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GI > Bowel Obstruction > Flashcards

Bowel Obstruction Flashcards

1
Q

What is meant by bowel obstruction?

A
  • Dilatation of bowel proximal

- Peristalsis is disrupted

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2
Q

How does a patient present with an upper small bowel obstruction?

A
  • Acute presentation (within hours)

- Large volumes vomited

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3
Q

What symptoms would indicate a distal small bowel or a large bowel obstruction?

A
  • Colicky abdominal pain and distension.
  • Vomiting (possibly ‘faeculent’)
  • Constipation
  • Complete/ Incomplete obstruction
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4
Q

Vomiting can still occur even if a patient takes nothing by mouth. TRUE/FALSE?

A 
TRUE
Due to GI secretions still being produced
- Saliva
- gastric secretions
- pancreatic secretions
- bile
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5
Q

HOw can the consistency of vomit give a clue as to where a GI obstruction is?

A
  • Semi-digested food (no bile) = gastric outlet obstruction
  • Bile-stained fluid suggests = small bowel obstruction
  • Thicker, brown, foul-smelling vomitus (‘faeculent’) = distal obstruction
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6
Q

Why does bowel obstruction cause absolute constipation?

A

Bowel gas is absorbed distal to the obstruction.
=> neither faeces or flatus passed rectally

=> pathognomonic of bowel obstruction.

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7
Q

HOw can an incompetent ileo-caecal valve delay the onset of symptoms?

A

Allows blockage to reflux back into small bowel

=> gives it more room to block

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8
Q

What are the physical signs of intestinal obstruction?

A
  • Dehydration (dry mouth, loss of skin elasticity)
  • Abdominal distension
  • Visible peristalsis
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9
Q

What is the most useful initial investigation if you suspect a patient has a bowel obstruction?

A

supine abdominal X-ray:

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10
Q

Describe how dilated small bowel loops appear on an abdominal X-Ray

A
  • Distended small bowel loops
  • lie in a central position
  • valvulae coniventes (all way across bowel diameter)
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11
Q

Describe how distended large bowel appears on an abdominal X-Ray

A
  • lie in its anatomical position

- haustra coli (dont extend all way across bowel)

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12
Q

What is involved in the initial management of intestinal obstruction?

A
  • Nil by mouth.
  • Insert IV cannula and send blood
  • Resuscitate with IV fluids, replacing electrolyte losses.
  • NG tube to decompress the stomach.
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13
Q

What are the potential mechanical causes of intestinal obstruction?

A
  • Adhesions
  • Abdominal wall hernia
  • Volvulus
  • Tumour
  • Inflammatory strictures
  • Bolus obstruction
  • Intussusception
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14
Q

HOw do patient’s acquire adhesions in the bowel?

A
  • congenital
  • from previous abdominal surgery
  • from peritonitis
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15
Q

What is an inguinal hernia?

A

Dilated loop of bowel escapes through a defective inguinal ring

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16
Q

What inflammatory conditions can cause bowel strictures that may result in obstruction?

A
  • IBD (UC/Crohn’s)
17
Q

What can cause a bolus obstruction?

A

Food bolus
Impacted faeces
Impacted ‘gallstone ileus’ (rare)
Trichobezoar (rare)

18
Q

What happens in intussusception?

A

a segment of bowel wall becomes telescoped into the segment distal to it.

Common in children.

19
Q

What usually causes intussusception to occur?

A
  • initiated by a mass in the bowel wall

=> e.g. enlargement of lymphatic tissue or tumour

20
Q

Intussusception is most common in which group of patients?

A

Children

21
Q

What symptom can be an indication of bowel strangulation?

A

Pain over a hernia

22
Q

What are the potential causes of an adynamic bowel obstruction?

A
  • Paralytic ileus (i.e. bowel cant perform peristalsis)

- Pseudo-obstruction

23
Q

What are the risk factors for a paralytic ileus?

A
  • Recent GI surgery
  • Inflammation with peritonitis
  • Diabetic keto acidosis
24
Q

How is a paralytic ileus treated?

A

‘drip and suck’ while awaiting restoration of peristalsis

- i.e. fluids and an NG tube

25
Q

What is a pseudo-obstruction?

A
  • Acute dilatation of the colon

- absence of obstruction in acutely unwell patients

26
Q

What is linked to pseudo obstruction?

A 
Hip replacement surgery
Coronary Artery Bypass Grafts
Spinal #
Pneumonia
Frail / elderly patients
27
Q

How is pseudo obstruction confirmed?

A

AXR +/- CT

- shows gaseous distension to distal rectum

GI (33 decks)

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