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Bowel obstruction Flashcards

1
Q

where can bowel obstruction occur?

A

= any part of the GI tract

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2
Q

what happens when the Gi tract gets obstructed?

A

= dilatation of bowel proximal

= peristalsis is distrusted

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3
Q

describe symptoms of upper small bowel obstruction?

A
  • acute presentation
  • hours of onset
  • large volumes vomited
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4
Q

describe symptoms of distal small bowel/large bowel obstruction?

A
  • colicky abdominal pain and distension

- vomiting (possible ‘faeculent’)

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5
Q

what are symptoms of intestinal obstruction?

A
  • vomiting
  • pain
  • constipation
  • distension
  • complete obstruction
  • incomplete obstruction
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6
Q

True or false.

The more proximal the obstruction, the earlier vomiting develops.

A

true

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7
Q

Can vomiting still occur if nothing is taken by the mouth?

A

= yes.

  • GI secretions are continued to b produced
    e. g. saliva, gastric, pancreatic, bile, small intestine (up to several litres a day)
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8
Q

what suggests gastric outlet obstruction?

A

= semi-digested food eaten a day or two previously (no bile)

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9
Q

what suggests upper small bowel obstruction?

A

= copious bile stained fluid

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10
Q

what suggests distal obstruction?

A

= thicker, brown, foul-smelling vomitus (faeculent)

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11
Q

what causes pain in intestinal obstruction?

A

= distension of bowel

= intermittent episodes of colicky pain

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12
Q

what causes constipation in intestinal obstruction?

A
  • propulsion of bowel contents is arrested

- bowel gas is absurd distal to the obstruction

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13
Q

what is absolute consttipation?

A

neither faeces or flatus (gas) is passed

is pathognomonic of bowel obstruction

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14
Q

why do symptoms tend to develop more gradually in large bowel obstruction?

A

= due to large capacity of colon and caecum ant here absorptive capacity

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15
Q

what happens in large bowel obstruction if the ileo-caecal valve remain competent?

A

= backwards flow of accumulated bowel contents is prevented

  • the thin walled caecum progressively distends with swallowed air and eventually may rupture: ‘closed loop obstruction’
  • can cause rupturing
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16
Q

what happens in large bowel obstruction if the ileo-caecal valve becomes incompetent?

A

= small bowel distends, delaying onset of symptoms

17
Q

what happens if there is only partial bowel obstruction?

A

= clinical features less clearly defined

  • vomiting may be intermittent and bowel habit erratic
18
Q

what does chronic incomplete obstruction lead to?

A

= hypertrophy of muscle bowel wall proximally

  • peristaltic activity in this hypertrophic muscle is responsible for bouts of colicky pain which can be more prominent than in complete obstruction
19
Q

what are physical signs of intestinal obstruction?

A
  • dehydration, dry mouth, loss of skin turgor, elasticity
  • abdominal distension
  • visible peristalsis
  • relative lack of abdominal tenderness

= obstructing abdominal mass may be palpable
= on percussion centre of abdomen tends to be resonant due to gaseous distension
= groins must be examined for an obstruction hernia
= bowel sounds are high pitched and tinkling, or absent

20
Q

how would you investigate suspected bowel obstruction?

A
  • supin abdominal X-ray
21
Q

where do distended small bowel loops and distended large bowels tend to lie in suspected bowel obstruction?

A

Distended large bowel loops = lie in a central position and have valvulae coniventes

Distended large bowel
= tends to lie in its anatomical position and has hausfrau coli

22
Q

what may be performed after a X-ray to confirm he diagnosis?

A

= CT

23
Q

what are the 4 principles of initial management of intestinal obstruction?

A
  • nil by mouth
  • insert IV canula and send blood
  • resuscitate with IV fluids, replacing electrolyte losses
  • pass a nasogastric tube to decompress the stomach
24
Q

what are some mechanical causes of bowel obstruction?

A
  • Adhesions or bands
    (congenital or resulting from previous abdominal surgery or peritonitis)
  • Incarcerated abdominal wall hernia
  • Internal hernia
  • Volvulus
    (a mobile loop of bowel that rotates causing obstruction at its neck)
  • Tumour
  • Inflammatory strictures
  • Bolus obstruction
  • Intussusception
25
Q

what are examples of inflammatory strictures that act as a mechanical cause of bowel obstruction?

A
  • Crohn’s disease
  • diverticular disease
    = usually incomplete
26
Q

what can cause bolus obstruction that acts as a mechanical cause of bowel obstruction?

A

= something inside lumen of bowel causing obstruction

Examples;

  • food
  • impacted faeces
  • impacted gallstones ileus
  • trichobezoar (hair collection)
27
Q

what is intussusception?

A

= a segment of bowel wall that becomes telescoped into the segment distal to it
- usually initiated by a mass in the bowel wall: enlargement of lymphatic tissue or tumour

= common in children

28
Q

what is bowel strangulation?

A

= a segment of bowel becomes trapped

29
Q

what are the consequences of bowel strangulation?

A
  • venous return is obstructed
  • rising local intra-vascular pressure, therefore, arterial inflow is compromised
  • if strangulation is no relieve this will progress to infarction and perforation
30
Q

what are 2 examples of bowel obstruction?

A

= paralytic ileus

= pseudo-obstruction

31
Q

what happens in paralytic ileus?

A

= disruption of normal propulsive activity of GI tract, duet to failure of peristalsis

32
Q

what are risk factors for paralytic ileus?

A
  • recent GI surgery
  • inflammation with peritonitis
  • diabetic keto acidosis
33
Q

what are symptoms and signs of paralytic ileus?

A
  • similar to bowel obstruction

- pain and high pithced signs are less common

34
Q

how would you treat paralytic ileus?

A

= drip and suck while awaiting restoration of peristalsis

35
Q

what is pseudo-obstruction (Ogilvie’s syndrome)?

A

= acute dilatation of colon in absence of colonic obstruction in acutely unwell patients

36
Q

what is pseudo obstruction associated with?

A
  • hip replacement surgery
  • coronary artery bypass grafts
  • spinal
  • pneumonia
  • frail/elderly patients
37
Q

how would you diagnose pseudo-obstruction?

A

= AXR +/- CT
- confirms gaseous distension to distal rectum

= colon may require colonoscopic decompression if distension is causing pain or respiratory compromise

GI (43 decks)

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