Bowel Obstructions, Ischemic Bowel, & Small Bowel Neoplasms Flashcards
a physical or functional blockage of the small or large intestines
bowel obstruction
an obstruction that physically blocks the movement of bowel contents distal of the obstruction
mechanical obstruction
what is the most common surgical disorder of the small intestines?
mechanical obstruction
what is the most common cause of a small mechanical bowel obstruction?
surgical adhesions
what is the most common cause of a large mechanical bowel obstruction?
neoplasms
how to differentiate between complete and partial mechanical obstruction?
partial obstruction results in pure liquid and flatulence
complete obstruction results in obstipation (no gas/no bowel sounds)
a clinical syndrome in which intestinal motility is impaired in the absence of a mechanical obstruction, characterized by symptoms and signs of a bowel obstruction without a physical obstruction
functional bowel obstruction
what is a functional bowel obstruction also called?
ileus
what is a major cause of morbidity in hospitalized patients?
functional bowel obstruction
a patient presents with N/V (feculent emesis), colicky abdominal pain, abdominal distention, and hyperactive bowel sounds that progress to absent bowel sounds. Dx?
bowel obstruction
what 3 symptoms are suggestive of bowel ischemia or infection d/t bowel obstruction?
pain disproportionate to exam
fever
tachycardia
what is the diagnostic of choice to diagnose a bowel obstruction?
CT scan
what diagnostic can be used in bowel obstruction to see air and fluid?
abdominal series xray
what is the management for a mechanical bowel obstruction? (5)
IV hydration
judicial pain meds
NPO
NG tube for decompression
+/- surgery
what is the non-surgical treatment option for a mechanical bowel obstruction?
frequent serial abdominal exams for non-closed loop obstructions (twisting)
what is the management for a functional bowel obstruction? (6)
IV hydration
NPO
NG tube for decompression
judicial pain meds
correct underlying pathology
progress to liquids + solids
what medication can be used to treat a functional bowel obstruction caused by opiates?
alvimopan (mu-opioid receptor antagonist)
acute visceral artery insufficiency causing pain, tissue damage, and necrosis of the bowel
ischemic bowel disease
what are the 3 etiologies of ischemic bowel disease?
embolic occlusion
primary thrombosis
nonocclusive vascular insufficiency
a patient presents with severe abdominal pain that is out of proportion to the findings on the physical exam, and the pain is worsened by a meal. Dx?
acute ischemia
a patient presents with a history of post-prandial abdominal pain, avoidance of eating d/t pain, and weight loss. Dx?
chronic ischemia
what labs will be present in ischemic bowel disease? (2)
elevated WBCs
lactic acidosis
what is the imaging of choice for ischemic bowel disease? (2)
CT angiography OR MRA
what imaging should be avoided in ischemic bowel disease to prevent rupture?
colonoscopy
what is the most common risk factor for acute ischemic bowel disease?
afib
what is the surgical treatment for acute ischemia? (2)
general sx
immediate exploration +/- resection
what is the surgical treatment for chronic ischemia? (2)
vascular sx
angioplasty, vessel stent, or arterial bypass
what is the medical management for ischemic bowel disease? (6)
IV fluids + blood
NPO
oxygen
heparin (anticoagulate)
antibiotics
NG tube for decompression
aggressive neoplasm, mostly found in duodenum or proximal jejunum
adenocarcinoma
neoplasm most commonly in the distal small intestine, majority is non-Hodgkin’s B-cell
lymphoma
what is the treatment for carcinoid tumor of the intestine?
local excision
tumor that is commonly found in the stomach and intestines
carcinoid
what is a symptom of early disease in adenocarcinoma and lymphoma?
fecal occult blood
what are symptoms of late disease in adenocarcinoma and lymphoma? (6)
abdominal pain
weight loss
N/V
distention
anemia
obstruction
what imaging can be used for adenocarcinoma and lymphoma of the small intestines?
CT w/ contrast
what gives a definitive diagnosis of adenocarcinoma and lymphoma of the small intestines?
biopsy
what are 2 treatment options for adenocarcinoma and lymphoma of the small intestines?
surgical resection
chemo +/- radiation
what is the best indicator for poor prognosis of carcinoid of the intestines?
invasive growth / distant metastasis
what is the size of most carcinoid tumors?
< 2cm
what size carcinoid tumors are associated with metastasis?
> 2cm
a patient presents with facial flushing, diarrhea, wheezing, lightheadedness, tachycardia, and hypotension. Dx?
carcinoid syndrome
how do most patients with carcinoid tumors present?
asymptomatic
carcinoid of the intestines have a slow rate of _____
metastases
