Chapter 83: Bowel Obstruction Flashcards
Accounts for most bowel obstructions
Small bowel obstruction
The most common cause of small bowel obstruction
Adhesions after abdominal surgery
The second most common cause of small bowel obstruction
Incarceration of a hernia
Key features of Ileus compared to bowel obstruction
Pain: mild to moderate Location: diffuse PE: mild distention, +/- tenderness, decreased bowel sounds Lab: dehydration Imaging: may be normal Tx: observation and hydration
Bariatric surgery may be complicated by ____ after Roux-en-Y gastric bypass
Bariatric surgery may be complicated by internal hernias after Roux-en-Y gastric bypass
Type of polyp that in common in Peutz-Jeghers syndrome
Hamartomatous polyp
In gallstone ileus, the obstruction happen at?
Ileocecal valve
The leading point of intussusception and present as small bowel obstruction
Lymphomas
Most commonly composed of vegetable matter or pulp from persimmons.
Bezoars
Which patient are most susceptible to intraluminal obstruction by bezoars
Undergone GI pyloroplasty or pyloric resection
Blunt abdominal trauma may cause
Blunt abdominal trauma may cause a duodenal hematoma
The most common cause of large bowel obstruction
Neoplasm
The next most frequent cause of large bowel obstruction after cancer and diverticulitis is
Sigmoid volvulus
The pain of large bowel obstruction is usually ____
The pain of large bowel obstruction is usually hypogastric
In small bowel obstruction, it is the most reliable sign
Distention
Reliable sign of sigmoid volvulus
Emptiness of the left iliac fossa
True or False
The absence of stool or air in the rectal vault supports a diagnosis of obstruction and may aid in the diagnosis of bowel obstruction, but its presence does not eliminate a more proximal obstruction
True
The absence of stool or air in the rectal vault supports a diagnosis of obstruction and may aid in the diagnosis of bowel obstruction, but its presence does not eliminate a more proximal obstruction
True or False
A leukocytosis of >40,000/mm3 or left shift should make one suspect bowel gangrene, intra-abdominal abscess, or peritonitis
False
A leukocytosis of >20,000/mm3 or left shift should make one suspect bowel gangrene, intra-abdominal abscess, or peritonitis
True or False Leukocytosis of (>20,000/mm3) suggests mesenteric vascular occlusion
False Extreme leukocytosis (>40,000/mm3) suggests mesenteric vascular occlusion
This test may predict bowel ischemia or failure of conservative management
Procalcitonin
True or False
CT scan with oral and IV contrast is the imaging method of choice in the ED with bowel obstruction
True
CT scan with oral and IV contrast is the imaging method of choice in the ED
True or False
For colonic obstruction due to malignancy, tumor resection is the gold standard treatment
True
For colonic obstruction due to malignancy, tumor resection is the gold standard treatment
