Bowel Obstruction + Ischaemia Flashcards

1
Q

what is a simple bowel obstruction

A

occlusiion of bowel without vascular compromise

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2
Q

what is a strangulated obstruction

A

occlusion of bowel with vascular compromise

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3
Q

most common cause of small bowel obstruction

A

adhesions

strangulated hernias also common

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4
Q

what needs to be ruled out in large bowel obstruction

A

Colorectal cancer

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5
Q

other causes of bowel obstruction

A

luminal:

  • foreign body , impacted faeces, intussusception, gallstones

intramural:

-tumours, strictures, crohns, diverticulitis

extrinsic:

  • adhesions, volvulus, hernia, tumour compression
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6
Q

cardinal symptoms of bowel obstruction

A

colikcy abdominal pain

vomiting

absolute constipation

abdominal distention

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7
Q

signs of bowel obstruction on examination

A

abdominal tenderness

tympanic percussion

tinkling bowel sounds

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8
Q

imaging choice for bowel obstruction

A

CT now 1st line

supine CXR still frequently done

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9
Q

Difference between large + small bowel obstruction on XRAY

A

small:

  • central, valvulae conniventes transverse entire thickness of the bowel

large:

  • peripheral, haustra partially cross thickness of the bowel
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10
Q

what type of bowel obstruction is this

A

large

  • haustra
  • peripheral
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11
Q

what type of bowel obstruction is this

A

small

  • central
  • valvulae conniventes cross entire bowel width
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12
Q

what other imaging may be required in bowel obstruction

A

erect CXR if perforation suspected- shows air under diaphragm if perforated

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13
Q

management of bowel obstruction

A

Trial of ‘Drip + suck’: NG tube, nil by mouth, IV fluids.

analgesia.

Surgery: laparotomy. absolute indications if:

  • peritonitis
  • perforation
  • irreducible hernia
  • caecal volvulus
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14
Q

what is paralytic ileus

A

reduced small bowel motility in the absence of obstruction

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15
Q

what usually causes paralytic ileus

A

post abdo surgery

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16
Q

what are bowel sounds like in paralytic ileus compared to obstruction

A

ileus = silent

obstruction = tinkling

17
Q

management of paralytic ilieus

A

IV fluids, NG tube if vomiting, mobilise to stimulate peristalsis

18
Q

what is a pseudo-obstruction

A

reduced motility of the large bowel in the absence of obstruction

19
Q

what causes pseudo-obstruction

A

increased sympathetic tone

20
Q

what is a volvulus

A

twisting of a loop of intestine around its mesenteric attachment

  • results in bowel obstruction
  • affected loop can become ischaemic due to compromised blood supply
21
Q

most common sites for volvulus

A

sigmoid colon

  • counterclockwise twisting

caecum (2nd)

  • clockwise twisting
22
Q

coffee bean sign

A

sigmoid volvulus

23
Q

management of sigmoid volvulus

A

decompression by sigmoidoscope + flatus tube insertion

24
Q

management of a caecal volvulus

A

laparotomy with ileocaecal resection

25
what structures make up the foregut? what is the blood supply?
stomach, biliary system, liver, pancreas ## Footnote **Celiac artery**
26
what structures make up the midgut? what is the blood supply?
duodenum to first half of transverse colon -**superior mesenteric artery**
27
what structures make up the hindgut? what is the blood supply?
2nd half of transverse colon to rectum ## Footnote **- inferior mesenteric artery**
28
what is acute mesenteric ischaemia
acute reduction in blood flow through the superior mesenteric artery (most commonly) or coelic artery, injuring the small bowel
29
risk factors for acute mesenteric ishaemia
Atrial fibrillation Post MI Atherosclerosis Coagulation Disorders
30
what is chronic mesenteric ichaemia due to
atherosclerosis of the superior mesenteric artery / inferior mesenteric artery / coeliac artery aka intestinal angina
31
presentation of acute mesenteric ischaemia
sudden onset abdominal pain **disproportionate to exam findings** progressess to peritonism
32
how is mesenteric ishaemia diagnosed
CT angiogram
33
blood gas in mesenteric ishaemia
metabolic acidosis high lactate
34
management of acute mesenteric ischaemia
IV fluids + Abx Papaverine - opiod antispasmodic which causes vasodilation Thrombolysis In perforation/peritonitis: urgent laparoscopy/laparotom for embolectomy and resection of any infarcted bowel
35
management of chronic mesenteric ishaemia
systemic mesenteric bypass - percutaneous angioplasty if unfit for open surgery
36
what is ishaemic colitis
large bowel ishaemia, typically transient, leading to inflammation - usually due to atherosclerosis - splenic flexure most commonly affected
37
what is fulminant ishaemic colitis
ishaemic colitis with necrosis, perforation and sepsis
38
presentation of ishaemic colitis
abdominal pain, onset over hours, tenderness over affected area PR bleeding + diarrhoea
39
diagnostic test for ischaemic colitis
colonoscopy - sloughing, friability, ulceration