Bowel Obstruction

Question 1

Bowel Obstruction Epidemiology

Answer 1

Mostly small bowel obstruction

More common in those with presenile dementia and Alzheimer’s, Parkinson’s, MS and quadriplegia

Question 2

Bowel Obstruction RFs

Answer 2

• Small intestine; adhesions, strangulated hernia, malignancy, volvulus. Majority of SIOs are from adhesions. Malignancy is usually tumour of caecum as small bowel malignancies are very rare
• Large intestine; most often due to colorectal malignancies
• Sigmoid and caecal volvulus (sigmoid most common site)
• Paralytic+PO ileus
• Other

Question 3

Bowel Obstruction Presentation

Answer 3

Diffuse central abdominal colicky pain, nausea, vomiting, dysphagia, abdominal pain, failure to pass bowel movements
Distention, tympany, high pitched bowel sounds
-Lower the obstruction, slower the onset of vomiting, slower progress, earlier constipation, greater the distention
-Severe pain and tenderness suggests ischaemia

Question 4

Bowel Obstruction Ix

Answer 4

• Fluid charts to monitor intake and output
• Plain AXR
• Full bloods
• CT if high suspicion but normal AXR

Question 5

Bowel Obstruction Differentials

Answer 5

• Gastroenteritis; obstruction if bloated or reduced bowel movement. D+V can cause very active bowel sounds
• Ischaemia of the gut can cause pain and distention but there is usually bloody diarrhoea
• Acute pancreatitis if pain radiates to back
• Perforation can produce an acute abdomen with pyrexia and vomiting
• Intussusception
• TB

Question 6

Bowel Obstruction Management

Answer 6

• Conservative, fluids, electrolyte replacement, intestinal decompression and rest
• Endoscopy can be used for bowel decompression
• Await full resuscitation before surgery unless possible perforation or infarction of bowel
• Palpable mass and failure to improve are indications for surgery
• Volvulus can be treated conservatively

Question 7

Bowel Obstruction Complications

Answer 7

• Metastases
• Perforation and ischaemia
• Fluid and electrolyte imbalance