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Year 4 General surgery > Bowel obstruction > Flashcards

Bowel obstruction Flashcards

1
Q

how can you classify bowel obstruction

A

mechanical bowel obstruction

paralytic ileus

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2
Q

mechanical bowel obstruction classification

A

intraluminal
intramural
extramural

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3
Q

sites of bowel obstruction

A

SBO

LBO

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4
Q

degrees of bowel obstruction

A

partial
complete
closed loop - at 2 points, segment in middle is building up pressure

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5
Q

progression of BO

A

simple

strangulated

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6
Q

Causes of SBO

A
  1. adhesions
  2. hernias
    gallstone ileus
    Meckel’s diverticulum
    strictures - Crohn’s
    Malignancy
    Paed:
    congenital atresia
    intussusception
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7
Q

Causes of LBO

A
  1. tumours
  2. volvulus
    adhesions
    strictures
    faecal impaction
    Paed:
    Hirschprung disease
    meconium ileus
    rectal atresia
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8
Q

bacterial translocation in bowel obstruction

A

bacteria from bowel goes into bloodstream and peritoneum

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9
Q

4 cardinal symptoms of bowel obstruction

A

abdominal pain - colicky
vomiting
constipation
abdominal distension

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10
Q 
aspects of history you should ask in bowel obstruction for the following:
adhesions
obstructed hernia 
CRC 
bowel ischaemia 
perforation
A

adhesions - previous surgery, recurrent episodes (structural band)
obstructed hernia - irreducible lump
CRC - elderly, CIBH, weight loss, FH, polyps
bowel ischaemia - change in pain character, becomes sharp
perforation - dramatic change in pain, worse with movement, very unwell

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11
Q

clinical findings in bowel obstruction

A 
dehydration 
abdominal distension - 3rd space losses
abdominal inspection 
abdominal tenderness 
septic - perforation 
tympanic percussion 
high pitched tinkling sounds or absent later on 
collapsed empty rectum on DRE
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12
Q

explain tinkling bowel sounds

A

fluid in bowel moves from one point to another, trickling

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13
Q

always examine for a hernia, true or false

A

true, bowel obstruction might be from strangulated hernia

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14
Q

complications of bowel obstruction

A

perforation

infection

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15
Q

lab tests for BO

A

loss of acid and electrolytes, alkalosis in vomiting
high lactate, urea and creatinine
lactic acidosis in bowel strangulation
raised WCC - bacterial translocation

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16
Q

radiological investigations for BO

A

plain supine AXR

CT abdo pelvis

17
Q

AXR features for SBO

A

step laddering
valvulae coniventes
centrally in the abdomen

18
Q

AXR features for LBO

A

haustrations

peripherally located

19
Q

what does a coffee bean shape on AXR indicate

A

volvulus

very high risk of perforation

20
Q

what does gas in the bowel wall mean

A

sign of ischaemic bowel

21
Q

management of bowel obstruction

A

ABCDE - urgent resuscitation
‘DRIP’ - IV fluids, electrolyte correction
‘SUCK’ - NG tube for gastric decompression
Bowel rest
IV analgesia and antiemetics

22
Q

why would you not operate on a patient with bowel obstruction

A

not: likely adhesions, no signs of ischaemia/necrosis/perforation
need active monitoring for 3-5 days

23
Q

would you give prokinetics in BO?

A

No, Prokinetics are CONTRAINDICATED

24
Q

when would you operate on bowel obstruction

A 
ischaemia
necrosis 
perforation 
tumour 
hernia 
closed loop obstruction 
when it can't be managed conservatively
25
Q

adhesional BO is managed operatively/conservatively

A

conservatively

26
Q

what must you ensure before operating

A

optimise the patient a couple of hours prior to theatre
rehydrate, correct electrolytes, acidosis
Don’t just rush to surgery

27
Q

what do you do in theatre if you are unsure that the bowel is dead

A

wrap bowel in warm towels and wait
declares itself
either resect or leave it in

28
Q

how does an ileostomy look on the skin

A

spouts out of skin

like a smaller rose

29
Q

how does a colostomy look on the skin

A

smaller spout

30
Q

most common cause of paralytic ileus

A
  1. post operative
    others:
    hypokalaemia
    peritonitis and inflammation
    parturition
    pelvic fractures
    neuropathy
31
Q

would you do an abdominal CT to rule out mechanical obstruction, true or false

A

true

32
Q

what is mechanical bowel obstruction

A

interruption to the normal passage of bowel contents due to a structural abnormality

33
Q

what is a paralytic ileus

A

temporary impairment of peristalsis in the absence of mechanical obstruction

34
Q

what is a general rule for differentiating between small and large bowel obstruction from the history

A

small: early, large volume, bilious vomiting
late constipation
large: late onset, bilious then faeculent vomiting
early constipation
abdominal distension

Year 4 General surgery (14 decks)

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