Bowel obstruction

Question 1

what are the causes of obstruction?

Answer 1

adhesions
tumours
hernias

less common - gallstones, foreign body in lumen, diverticulitis, chron’s stricture, intussusception in wall, volvulus outside wall

Question 2

symptoms of obstruction

Answer 2

pain
vomiting
distension
absolute constipation

Question 3

SBO - features

Answer 3

+++ commoner than LBO
colicky pain early
dilated loops (>3cm) of SB on supine XR

Question 4

how do you differentiate small and large bowel on XR?

Answer 4

SB - central + folds cross complete diameter (valvulae conniventes)
LB - haustra (⅔ - shorter word)

Question 5

what is a major risk of LBO?

Answer 5

perforation

Question 6

sigmoid volvulus - what is it?

Answer 6

sigmoid colon twists anticlockwise

Question 7

sigmoid volvulus - major RF

Answer 7

chronic constipation

Question 8

sigmoid volvulus - main sign

Answer 8

coffee bean sign on AXR

Question 9

sigmoid volvulus - mgmt

and caecal?

Answer 9

rigid sigmoidoscopy + flatus tube
unless BO + peritonitic - laparotomy

caecal - surgery, oft right hemicolectomy

Question 10

diff between caecal and sigmoid BO

Answer 10

sigmoid - LBO

caecal - SBO

Question 11

sign on perf on AXR?

Answer 11

rigler’s double wall sign