Gen Surg: small + large bowel obstruction and ileus Flashcards
How does large bowel obstruction present?
Abdominal pain
Bloating
Absolute constipation
Nausea and vomiting
What are the causes of large bowel obstruction?
Colonic tumour
Volvulus (sigmoid or caecal)
Diverticular disease
Less common:
Hernias
Adhesions
What investigations would you do for a large bowel obstruction?
Abdominal xray
CT abdo to establish a cause
What are tympanic sounds in the abdomen?
Occurs over the air filled structures- should sound this way in the midline of the abdomen. It sounds long, high pitched and loud
How would you manage post-op ileus?
Conservatively:
* insert NG tube for stomach decompression for symptom control.
* Place pt on NBM regime to allow bowel to rest.
* Reduce opiate analgesia as reducing bowel motion.
* Do daily bloods as could have electrolyte abnormalities and AKI can develop. Encourage mobilisation.
What is post operative ileus?
A deceleration or arrest in intestinal motility following surgery. Classified as a functional bowel obstruction and is v common after abdominal or pelvic oath surgery.
How does post operative ileus present?
- Failure to pass faeces or wind
- Sensation of bloating and distension.
- Nausea and vomiting.
- Inability to tolerate oral diet
O/E
Abdominal distension and absent bowel sounds.
What is thumbprinting indicative of?
large bowel thickening usually caused by oedema
What are the causes of small bowel obstruction?
Adhesions,
incarcerated hernias,
crohns disease,
appendicitis,
malignancy,
gallstone ileus,
foreign body ingestion
Name a cause of intraluminal intestinal obstruction?
Gallstone ileus, foreign body, faecal impaction.
Name a cause of mural intestinal obstruction
Malignancy, strictures, intussusception, mocker’s diverticulum, lymphoma.
Name a cause of extraluminal intestinal obstruction
Hernia, adhesions, peritoneal mets, volvulus
What is the most common cause of small bowel obstruction?
Adhesions, hernias
How does small bowel obstruction present?
Abdo pain, vomiting (bilious)
, abdo distension,
absolute constipation (comes after the vomitting)
What would be seen on examination for small bowel obstruction?
- tinkling bowel sounds,
- focal tenderness.
What imaging would you do for small bowel obstruction? And what would you see?
AXR - see centrally dilated bowel >3cm. Valvulae conniventes are visible. Can do CT scan with IV contrast. Can do CXR - see pneumoperitoneum if perforated.
What initial management options would you discuss for small bowel obstruction?
- Urgent fluid resus,
- catheter to monitor fluid output,
- pt NBM-insert NG tube to decompress bowel
When is surgery indicated for small bowel obstruction?
Intestinal ishaemia,
closed loop bowel obstruction.
If hernia is present and strangulated - need surgical correction.
What are complications of small bowel obstruction?
Bowel ischaemia, bowel perforation, dehydration and renal impairment
What are most common causes of large bowel obstruction?
Malignancy
diverticular disease
volvulus
What is seen on AXR of large bowel obstruction?
Peripherally dilated bowel. Haustral lines visible.
How does a large bowel obstruction look on X-ray?
Peripherally dilated loops of bowel
Sigmoid volvulus RF?
Older patients
Chronic constipation
Chagas disease
Neuro conditions- parkisons, Duchenne muscular dystrophy
psych conditions e.g. schizophrenia
Clinical features of sigmoid volvulus?
- Constipation
- abdo bleeding
- abdo pain
- nausea and vomitting
Axr of sigmoid volvulus?
Large bowel obstruction and coffee bean sign
Management of sigmoid volvulus?
- Rigid sigmoidoscopy with rectal tube insertion
Management of caecal volvulus?
- usually operative, right hemicolectomy is often needed
abdominal pain, vomitting and bloating post bowel surgery?
post-operative ileus
