Ileus 1.04

Question 1

Define Mechanical Obstruction

Answer 1

Lumen is blocked so Luminal contents cannot pass through.

Question 2

Define Functional Obstruction

Answer 2

Obstruction of luminal contents is caused by neurogenic or functional disturbances that affect gut motility therefore having uncoordinated peristalsis from one region of the gut to the other.

Question 3

Define Simple Obstruction

Answer 3

The intestinal lumen is partially or completely obstructed without any compromise to blood flow.

Question 4

Define Strangulation Obstruction

Answer 4

The obstructed segment has compromised blood flow resulting in tissue ischaemia and necrosis.

Question 5

Define Open loop Obstruction

Answer 5

Intestinal lumen is obstructed but proximal decompression is possible via emesis (vomiting).

Question 6

Define Closed-loop Obstruction

Answer 6

The intestinal lumen is obstructed and no decompression is possible both proximally or distally so therefore there is build up of gas and secretions in the loop.

Question 7

General symptoms of Ileus (intestinal obstruction)?

Answer 7

Abdominal pain
Nausea and vomiting
Constipation

Question 8

The character of abdominal pain in strangulation obstruction?

Answer 8

Crappy or colicky pain in the early stages.
Constant pain as the condition progresses.
Localized severe pain when the strangulated loop comes into contact with the abdominal wall.

Question 9

Characteristic X-RAY appearance for ileus?

Answer 9

Distended gas and fluid-filled loops.

Question 10

The standard method of imaging for ileus?

Answer 10

Abdominal X-RAY in an erect or supine position. (standing up and lying down flat)

Question 11

Define Volvulus.

Answer 11

Form of closed loop obstruction where the loop of the bowel is twisted 180 degrees about the axis of its mesentery. Ischaemia and obstruction of the twisted loop occur.

Question 12

Common site of Volvulus?

Answer 12

Sigmoid colon in 65% of cases.

Extra info: cecum is next common.

Question 13

Define intussusception?

Answer 13

Intussusception is when one segment (intussusceptum) invaginates (telescopes) through adjacent segment (intussusceptiens). Obstruction + strangulation.

Extra info:
The intussuscepting segment is strangulated and has ischaemic injury and obstruction.
More commonly in 6-12 months old children and more so in small bowel than large bowel.

Question 14

What are the four types of intussusception?

Answer 14

1. Enteric
2. Ileocolic (most common)
3. Ileocecal
4. Colonic

Question 15

Who does intussusception usually occur in frequently?

Answer 15

Children 6-12 months old because of weaning.

Question 16

Pathological condition associated with intussusception?

Answer 16

Tumours and 90% of the time its in adults.

Question 17

Gallstone ileus?

Answer 17

Intense inflammation of the gall bladder with gall stones present causes fistula formation between the biliary tree and small/large intestine causing gall stones to travel into the intestinal lumen causing obstruction.

Question 18

Most common cause of large bowel obstruction?

Answer 18

Carcinoma

Question 19

Leading disorder in strangulation obstruction?

Answer 19

Blood flow of affected loop compromised.

Question 20

Excessive vomiting in small bowel obstruction is caused by?

Answer 20

Hypokalemia (decreased potassium)

Question 21

Except pain what are other symptoms of small bowel obstruction?

Answer 21

Nausea and vomiting (due to hypokalemia)

Question 22

Describe the pain in strangulated obstruction

Answer 22

constant severe pain.

Question 23

Main cause of intussusception in adults?

Answer 23

Tumours and Carcinoma

Question 24

Name of Feculent emesis from bowel obstruction?

Answer 24

Miserere

Question 25

Describe pain in large bowel obstruction

Answer 25

dull crampy pain

Question 26

Except pain what are the other symptoms in large bowel obstruction?

Answer 26

Failure to pass stool and flatus.
-Basically constipation and gas.

Question 27

Typical X-RAY finding in bowel obstruction?

Answer 27

Air fluid levels.

Question 28

4 distinct pathways physiological mechanisms lead to acute mesenteric ischemia?

Answer 28

1. ARTERIAL EMBOLUS
2. ARTERIAL THROMBOSIS
3. VENOUS THROMBOSIS
4. VASOSPASMS

Question 29

Most common cause of acute mesenteric ischaemia?

Answer 29

Embolus 50% of cases.

Question 30

which type of bowel obstruction has rapid change in bowel wall?

Answer 30

Closed loop obstruction
because of build up of gas and secretions that distend the segment.

Question 31

Most common underlying cause for mesenteric thrombosis ?

Answer 31

Atherosclerosis

Question 32

Most affected vessel in mesenteric embolus

Answer 32

Superior mesenteric artery.