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GI/Gen surg AM > Bowel obstruction > Flashcards

Bowel obstruction Flashcards

1
Q

What is bowel obstruction?

A

Impaired flow of normal intestinal contents

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2
Q

Where do bowel obstructions happen?

A

80% small bowel

20% large bowel

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3
Q

What ate the 2 classes of cause of bowel obstruction?

A

Dynamic

Adynamic

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4
Q

What is a dynamic bowel obstruction?

A

Bowel obstruction with increasing peristalsis working against an obstructing agent

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5
Q

What are the causes of bowel obstruction in a newborn?

A

Imperforate anus
Congenital atresia or stenosis
Volvulus
Meconium ileus

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6
Q

What is the common cause of bowel obstruction in 2-3 month old?

A

Strangulated hernia

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7
Q

What is the common cause of bowel obstruction in 3-18 month old?

A

Intussuseption

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8
Q

What are the causes of bowel obstruction in children and young adults?

A

Strangulated hernia

Post op adhesions

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9
Q

What are the common causes of obstruction in adults?

A

Strangulated hernia
Post op adhesions
Maligancy
Volvulus

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10
Q

What is the most common cause of small bowel obstruction?

A

Adhesions

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11
Q

What is the most common cause of small bowle obstruction in a virgin abdomen?

A

Tumour

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12
Q

What is the most common cause of large bowel obstruction?

A

Tumour

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13
Q

What is an adynamic bowel obstruction?

A

Bowel obstruction with cessation of peristalsis and absence of true propulsive waves

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14
Q

What are the causes of adynamic bowel obstruction?

A

Mesenteric vascular occlusion
Paralytic ileus
Large bowel pseudo-obstruction

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15
Q

Who is mesenteric vascular occlusion seen in?

A

Those with PCV, atherosclerosis, AF

People who aren’t very well

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16
Q

What is the presentation of mesenteric vascular occlusion?

A

Pain of sudden onset, severe and out of proportion with physical signs
Co-morbidities
Very unwell

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17
Q

What investigations are done for mesenteric vascular occlusion?

A

CT angio

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18
Q

hat is paralytic ileus?

A

Cessation of peristalsis due to failure of neuromuscular mechanism

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19
Q

What are the common triggers of paralytic ileus?

A

Post op
Infection
Fluid and electrolyte abnormalities
Reflex to trauma

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20
Q

What is the presentation of paralytic ileus?

A

NO pain

Vomiting and distension

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21
Q

What is large bowel pseudo-obstruction?

A

Signs, symptoms and AXR appearance of LBO but no identifiable mechanical cause

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22
Q

What is the presentation of large bowel pseudo-obstruction?

A

Older person with co-morbidities, with progressive abdominal distension and absolute constipation

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23
Q

What investigations are done for large bowel pseudo-obstruction?

A

AXR

CT- bowel dilated but no transition point or identifiable obstruction

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24
Q

What is a simple bowel obstruction?

A

Obstruction of intestinal lumen without interference of its blood supply

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25
Q

What causes a simple bowel obstruction?

A 
Gallstones
Impacted faeces
Strictures
Adhesions
Tumours
26
Q

What is the pathophysiology of a simple bowel obstruction?

A

Proximal- increased peristalsis, distension with gas and fluid
Transition point
Distal= collapsed and immobile bowel

27
Q

What are the effects of simple bowel obstruction?

A

Dehydration from vomiting and third space losses
Electrolyte imbalances
Translocation of bacteria –> peritonitis

28
Q

What are the causes of death in simple bowel obstruction?

A

Peritonitis

Fluid and electrolyte imbalance

29
Q

What is a strangulating bowel obstruction?

A

Intestinal obstruction with persistent interference of blood supply

30
Q

What are the causes of strangulated bowel obstruction?

A 
Strangulated hernia
Intussusception
Adhesions
Volvulus
vascular occlusion
31
Q

What is the pathophysiology of strangulated bowel obstruction?

A

Venous return impaired first- dark and congested bowel
Serosanguinous fluid build up and increases pressure
Increased pressure impairs arterial supply, causing necrosis

32
Q

What are the causes of death in strangulated bowel obstruction?

A

Short segment= peritonitis

Long segment= peritonitis, hypovolaemia

33
Q

What is a closed loop obstruction?

A

Affected bowel segment obstructed at both proximal and distal end

34
Q

What can cause closed loop obstruction?

A

Obstructed hernia
Volvulus
Obstructed colon with competent ileocaecal valve

35
Q

What is the presentation of an obstructed bowel with competent ileocaecal valve?

A

Abdo pain and distension, with vomiting after 24-36 hours

Caecum becomes dilated and can perforate

36
Q

When are we worried about perforation of the caecum and why?

A

Thinnest part of bowel

When approaching 10cm

37
Q

What is a Richter’s hernia?

A

Incomplete obstruction due to partial herniation of bowel through small hernia, commonly femoral hernias

38
Q

What are the features of small bowel obstruction, in order of appearance?

A

Pain
Vomiting
Abdo distension
Absolute constipation

39
Q

What are the features of large bowel obstruction in order of appearance?

A

Absolute constipation
Abdo distension
Pain
Vomiting

40
Q

Describe the pain in simple bowel obstruction?

A

Generalised colicky, relief between attacks

Attacks increase in frequency, severity and duration

41
Q

What is the rule with vomiting in bowel obstruction?

A

The higher the obstruction, the worse and earlier the vomiting

42
Q

When is vomiting seen in large bowel obstruction?

A

Faecal vomiting after 24-36 hours if incompetent ileocaecal valve

43
Q

Describe the distension in a small bowel obstruction

A

The later the obstruction, the worse the distension

Ileal= central abdo distension

44
Q

Describe the distension in large bowel obstruction

A

Distension in flanks

45
Q

What is the presentation of a strangulated obstruction?

A

Pain is severe and never completely absent between attacks
Tender rigid abdomen
Temperature, tachycardia, unwell
Early raised WCC
NG suction for 1-2 hours doesn’t relieve pain

46
Q

What bloods are done in bowel obstruction?

A 
FBC- low Hb= think cancer
-High WCC early= strangulation
-High WCC late= peritonitis
U&Es
LFTs
ABG if unwell- metabolic acidosis in strangulation
47
Q

What imaging is done for bowel obstruction?

A

AXR

CT

48
Q

What s the AXR appearance in small bowel obstruction?

A

Transverse complete regular striations

Small bowel distension

49
Q

What is the AXR appearance in large bowel obstruction?

A

Haustrations

Distension

50
Q

What is the AXR appearance in a sigmoid volvulus?

A

Coffee bean sign

51
Q

What is diagnostic of a bowel obstruction?

A

CT with transition point

52
Q

What is the general management of bowel obstruction?

A

Drip and suck
NG tube- symptomatic relief and reduce aspiration risk
Resus fluids and electrolytes
Treat cause

53
Q

What are the indications for surgery in bowel obstruction?

A 
Obstructed herna
Suspected strangulation
SBO in virgin abdomen
Failure of conservative management in 48 in adhesions
Obstructing tumours on CT
54
Q

Where does intussusception normally occur?

A

Ileo-colic

55
Q

What is the management of an intussusception?

A

Paeds- air enema

Adults- normally organic cause, surgical excision

56
Q

What is the management f a volvulus?

A 
Caecal= right hemicolectomy
Sigmoid= emergency endoscopic decompression
57
Q

What is the management of adhesive obstruction?

A

Conservative- NG, fluids, pain relief

Surgery if failure of conservative management after 48 hours or suspected strangulation

58
Q

What is the management of gallstone ileus?

A

Enterotomy and removal of stone

59
Q

What is the management of mesenteric vascular occlusion?

A

Young= surgery

Older, co-morbid= palliate

60
Q

What is the management of paralytic ileus?

A

Treat underlying cause

Supportive

61
Q

What is the management of large bowel pseudo-obstruction?

A

Supportive

Treat any remediable underlying cause

GI/Gen surg AM (28 decks)

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