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X Clin Med III Exam 2 > Bowel Obstruction > Flashcards

Bowel Obstruction Flashcards

1
Q

Partial vs complete bowel obstruction

A

Partial- fluid or air continue to pass

Complete- cessation of passage of stool or flatus

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2
Q

Categories of bowel obstruction causes

A

Extrinsic/extra luminal (external to bowel)
Intrinsic (within wall of bowel)
Intraluminal (defect that prevents passage of GI contents)

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3
Q

What is happening in the bowel during an obstruction?

A

Bowel dilatation and retention of fluid within lumen proximal to obstruction while distal the bowel decompresses (swallowed air and gas from fermentation contribute to distention)

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4
Q

Why are pts with an obstruction usually dehydrated?

A

Edematous bowel leads to fluid sequestration so depletes volume

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5
Q

How do complications result from bowel obstructions?

A

Dilatation–poor vascular supply and perfusion–ischemia–necrosis–perforation–peritonitis

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6
Q

Most common obstruction

A

SBO

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7
Q

Most common causes of SBO

A 
Adhesions MOSTLY (from prior abdominal/pelvic surgery)
Hernia (abd wall/groin)
Neoplasm (primary or metastatic tumor)
Or intestinal inflammation/abscess, strictures, FB ingestion, intussusception, volvulus
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8
Q

What questions can be asked to determine if IBD associated with SBO?

A

N/v/d, constipation, hematochezia and length

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9
Q

Presentation of SBO

A 
Maybe fevers/chills
Abd pain (initially can be periumbilical, intermittent and crampy) and more focal can be peritonitis
Bloating/distention, anorexia, n/v, hematochezia, obstipation (can't pass)
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10
Q

Red flags to indicate peritonitis on SBO exam

A

Shock vitals (tachycardia and hypotension)
Lying motionless
Hypoactive/absent bowel sounds (late phase)
Peritoneal signs (guarding, rigidity, rebound tenderness)

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11
Q

Diagnostics used in SBO

A 
CBC/CMP
Amylase/lipase
UA (and elevated specific gravity)
Lactate/LDH
Plan abd films
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12
Q

Why is a CT scan helpful for SBO?

A

ID location, severity, etiology and complications

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13
Q

What is seen on a supine and upright abd x-rays for SBO?

A

Dilated loops of bowel with air fluid levels
Proximal bowel dilatation with distal bowel collapse
Look for free air consistent with perforation

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14
Q

What is seen on CT abd for SBO?

A

Dilated proximal bowel with distal collapsed loops
Bowel wall thickening > 3 cm
Submucosal edema

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15
Q

What other imaging can be used for SBO when xray and CT are contraindicated (pregnant, kidney function, allergy)?

A

Abd u/s
CT/MR enterography
UGI/SBFT

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16
Q

Management of SBO

A

Admit
Non operative (NPO, IVF, lytes, NG tube, anti-emetics)
Gastrograffin (diagnostic and therapeutic)
Monitor over 2-5 days

17
Q

Indications for surgical exploration of SBO

A

Complicated bowel obstruction
Intestinal strangulation
Worsening sxs or unresolved with NG tube and bowel rest

18
Q

Signs of complete bowel obstruction

A

Ischemia, necrosis, perf

Worsening abd pain, fever, tachycardia, leukocytosis, metabolic acidosis, peritonitis

19
Q

Signs of peritonitis

A

Pts look sick, lie still to minimize discomfort, hypoactive/absent bowel sounds, peritoneal signs, significant pain with light bumps

20
Q

Causes of intestinal strangulation

A

Strangulated hernia
Volvulus
Intussusception

21
Q

What is an ileus?

A

Hypomotility of GI tract in absence of mechanical bowel obstruction often secondary to post op abd surgery
Can be physiologic or pathologic (no return of function in 4-5 days)
Can be nonsurgical causes (hypomotility agents)

22
Q

Presentation of ileus

A

Abd pain, distention, bloating, gassiness, n/c, can’t tolerate PO

23
Q

What is seen on supine/upright abd films of ileus?

A

Dilated loops of bowel but air present in both small bowel and colon
No air fluid levels

24
Q

Management for ileus

A

Support with IVF
Lyte management, pain (use NSAIDs), bowel rest (NPO/CL)
NG tube if persistent n/v

25
Q

Causes of large bowel obstruction

A 
Mostly adenocarcinoma (commonly colon and rectum)
Stricture due to diverticulitis/ischemia, volvulus, IBD, fecal impaction, FBs
26
Q

Presentation of LBO

A

Similar to SBO

Fever/chills, pain, bloating, constipation, n/v, tenderness, peritoneal signs maybe, hematochezia

27
Q

Diagnostics for LBO

A 
CBC, CMP, UA, LDH/lactate
Plain abd films (supine and upright)
CXR for free air
Gastrograffin enema
CT scan
28
Q

What is seen on up right abd xrays for LBO?

A

Distended colon proximal to obstruction

29
Q

Management for partial LBO

A

Surgical consult, NPO, IVF, abx, NG tube to decompress if vomiting
Avoid narcotics and anticholinergics

30
Q

Management for complete LBO (based on cause)

A

Cancer/stricture-resection
Intussusception- barium enema
Fecal impaction-enema
Volvulus (sigmoid is resection and sigmoid is reduction)

31
Q

Types of volvulus

A

Sigmoid (more common)

Cecal

32
Q

Risk factors of sigmoid volvulus

A 
About 70 YO
Chronic constipation
Redundant sigmoid colon
Colonic dysmotility
Hypomotility agents
33
Q

Presentation of sigmoid volvulus

A 
Cramping abd pain
n/v
Pain before vomiting
Constipation
Distended tympanitic abd
TTP
34
Q

Diagnostics of sigmoid volvulus

A

Upright abd xray
CT scan
Contrast enema (diagnostic and therapeutic)

35
Q

Management to sigmoid volvulus

A

Flex sig to decompress and derotate

Surgery to resect redundant sigmoid colon and prevent recurrence

36
Q

Mean age of cecal volvulus

A

33-53 (younger)

37
Q

Presentation of cecal volvulus

A

Episodic pain of acute abd catastrophe
Distended abd
Tympanitis

38
Q

Diagnostics for cecal volvulus

A 
Upright abd xray (dilated cecum typically displaced medially superiorly)
CT scan (diagnostic)

X Clin Med III Exam 2 (9 decks)

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