
  • Increased peristalsis
  • Increased intraluminal pressure
  • Vomiting
  • Fluid from surrounding areas move into lumen
  • Lymphatic and venous congestion in oedamatous tissues
  • Localised anoxia, mucosal depletion necrosis perforation and peritonitis
  • Bacterial overgrowth and septicaemia
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10
Q

What hernias most commonly cause small bowel obstruction

A

Femoral

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11
Q

What is the site of obstruction when a hernia causes it

A

The neck of the hernia

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12
Q

How does a strangulated obstruction appear

A

Persistent pain
Discolouration
Tenderness

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13
Q

What would a CT be used for in bowel obstruction

A
  • Level of obstruction/ degree of obstruction
  • The cause (volvulus, hernia etc)
  • Degree of ischaemia
  • Free fluid and gas
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14
Q

Who shouldn’t barium be used in

A

Patients with peritonitis

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15
Q

What would be seen in a supine abdominal x-ray in somebody with small bowel obstruction

A
  • Central gas shadows
  • No gas in the large bowel
  • Valvulae connarentes that cross the lumen
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16
Q

What would be soon in a supine abdominal x-ray in somebody with large bowel obstruction

A
  • Peripheral gas shadows

- Haustra do not cross the lumen

17
Q

What is closed loop obstruction

A

Obstruction at two points, loop of grossly distended bowel at risk of perforation

18
Q

What are some causes of large bowel obstruction

A
  • Colon carcinoma
  • Constipation
  • Diverticular disease
  • Volvulus
19
Q

How do large and small bowel obstruction differ?

A

In small bowel obstruction, vomiting occurs earlier, pain is higher in the abdomen and distension is higher. In large bowel obstruction the pain is more constant

20
Q

What is ileus

A

A functional obstruction from reduced motility

21
Q

How do you identify ileus

A

No pain

Bowel sounds are absent

22
Q

What is pseudo obsutrction

A

Presents like a mechanical GI obstruction but there is no obvious cause

23
Q

Name some complications of bowel obstruction

A
  • Normal complications of carcinoma
  • Perforation and ischaemia of the bowel may cause peritonitis and septicaemia
  • Fluid and electrolyte imbalance
  • Acute, colonic pseudo-obstruction
24
Q

What could be seen in an NG tube

A

Faeculunt fluid in vomit or from an NG tube

25
Q

Describe the conservative management of bowel obstruction

A
  • Fluid resus and electrolyte replacement
  • Treat psudo- obstruction
  • Endoscopy can be used to complete intestinal decompression
  • Bowel rest
26
Q

Name some indications of early surgery

A
  • Peritonitis
  • Perforation
  • Irreducible hernia
  • Palpable mass
27
Q

In which type of bowel obstruction does biochemical derangement happen quicker

A

Small

28
Q

Describe the steps of biochemical derangement

A
  • Rapid build up of fluid and gas proximal to obstruction
  • Oedema and increased distention occur
  • Stasis and bacterial overgrowth make the fluid faeculant
29
Q

If there is an obstruction/ tumour in the caecum what surgery would be advised?

A

RIGHT HEMICOLECTOMY

- Removal of the right colon- ileocolic anastomosis

30
Q

If there is an obstruction/ tumour higher in the ascending colon what surgery would be advised

A

EXTENDED RIGHT HEMICOLECTOMY

- Right colon and portion of transverse colon removed

31
Q

When would a transverse colectomy be used?

A

Tumour in the transverse colon

32
Q

When would a sigmoid colectomy be used?

A

Tumour in the sigmoid colon`

33
Q

When would a Hartmann’s operation be used

A

Obstructing tumour in sigmoid colon

34
Q

Describe a Hartmann;s

A

Temporary colostomy with rectal pouch, colorectal anastomosis

MET 3A (15 decks)

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