Bowel Obstruction

Question 1

Acute abdomen

Answer 1

<10 days pain, usually a progressive intra-abdominal condition which causes severe morbidity or threat to life

Question 2

Symptoms of intestinal obstruction

Answer 2

Vomiting, pain, constipation, distension

Question 3

The more proximal the obstruction, the __ the vomiting occurs

Answer 3

Earlier

Question 4

What things can be vomited in intestinal obstruction?

Answer 4

Bile, gastric secretions, pancreatic secretions, biliary secretions, faeculent

Question 5

Semi digested food eaten 2 days previously to vomiting suggests what type of obstruction?

Answer 5

Gastric outlet obstruction

Question 6

Copious bile-stained food as vomit suggests what type of obstruction?

Answer 6

Upper small bowel obstruction

Question 7

“faeculent” vomit suggests what type of obstruction?

Answer 7

A more distal obstruction

Question 8

What causes pain as a symptom of intestinal obstruction?

Answer 8

Distension caused by swallowed air and intestinal fluid secreted proximal to an obstruction causes pain

Question 9

What causes colicky pain as a symptom of intestinal obstruction?

Answer 9

Peristalsis trying to overcome the obstruction

Question 10

Why do symptoms tend to develop more gradually in large bowel obstruction?

Answer 10

Due to the large capacity of the colon and caecum and their absorptive capacity

Question 11

Physical signs of intestinal obstruction

Answer 11

Dehydration, abdominal distension, visible peristalsis, lack of abdominal tenderness, may be palpable mass, centre of abdomen tends to be resonant on percussion due to gaseous distension, high-pitched and tinkling bowel sounds

Question 12

Most useful investigation for intestinal obstruction

Answer 12

Supine abdominal X-ray - Bowel proximal to the obstruction is distended with gas. Distended small bowel loops tend to lie in a central position and have valvulae conniventes

Question 13

Investigation other than AXR for intestinal obstruction

Answer 13

CT scan to confirm diagnosis and look for cause

Question 14

Initial management for intestinal obstruction

Answer 14

Nil by mouth, IV cannula and send blood, resuscitate with IV fluids to replace electrolyte losses, pass NG tube to decompress the stomach

Question 15

Mechanical causes of bowel obstruction

Answer 15

Adhesions or bands, incarcerated abdominal wall hernia, internal hernia, volvulus, tumour, inflammatory strictures, bolus, intussusception

Question 16

Bowel strangulation

Answer 16

A segment of the bowel becomes trapped and the venous return is obstructed. With rising local intravascular pressure, subsequent arterial inflow is compromised

Question 17

What can occur if bowel strangulation is not relieved?

Answer 17

Infarction and perforation

Question 18

Management for bowel strangulation

Answer 18

Urgent surgical intervention

Question 19

Paralytic ileus

Answer 19

Disruption of the normal propulsive activity of the GI tract due to failure of peristalsis

Question 20

Risk factors for paralytic ileus

Answer 20

Recent surgery, inflammation with peritonitis, diabetic ketoacidosis

Question 21

Symptoms and signs of paralytic ileus

Answer 21

Vomiting, constipation, distension, dehydration, abdominal distension, lack of abdominal tenderness, may be palpable mass, centre of abdomen tends to be resonant on percussion due to gaseous distension

Question 22

Treatment for paralytic ileus

Answer 22

‘Drip and suck’ while awaiting restoration of peristalsis

Question 23

Pseudo-obstruction/Ogilve’s syndrome

Answer 23

Acute dilatation of the colon in the absence of colonic obstruction in acutely unwell patients

Question 24

What is pseudo-obstruction/Ogilve’s syndrome associated with?

Answer 24

Hip replacement, CABG, spinal, pneumonia, frail/elderly patients

Question 25

Diagnosis of pseudo-obstruction/Ogilve’s syndrome

Answer 25

Abdominal X-ray +/- CT scan to confirm gaseous distention to distal rectum