Bowel obstruction

Question 1

What are causes of small bowel obstruction

Answer 1

Adhesions

Hernias

Caecal volvulus

Gallstone ileus

Question 2

What are causes of large bowel obstruction

Answer 2

Colon cancer

Diverticular disease

Sigmoid or caecal volvulus

Crohn’s

Question 3

What are Sx of bowel obstruction?

Answer 3

Abdominal pain
Bloating and distension
No passage of faeces or flatus 
Vomiting (SBO)
Tinkling bowel sounds 

No bowel sounds = ileus

Sx of underlying cause e.g. cancer = PR bleeding and weight loss

Question 4

What are differential diagnoses for bowel obstruction?

Answer 4

Paralytic ileus

pseudoobstruction

toxic megacolon

constipation

Question 5

What Ix in bowel obstruction

Answer 5

CT: definitive diagnosis

AXR

Bloods: routine. Lactate important if ishcaemia suspected

Erect CXR: look for pneumonperitoneum suggesting perforation

Question 6

What are x-ray features of SBO?

Answer 6

Dilated bowel >3cm
Central
Valvulae conniventes

Question 7

What are x-ray features of LBO?

Answer 7

Dilated bowel >6cm
peripheral
haustral lines

Question 8

What is Rx of bowel obstruction

Answer 8

Conservative: NBM, NG tube, IV fluids and electrolytes

Surgical: if ischaemia or strangulation (closed loop). May need stoma

Question 9

What are complications of bowel obstruction

Answer 9

Ischaemia

Perforation

Dehydration and renal impairment