Bowel obstruction Flashcards by K D

Q

Classification of bowel obstruction

A

1) Simple
2) Closed loop
3) Strangulated

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Q

Simple bowel obstruction

A

One obstructing point

No vascular compromise

Partial or complete

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Q

Closed loop bowel obstruction

A

2 obstructing points

Gross distention -> perforation

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Q

Cause of closed loop obstruction

A

volvulus

or ileocaecal valve incompetence

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Q

Common causes of small bowel obstruction

A

Adhesions

Hernia

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Q

Large bowel obstruction cause

A

CRC

Diverticular stricture

Volvulus

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Q

Non mechanical bowel obstruction

A

Paralytic ileus

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Q

Causes of paralytic ileus

A

Post op

Peritonitis

Pancreatitis

Metabolic: ↓K, ↓Na, ↓Mg, uraemia

Mesenteric ischaemia

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Q

Mechanical causes of bowel obstruction

A

Luminal

Mural

Extra-mural

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Q

Luminal causes of bowel obstruction

A

Impacted faeces

Intussusception

Gallstones

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Q

Mural causes of bowel obstruction

A

Benign stricture (IBD, colitis)

CRC

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Q

Extra-mural causes of bowel obstruction

A

Hernia

Adhesions

Volvulus

Extrinsic compression

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Q

Presentation of bowel obstruction

A

Colic abdo pain

Abdo distension

Vomiting / nausea

Absolute constipation

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Q

Bowel sounds with bowel obstruction

A

Mechanical obstruction - increased bowel sounds (“tinkling”)

Ileus - absent

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Q

Investigations for bowel obstruction

A

Increased amylase and lactate if perforated

Erect CXR - pneumoperitoneum if perf

AXR

Colonoscopy +/- stent

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Q

Small bowel AXR findings in bowel obstruction

A

Small bowel:

> 3 cm diameter
Central
Valvulae coniventes

Q

Large bowel AXR findings in bowel obstruction

A

> 6 cm
Peripheral
Haustra

Q

Valvulae coniventes

A

Lines completely across bowel on AXR

Small bowel

Q

Haustra

A

Lines partially across bowel on AXR

Large bowel

Q

Ileus AXR findings

A

Both small and large bowel may be visible

Q

Medical management of bowel obstruction

A

NBM

IV fluids

NGT

Catheter

Analgesia

Abx (cef+met)

Q

Abx for strangulation or perforation

A

Ceftriaxone + Metronidazole

Q

Indications for surgical management of bowel obstruction

A

Closed loop obstruction

Obstructing neoplasm

Strangulation / perf

Failure of medical Mx (> 72 hrs)

Q

Surgical options for bowel obstruction

A

Adhesiolysis

Hartmann’s procedure

Colectomy

Palliative stent bypass procedure

Loop ileostomy

Caecostomy

Most common site of volvulus

Sigmoid

Sigmoid volvulus AXR findings

Coffee bean sign

Management of sigmoid volvulus

Sigmoidoscopy and flatus tube insertion Sigmoid colectomy occasionally required Often recurs - elective sigmoidectomy