Bowel obstruction

Question 1

Intestinal obstruction main features

Answer 1

Vomiting, nausea + anorexia
Constipation, absolute in distal obstruction
Abdo distension inc as obstruction progresses
Tinkling bowel sounds

Question 2

Small vs large bowel obstruction

Answer 2

Small - early vomiting, less distension, pain higher in abdo
Large - pain more constant
AXR to differentiate

Question 3

Main classifications bowel obstruction

Answer 3

Small or large bowel
Ileus or mechanical obstruction
Simple (one obstruction, no vasc issue), closed loop (two points) or strangulated (blood supply compromised, local pain w peritonism)

Question 4

Paralytic ileus features

Answer 4

Paralytic due to absence of peristaltic contractions

Surgery/ pancreatitis/ spinal injury/ hypoK/ hypoNa/ drugs e.g. TCAs

Question 5

Pseudo-obstruction features

Answer 5

Ogilvie’s syndrome is acute pseudo-obstruction, similar clinical features to mechanical obstruction
Predisposed by pelvic surgery/ trauma/ neuro disorders
Weight loss from malabsorption is an issue

Question 6

Pseudo-obstruction treatment

Answer 6

Neostigmine

Colonoscopic decompression

Question 7

Sigmoid volvulus features and issues

Answer 7

Bowel twists on mesentry, can cause rapid strangulated obstruction
Occurs more in elderly/constipated/comorbid
Complicates to perforation -> severe peritonitis

Question 8

Sigmoid volvulus treatment

Answer 8

Treated with insertion of flatus tube/sigmoidoscopy/ sigmoid colectomy if severe

Question 9

Bowel obstruction management

Answer 9

Surgery for strangulation/large bowel obstruction, ileus and small bowel obstruction more conservative
NGT + IV fluids/nutrition to rebalance electrolytes
CT/colonoscopy to establish cause

Question 10

Bowel obstruction causes

Answer 10

Small: adhesions (so surgery to treat can be self destructive), hernias
Large: Colon cancer, constipation, volvulus