Bowel Obstruction

Question 1

Mechanical causes of gut obstruction

Answer 1

1 in the lumen children
Meconium illeus 15 % of CF children
Bezoa preteen girls who eat their hair

2 in the wall
Hirshprungs
Crohn’s disease inflamation in the wall can cuases stenosis
Cysts duplication cysts

3 outside the wall
Volvulus loops of bowel twists leads to a gut obstruction
Bands congenital or 2ary to appendicitis
Hernias inguinal hernias males>females high risk to the testicle

Question 2

Paralytic non mechanical gut obstruction

Answer 2

The gut stops working seen in
Infections
Toxic metabolic sepsis burns leads to multi organ failure leads to gut obstruction
Intrinsic

Question 3

Signs of gut obstruction

Answer 3

Distention of abdoman
Pain. ( relived by NG tube
Reduced /absent bowel sounds constipation stop passing BM
Vomit bile stained

Then the obstruction can effect the blood supply and lead to dead gut
Then get local pain ( not relived by NG)
Mass
Tenderness ++

Generalized dead gut
Fever
Tachycardia
Toxic

Question 4

Investigation of gut obstruction

Answer 4

AXR erect and supine
Right side up and see the liver if gas above it there is free gas in abdo
Blood test
Urine output dehydration calculated

Question 5

Intusscescption

Answer 5

Telescoping of the bowel 
Primary intussecpition happens 3-24/12 
Peaks 11-12months of age 
Caused by hypertrophy of the intramural lymphoid tissue 
( can get 2ary to viral gastro)

Question 6

Secondary intussception

Answer 6

2ary to a fixed point 
Mechels diverticulum 
Polyps
Cysts 
Lymphoma 
Haematoma

Question 7

Presentation of Intussecption

Answer 7

Pain ( commonest presentation episodic pain and between attacks the child looks tired/ lethargic/ unwell

Vomiting first non bilious reflex to pain
Then bile stained vomiting secondary to obstruction
PR bleeding mixed with mucus red current jelly
Mass <50% hard to feel

Question 8

Atypical presentation to intussepction

Answer 8

1 starts like gastro but then changes to bile stained vomiting
2 pure gut obstruction
3 pr bleeding alone ( loose intussception)
4 chronic intussectip

Question 9

Diagnosis Of intussecption

Answer 9

First need to consider it
USS is the key to diagnosis

Treatment is IV fluids
NG
Hydrostatic reduction gas or Ba enema

Question 10

Recurrence rate of Intussception

Answer 10

5% 1/20

Can be immediate or delayed