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Gastrointestinal Conditions (JBR) > Bowel Obstruction & Volvulus > Flashcards

Bowel Obstruction & Volvulus Flashcards

1
Q

What gases small bowel obstruction?

A

Fluid, gas

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2
Q

What are features of small bowel obstruction?

A 
Colicky, central pain
Absolute constipation 
Vomiting
Burping 
Abdominal distension
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3
Q

Fluid and gas in small bowel obstruction dilates the bowel ______ and disrupts?

A

proximally

peristalsis

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4
Q

In complete bowel obstruction there is no ________ passed

A

flatus or stool

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5
Q

What are risk factors for small bowel obstruction?

A 
Adhesions
Strangulated hernia
Malignancy
Caecal volvulus 
Diverticular disease
Stricture
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6
Q

How does a small bowel obstruction present?

A

Acute diffuse abdominal pain of colicky nature
Early vomiting
Late constipation
Tinkling bowel sounds

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7
Q

If there is semi-digested food (eaten 1-2 days ago) in vomitus it indicates?

A

Gastric outlet obstruction

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8
Q

Copious bile stained vomit indicates?

A

Upper small bowel obstruction

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9
Q

Thicker, brown foul-smelling (faeculent) vomit indicates?

A

More distal obstruction

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10
Q

How do you investigate bowel obstruction?

A

AXR

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11
Q

Symptoms of a small bowel obstruction have _____ onset than large bowel obstruction

A

faster

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12
Q

How do you treat a small bowel obstruction?

A

Bowel rest
NG tube - drip and suck
Correct electrolyte imbalance

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13
Q

What is meant by “drip and suck”?

A 
ABC
Analgesia 
Fluids with potassium
Catheterise
NG tube (suck not feed)
Anti-thromboembolism measures
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14
Q

How long should you drip and suck for?

A

Up to 72 hours

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15
Q

After 72 hours of drip and suck it is recommended to?

A

Operate

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16
Q

When should you intervene and operate for a small bowel obstruction?

A

If strangulation, perforation +/- ischaemia

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17
Q

What causes large bowel obstruction?

A

Most commonly CRC but can be same cause as SBO

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18
Q

What happens in large bowel obstruction if the ileocaecal valve stays competent?

A

Backwards flow of accumulated bowel prevented
Caecum progressively distends with swallowed air
Eventually rupture

19
Q

What happens in large bowel obstruction if the ileo-caecal valve is incompetent?

A

Small bowel distends delaying onset of symptoms

20
Q

What are the mechanical causes of large bowel obstruction?

A 
Adhesions or bands
Incarcerated abdominal wall hernia
Volvulus
Tumour
inflammatory strictures
Bowel Strangulation
Intussusception
Dynamic bowel obstruction
21
Q

What are causes of adhesions or bands in the large bowel?

A

Congenital
post-surgery
Peritonitis

22
Q

What is the sign of volvulus on AXR?

A

Coffee-bean sign

23
Q

What are causes of inflammatory strictures of large bowel?

A

Crohn’s +/- Diverticular disease

24
Q

What is intussusception?

A

Segment of boel wall becomes telescoped into segment distal to it - usually initiated by mass in bowel wall

25
Q

What are subtypes of adynamic bowel obstruction?

A

Paralytic ileus

Pseudo-obstruction (Ogilvie’s Syndrome)

26
Q

What is a paralytic ileus?

A

Failed peristalsis

27
Q

What is a pseudo-obstruction? (large bowel)

A

Acute dilation of colon without obstruction in the acutely unwell

28
Q

What is pseudo-obstruction of large bowel associated with?

A 
Hip replacement 
CABG
Spinal 
Pneumonia 
Frail/elderly patients
29
Q

How do you investigate a pseudo-obstruction? (large bowel)

A

AXR/CT

30
Q

How do you treat a pseudo-obstruction? (large bowel)

A

May require colonoscopy to decompress

31
Q

How does a large bowel obstruction present?

A

Early constipation, late vomiting - otherwise like SBO

Symptoms tend to develop more slowly

32
Q

How do you investigate a large bowel obstruction?

A

Supine AXR

33
Q

What would be seen on AXR with a bowel obstruction?

A

Bowel proximal to obstruction distended

34
Q

What are AXR features of distended small bowel?

A

Central with circular folds (coin-stacking)

35
Q

What are AXR features of distended large bowel?

A

Normal anatomical position (hausfrau)

36
Q

What are treatment options for large bowel obstruction?

A

CT, decompression via flatus tube or endoscopy, surgery

Drip and suck

37
Q

What is a volvulus?

A

Piece of bowel twists on its mesentery

38
Q

Which pieces of bowel are usually involved in volvulus?

A

Caecum

Sigmoid colon

39
Q

Volvulus leads to a loop of bowel full of faeces and distention - this is called a?

A

Closed loop obstruction

40
Q

What are risk factors for Volvulus?

A 
Elderly
Debilitated
Cosntiaption
Megacolon
Congenitally elongated colon
41
Q

How does a volvulus present?

A

Sudden onset of colicky lower abdominal pain with gross abdominal distension and a failure to pass flatus or stool

42
Q

How do you investigate a volvulus?

A

Tympanic (bell-sounding) abdomen on percussion

Coffee-bean sign on AXR

43
Q

How do you manage volvulus?

A

Flatus tube
Decompression via flexible sigmoidoscopy
Surgical resection

Gastrointestinal Conditions (JBR) (33 decks)

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