Chapter 17: SI and Colon Flashcards
What are signs of obstruction of the SI?
- Abdominal distension
- Vomitting
- Pain
- Constipation
- Tympanic
MCC of Small Bowel Obstruction
- Bulges (Hernias)
- Adhesions
- Intussception
- Volvulus
MCC SBO in the world
Hernias
MCC SBO in the USA
Adhesions
What is a hernia?
Weakness/defect in abdominal wall that allows a serosa lined pouch of peritoneum to protude (hernia sac) & can trap bowel segments externally.
Acquired hernias most typically occur ________ into which sites?
- Anteriorly
- Femoral and Inguinal canals
- Umbilicus
- Surgical scars
How do hernias cause obstruction?
External herniation (visceral protrusion)
Which type of hernia is most often associated with obstruction and why?
-
Inguinal hernias
- They have narrow orrifices and large sacs
-
Inguinal hernias
What is the sequalae of hernias?
- Incarceration: venous stasis + edema increase size of hernia loop => becomes permanent entrapment
- Strangulation: squeeze arteries and veins
- Infarction
What is an adhesion?
- Local inflammation that heals (fibrosis) and forms bands of scar tissue in peritoneal cavity, most often after surgery
*Also in trauma, infection, endometriosis
Adhesions can lead to the formation of ___________.
Internal hernias
- (Viscera can slide through fibrous bridges created by scar tissue/fibrous bridges => internal hernia)
- In women, adhesions can cause?
- Treatment of adhesions?
- Infertility bc ovum cannot be transported
- Surgery (lysis of adhesions; can lead to more adhesions)
What is a volvulus and where is it most common?
- Twisting of the bowel around mesentary, causing obstruction and infarction
- Sigmoid colon > cecum
Volvulus can lead to ___________
Toxic megacolon
What is the classic patient for volvulus?
Older patient (>70s)***and if in children, can be due to Meckels
- What is the most common cause of intestinal obstruction in children < 2 years old?
Intuscception (spontaneous or viral infection; rotavirus)
What is intussception?
Where is it most common?
- Proximal Intestinal segment gets trapped by a leading edge (lesion), and “telescopes” (with the mesentary) into the immediately distal segment due to peristalsis.
- MC: ileocecal junction (terminal ileum telescopes into cecum)
If untreated, intusseception can cause (3):
- Obstruction
- Bleeding (mesentary is pulled with it = compresses vessels ) => current jelly stool
- Infarction
Although typically idiopathic, some cases of intussusception have been associated with what?
Children: viral infections (rotavirus vaccine)
Adults (rare): intraluminal mass or tumor
What is the leading point seen in Intussception caused by a viral infection, like rotavirus?
- Reactive hyperplasia of Peyers patches and lymphoid tissue, causing them to trap the intestines
___________ is used diagnostically and therapeutically for intussusception in infants and young children?
Contrast enemas
What occurs when there is blood loss to the intestines?
- Slow and progressive blood loss = collateral blood supply compensates
- Abrupt blood loss= infarction of several meters
What symptoms are seen in ischemic bowel disease?
Ischemic Bowel Disease, typically occurs with a CV defect.
- 1. Abdominal pain
- 2. Hemtochezia
- 3. Decreased bowel sounds
___________ are at increased risk for ischemic bowel disease (2):
Watershed zones between major vessels (2)
- Splenic flexure via the marginal artery of dremmond (connects superior and inferior mesenteric a.)
-
Rectosigmoid colon
- IMA, pudendal, and iliac arteries end


