Bowel Obstruction

Question 1

What type of GI obstruction will present more quickly?

Answer 1

Upper GI obstruction

Question 2

Characteristics of vomiting due to GI obstructions?

Answer 2

Even if nothing is taken by mouth GI secretions continue to be produced so therefore they will keep vomiting
If vomit is sem-digested that suggests gastric outlet obstruction
Often it is bile stained fluid so therefore it must be distal to the second part of the duodenum
Foul smelling, thicker and brown vomit suggests a much more distal obstruction

Question 3

Explain absolute constipation- what does it suggest?

Answer 3

patient is not passing faeces or gas and presumption is that they have a bowel obstruction

Question 4

What is the risk if you have a bowel obstruction and a competent ileocaecal valve? How does this differ from a incompetent ileocaecal valve?

Answer 4

You have a closed loop obstruction and fluid is coming down but it cannot go back out so the caecum is at risk of perforation.

There is a delayed onset of symptoms.

Question 5

What can occur in a chronic incomplete obstruction?

Answer 5

There may be gradual hypertrophy of the muscle of the 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.

Question 6

7 mechanical causes of bowel obstruction?

Answer 6

Adhesions or bands
Hernia
Volvulus
Tumour
Inflammatory strictures
Bolus obstruction
Intussusception

Question 7

What is paralytic ileus?

Answer 7

Dynamic obstruction
There is disruption of propulsive activity as peristalsis fails. Risk factors are surgery, peritonitis and diabetic ketoacidosis

Question 8

What is pseudo obstruction?

Answer 8

Dilation of colon without obstruction associated with surgeries, pneumonia and the elderly

Question 9

What type of bowel sounds are heard in obstruction?

Answer 9

High pitched and tinkling

Question 10

Physical signs of bowel obstruction?

Answer 10

Pain
Distension
Constipation
Vomiting
Dehydration
Visible Peristalsis 
Resonant percussion in centre of abdomen
High pitched and tinkling bowel sounds

Question 11

Management of bowel obstruction?

Answer 11

Nil by mouth
Insert IV canula and send bloods
IV fluids
Pass NG tube to decompress stomach and stop vomiting