Bowel obstruction and Acute abdomen

Question 1

Define bowel obstruction

Answer 1

Interruption of the normal passage of bowel contents through the bowel due to mechanical or functional ob

Question 2

Acute abdomen

Answer 2

Sudden onset of severe abdominal pain due to presence of an abdominal pathology which if left untreated within 72 hours will result in patient morbidity and mortality

Question 3

State 2 classifications of BO

Answer 3

Anatomical- small or large BO
Pathological - mechanical and functional

Question 4

Characteristics of HIGH small BO x3

Answer 4

Profuse vomiting
Minimal distension
Dehydration

Question 5

Characteristics of LOW small BO x2

Answer 5

Central abdominal distension
Multiple central fluid seen

Question 6

Characteristics of large BO x4

Answer 6

Mild pain- cramp and intermittent
Early pronounced distension
Late vomiting and dehydration
Proximal colon and cecum distension

Question 7

Intraluminal causes of mechanical BO x3

Answer 7

Fecal impaction in bed ridden patients
Foreign bodies -worms or bezoars
Gallstones

Question 8

Intramural causes of mechanical BO x3

Answer 8

Masses
Intestinal atresia
Inflammatory strictures

Question 9

State 4 extra mural causes of mechanical BO

Answer 9

Hernia
Intussusception
Intraperitoneal adhesions
Volvulus- sigmoid and cecum

Question 10

State 2 causes of functional obstruction

Answer 10

Paralytic ileus > failure to transmit peristaltic waves
Pseudo-obstruction without mechanical or pathological cause

Question 11

State 4 cardinal signs of BO

Answer 11

Pain, vomiting, abdominal distension, constipation

Question 12

State 4 changes in the bowel that occur with BO

Answer 12

Proximal dilation
Distal collapse
Strangulation
Simple/closed loop obstruction

Question 13

Differential diagnosis for SBO x5

Answer 13

Adhesions
Hernias
Volvulus
Neoplasms
Ischemic strictures
Foreign bodies

Question 14

Differential diagnosis for LBO x4

Answer 14

Hernia
Volvulus
Strictures- diverticulitis, IBD
Colon cancer

Question 15

Causes of BO in children x4

Answer 15

Small- intussusception, intestinal atresia
Large- atresia, hirschsprungs, anorectal malformations

Question 16

Common Xray findings of BO x4

Answer 16

Coffee bean sign- sigmoid volvulus
Thumb print sign- mucosal thickening
Riglers sign- double wall due to extraluminal air
Toxic megacolon- bowel wall edema, gas in bowel due to gas gangrene

Question 17

Principles of BO management x3

Answer 17

GI drainage
Relief of obstruction
Fluid and electrolyte replacement