Gen Surg - Bowel

Question 1

what is an intestinal obstruction

Answer 1

it is a mechanical blockage arising from a structural abnormality — that presents a physical barrier for the progression of gut contents

Question 2

what types of I/O are there

Answer 2

small vs large bowel

complete vs incomplete/partial
partial —- some gas or liquid stool may pass

acute vs sub-acute

complicated vs uncomplicated
complicated —- ischaemia, necrosis, perforation

Question 3

what can cause intestinal obstruction

Answer 3

small bowel obstruction
adhesions (common)
strangulated hernia (common)
malignancy
intussusception
strictures — sec to CD or radiation
Meckel’s diverticulum

large bowel
colon ca (common)
strangulated hernias
diverticulitis
volvulus
intussusception
strictures

Question 4

how does intestinal obstruction present

Answer 4

symptoms (Hx)
abdominal pain & distension
constipation/obstipation
vomiting
bilious = ?SBO
faeculent = ?LBO

signs (exam)
abdo distention — pronounced + early in LBO
tenderness, rigidity, guarding
high pitched (tinkling) or absent bowel sounds
DRE: empty rectum

Question 5

what Ix would u order for a suspected I/O

Answer 5

erect CXR
PFA
dilated loops of bowel
3, 6, 9 rule — small bowel = 3cm or less, large bowel; caecum
CT scan w contrast — to find out cause of obstruction

Question 6

how would u manage bowel obstruction

Answer 6

drip & suck
drip: begin IV fluids —- maintenance fluids + electrolyte management
suck: insert wide bore NG tube + leave in for free drainage
NPO
analgesia
insert urinary catheter —- U/O charting

definitive Tx acc to cause
ischaemic bowel = resection
tumour = resection, chemo, RT
stricture = dilation/resection of abnormal segment
adhesion = adhesiolysis
hernia = hernia repair
volvulus = colonoscopy + pneumatic decompression

Question 7

what is a stoma

Answer 7

it a purposeful anastomosis between a hollow viscera and the skin

it can be temporary or permanent

Question 8

what is a defunctioning stoma

Answer 8

it is when bowel resection is done, and a stoma is created proximal to the anastomosis post-resection so as to protect the anastomosis & allow for optimal healing conditions

once healing is achieved, the stoma can be reversed so as to allow normal bowel continuity

Question 9

what are some complications that can happen to stomas

Answer 9

stoma stenosis
stoma retraction
parastomal hernia
stoma necrosis
high output stoma