Bowel Obstructions Flashcards
Causes of small bowel obstruction outside the bowel
Adhesions - previous operations, intraabdominal hernias
Causes of small bowel obstruction from the bowel wall
Crohn’s, appendicitis
Causes of SBO inside the bowel
Malignancy, foreign body ingestion, gallstone ileus
Common causes of SBO in children
Intussusception, volvulus, intestinal atresia, appendicitis
Presentation of SBO
Initial colicky pain which becomes continuous, distention, vomiting (bilious), failure to pass stool, tympanic high pitched bowel sound, empty rectum, fever, fluid depleted
Blood results in SBO
FBC showing leukocytosis and anaemia, U&E’s showing organ dys and hypovolaemia, high lactate for bowel ischaemia or necrosis, amylase
Imaging in SBO
Sit upright to look for pneumoperitoneum, absence of air in rectum
What are signs of emergency in SBO
Signs of peritonitis
Investigations to conduct if the patient is stable with SBO
CT abdo and pelvis for best diagnosis, contrast SB using gastrogaffin, MRI, US, diagnostic laparotomy
Management of SBO
Correct of fluid and electrolyes, fluid resus, NG tube to aspirate content for decompression, sugery if conservative measurements fail
Presentation of large bowel obstruction
Abdominal cramping pain, bloating, absolute constipation, nausea, vomiting in late stages
Causes of LBO
Colonic tumour, strictures from IBD or diverticular disease, vovulus, hernias, adhesions
Investigations into LBO
Abdominal Xr and CT
Management of LBO
Analgesia, fluids, antiemetics, decompression of sigmoid volvulis, 70% require surgical intervention.
Definition of Diverticular disease
Clinical conition resulting from the presence of diverticular which are outpouchings of the mucosa and submucosa, typically sigmoid colon
What is diverticulitis
Inflammation of diverticular, typically age >50
Presentation of diverticular disease
Constipation, LLQ pain, some rectal bleeding
Presentation of diverticulitis
Acutely with LLQ pain, fever, nausea, vomiting, pyrexia
Complications of diverticulitis
Abscess formation, perforation (if diffuse tenderness/peritonitis), fistulas (especially colovesical fistulas)
Management of diverticular disease
Increased dietary fibre, hydration, analgeisa
Management of diverticulitis
Initially managed with oral antibiotics - 7 day amoxiclav
Indications for surgery in diverticular disease
Option if rectal bleeding uncontrolled, unresponsive to anti-biotics, abscess, perfoartion, stricture or obstruction
Definition of diverticulosis
Diverticula found incidentally
What is vovulus
Twisting of a loop of intestine around its mesenteric attachment, resulting in a closed loop bowel obstruction.
What can happen in the affected bowel of vovulus
Affected bowel can become ischaemic due to a compromised blood supply, rapidly leading to bowel necrosis and perforation
Risk factors for vovulus
Increasing age, neuropsychiatric disorders, nursing homes, chronic constipation or laxative use, male, previous abdominal operations
Symptoms of vovulus
Colicky pain, distension, absolute distension, vomiting is a late sign
Investigations into suspected volvulus
CT scan, abdo pelvis with contrast - dilated sigmoid colon with ‘whirl’
Conservative management of vovulus
Decompression with sigmoidoscope and insertion of flatus tube
Sugical management of vovulus
Hartmann’s procedure in cases of perforation or ischaemia, failed decompression attempts, necrotic bowel. If recurrent sigmoidectomy.
Most common site of vovulus
Most common sigmoid colon, then caecum
Management of caecal vovulus
Laparotomy and ileocaecal resection
Definition of intusussception
Invagination of proximal bowel into a distal segment passing into the caecum through the ileocaecal valve
Complications of intussusception
Bowel perforation, peritonitis, gut necrosis
Presentation of vovulus
Paroxysmal, severe colicky pain and the child characteristically draws up legs. Increasingly lethargic, vomiting, refuse feeds, jelly stools, distention, sausage-shaped mass in abdomen
Management of vovulus
Rectal air insufflation or contrast enema, operative reduction
Clinical features of haemorrhoids
Bright red PR bleed associated with defecation. If painful suggests thrombosis external haemorrhoid or alternative diagnosis.
How to diagnose haemorrhoids
Anascopic examination, palpable mass present with prolapsing
Grade 1 haemorrhoid
No prolapse
Grade 2 haemorrhoid
Prolapse on straining but spontanouesly reduces
Grade 3 haemorrhoid
Prolapse requiring manual reduction
Grade 4 haemorrhoid
Cannot be manually reduced (external)
Management of haemorrhoid
Conservatively with or without topical steroids for pruritis. Rubber band ligation, slerotherapy or IR photocoagulation. Haemorrhoidectomy
What is mesenteric ichaemia
Acute mesenteric ischaemia is a severe a lige threatening surgical emergency where there is sudden intestinal hypoperfusion. Chronic is more common in elderly
Which vessel is normally occluded in mesenteric ichaemia
Superior mesenteric artery
Acute presentation of mesenteric ischaemia
Severe abdo pain and guarding, nausea and vomiting, signs of shock, metabolic acidosis on ABG, PR bleeding in advanced
Presentation of chronic mesenteric ichaemia
Diffuse colicky pain, worse after eating, weight loss, diarrhoea, meleana
Risk factors for mesenteric ischaemia
Smoking, diabetes, high cholesterol, AF - emboli risk factors and atherosclerosis risk factors
