Bowel Obstruction Flashcards
What are the 4 cardinal signs of bowel obstruction
- Vomiting
- Colicky pain
- Absolute constipation
- Distension
What would be heard in bowel obstruction
Tinkling bowel sounds
What are some common causes of small bowel obstruction
- Hernias
- Volvulus
- Adhesions
- Tumours
- Crohns
- Gallstone ileus
How do strictures appear
Strands of fibrous materials
What is the pain like in small bowel obstruction
Colicky pain often around umbilicus
What kind of abdominal x-ray is used
Supine
Define obstruction
Mechanical blockage arising from a structural abnormality that presents barrier to progression of gut contents
What is ileus
A paralytic/ functional variety of obstruction
What does obstruction result in?
- 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
What hernias most commonly cause small bowel obstruction
Femoral
What is the site of obstruction when a hernia causes it
The neck of the hernia
How does a strangulated obstruction appear
Persistent pain
Discolouration
Tenderness
What would a CT be used for in bowel obstruction
- Level of obstruction/ degree of obstruction
- The cause (volvulus, hernia etc)
- Degree of ischaemia
- Free fluid and gas
Who shouldn’t barium be used in
Patients with peritonitis
What would be seen in a supine abdominal x-ray in somebody with small bowel obstruction
- Central gas shadows
- No gas in the large bowel
- Valvulae connarentes that cross the lumen
What would be soon in a supine abdominal x-ray in somebody with large bowel obstruction
- Peripheral gas shadows
- Haustra do not cross the lumen
What is closed loop obstruction
Obstruction at two points, loop of grossly distended bowel at risk of perforation
What are some causes of large bowel obstruction
- Colon carcinoma
- Constipation
- Diverticular disease
- Volvulus
How do large and small bowel obstruction differ?
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
What is ileus
A functional obstruction from reduced motility
How do you identify ileus
No pain
Bowel sounds are absent
What is pseudo obsutrction
Presents like a mechanical GI obstruction but there is no obvious cause
Name some complications of bowel obstruction
- Normal complications of carcinoma
- Perforation and ischaemia of the bowel may cause peritonitis and septicaemia
- Fluid and electrolyte imbalance
- Acute, colonic pseudo-obstruction
What could be seen in an NG tube
Faeculunt fluid in vomit or from an NG tube
Describe the conservative management of bowel obstruction
- Fluid resus and electrolyte replacement
- Treat psudo- obstruction
- Endoscopy can be used to complete intestinal decompression
- Bowel rest
Name some indications of early surgery
- Peritonitis
- Perforation
- Irreducible hernia
- Palpable mass
In which type of bowel obstruction does biochemical derangement happen quicker
Small
Describe the steps of biochemical derangement
- Rapid build up of fluid and gas proximal to obstruction
- Oedema and increased distention occur
- Stasis and bacterial overgrowth make the fluid faeculant
If there is an obstruction/ tumour in the caecum what surgery would be advised?
RIGHT HEMICOLECTOMY
- Removal of the right colon- ileocolic anastomosis
If there is an obstruction/ tumour higher in the ascending colon what surgery would be advised
EXTENDED RIGHT HEMICOLECTOMY
- Right colon and portion of transverse colon removed
When would a transverse colectomy be used?
Tumour in the transverse colon
When would a sigmoid colectomy be used?
Tumour in the sigmoid colon`
When would a Hartmann’s operation be used
Obstructing tumour in sigmoid colon
Describe a Hartmann;s
Temporary colostomy with rectal pouch, colorectal anastomosis
