Bowel obstruction (SBO + LBO) Flashcards
1
Q
Define simple obstruction.
A
- Obstruction of the bowel without damage to the blood supply
- Intestinal blockage in the absence of peritonitis
- Reflects early/partial obstruction and may respond to non-operative therapy
2
Q
Define complicated obstruction.
A
- Surgical emergency
- Obstruction has progressed to intestinal ischaemia/gangrene and/or perforation
- Life threatening –> requires urgent resuscitation + surgery
3
Q
Define partial/incomplete obstruction.
A
- Blockage of the intestine is not complete
- Partial passage of flatus and occasionally stool
- May resolve with non-operative therapy
4
Q
Define complete obstruction.
A
- Emergency
- Lumen of intestine is completely obstructed
- Failure to pass flatus and stool
- Generally associated with peritonitis
- Will not respond to non-operative therapy
5
Q
Define mechanical obstruction.
A
- When something is physically obstructing the passage of contents
- Usually occurs in the small bowel
6
Q
What can cause mechanical obstruction?
A
- Scar tissue
- Adhesions
- Entrapment through a hernia
- Foreign bodies
- Gallstones
- Tumours
- Impacted faeces
- Volvulus
7
Q
What are the cardinal features of obstruction?
A
- Abdominal distension
- Absolute constipation
- Vomiting
- Colicky pain
8
Q
Define adynamic ileus.
A
- Failure of passage of enteric contents through small bowel and colon that are not mechanically obstructed
- Paralysis of intestinal motility
9
Q
What can cause adynamic ileus?
A
- drugs (opioids)
- metabolic (hyponatraemia)
- sepsis
- abdo trauma or surgery
- MI/congestive heart failure
- head injury/ neurosurgery
- intra-abdominal inflammation and peritonitis
- retroperitoneal haematoma
10
Q
Define acute obstruction.
A
- Intestinal obstruction of short duration, in a patent who has not previously undergone abdominal surgery
- importance of lack of previous abdo surgery is that the obstruction is much less likely settle on non-operative management
11
Q
Define subacute obstruction.
A
- Intestinal obstruction of short duration, in a patient who has previously undergone abdominal surgery
- importance of previous surgery is that the obstruction is most likely due to adhesions, is often incomplete and will often settle without operative intervention
12
Q
Define chronic obstruction.
A
- Intestinal obstruction of longer duration and would typically be seen in a patient with large bowel obstruction who has an incompetent ileo-caecal valve
13
Q
Define closed loop obstruction.
A
- Specific form of mechanical obstruction characterised by increasing distension of a loop of bowel
- due to a combination of complete obstruction distally and a valve like mechanism proximally allowing the bowel to fill but not reflux
- e.g. with an obstruction in the caecum when the ileo-caecal valve remains competent
14
Q
What can cause closed loop obstruction?
A
- Hernias
- Adhesions
- Volvulus
15
Q
What are the differential diagnoses for bowel obstruction?
A
- Acute colonic pseudo-obstruction
- Chronic/idiopathic megacolon
- Toxic megacolon
- Endometriosis
- Pseudomembranous colitis
- Ileus
- Intussusception
- Intra-abdominal sepsis
- Pneumonia/systemic illness
