GI obstruction Flashcards
What are the three broad anatomical types of GI obstruction?
- Gastric outlet obstruction
- Small bowel obstruction
- Large bowel obstruction
Name three causes of gastric outlet obstruction
- Peptic ulcer disease
- Gastric cancer; gastric polyps
- Ingestion of caustic substances
- Pyloric stenosis
- Pancreatic malignancy; pancreatic pseudocysts
- Duodenal cancer; ampullary cancer
- Cholangiocarcinoma; Bouveret syndrome
What are the cardinal symptoms of gastric outlet obstruction?
- Nausea
- Vomiting
- Post-prandial
- Non-bilious; undigested food
- Epigastric pain
What is Bouveret syndrome?
Subgroup of gallstone ileus
Cholecystoduodenal fistula allows the passage of a stone which impacts in the duodenum and causes gastric outlet obstruction
Outline the management of gastric outlet obstruction
-
‘Drip and suck’
- Maintain hydration and electrolyte balance (esp Cl-)
- Gastric decompression using NG tube
- Treat underlying causes where possible:
- If PUD ➔ IV omeprazole or Lansoprazole
- Gastric polyps ➔ endoscopic excision
- Pyloric stenosis ➔ Pyloromyotomy
- Malignant causes ➔ metallic stenting
What electrolyte imbalance is associated with gastric outlet obstruction?
Metabolic alkalosis due to vomiting
What are the cardinal features of intestinal obstruction?
- Colicky pain
- Vomiting: bilious or faeculent
- Distension
- Absolute constipation
What is ‘faeculent’ vomiting?
Vomiting of faeces due to bacterial fermentation of intestinal content in established obstruction
What are the two types of obstruction?
- Ileus (functional): reduced bowel motility
- Mechanical obstruction
What radiographic features are seen in Gallstone ileus?
Rigler’s triad:
- Opacity in RIF
- Dilated small bowel
- Air in biliary tree
Name four presenting features of small bowel obstruction
- Abdominal pain: paroxysmal colicky
- Faeculent vomiting
- Obstipation; failure to pass flatus
- Abdominal distension
- Visible peristalsis; hernia; scar
- High-pitched tinkling bowel sounds
- Dehydration; peritonitis
Name three causes of small bowel obstruction
- Adhesions
- 60-70% of adhesional SBO is self-limiting
- Hernias
- Tumours: eg. GI stromal tumour; carcinoid tumour; lymphoma
Name two causes of adhesions
- Surgery
- Extensive surgery may cause more adhesions
- May appear many years after a surgical procedure
- Trauma
- Intra-abdominal infection: eg. salpingitis, appendicitis
Which hernias commonly cause obstruction?
- Femoral hernia: narrow femoral canal
- Inguinal hernia: high prevalence
- Some parastomal or incisional hernias
On x-ray, when is the small bowel considered obstructed?
Small bowel dilation >3cm