Bowel obstructions

Question 1

Causes of small bowel obstruction

Answer 1

adhesions
congenital hernias
caecal carcinoma obstructing ileocaecal valve
inflammatory strictures
luminal lesions (gallstones, foreign bodies, bezoars)
tumours

Question 2

What is absolute constipation?

Answer 2

not passing faeces or flatus

Question 3

Small bowel obstruction presentation

Answer 3

central ‘midgut’ pain
distension
vomiting - bilious/faeculent
bowels not open abruptly
history of surgery

Question 4

Small bowel obstruction investigation

Answer 4

bloods - FBC, UE, CRP, lactate
AXR/CXR
CT scan - localise cause

Question 5

Small bowel obstruction management

Answer 5

analgesia - parenteral
IV access + fluids (saline +/- potassium)
NG decompression
antibiotics if aspiration has occurred
adhesional obstruction - gastrograffin if comfortable - trial 24h
surgery

Question 6

Causes of large bowel obstruction

Answer 6

tumours - usually carcinoma
strictures - usually diverticular
volvulus - sigmoid, caecal

Question 7

Large bowel obstruction presentation

Answer 7

distension
in malignancy, gradual change in bowel output until obstipated
hindgut pain - lower abdomen
pain builds up in RIF if ICV competent
ICV incompetent = vomiting

Question 8

Large bowel obstruction investigation

Answer 8

bloods - anaemia, UEs, lactate, CRP
IV access + fluid resuscitation
does not necessarily need NGT
AXR/CXR
CT

Question 9

Large bowel obstruction management

Answer 9

diverticular stricture - Hartmann’s
volvulus - decompress endoscopically (ischaemic = Hartmann’s)
sigmoid carcinoma - stent vs resection