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1- GIT Medicine > Intestinal Obstruction > Flashcards

Intestinal Obstruction Flashcards

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1
Q

Definition

A

Stoppage of onwards passage of intestinal contents ( food, digestive juices, gases )

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2
Q

Different ways to classify intestinal obstruction

A

Mechanical , paralytic

High , low,

Acute, chronic, acute on chronic

Simple, closed loop, strangulation

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3
Q

Different areas of obstruction in intestines

A

Intraluminal
Intramural
Extramural
Mesenteric vascular obstruction
Others

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4
Q

Causes of intraluminal obstruction

A

Foreign bodies
Pedunculated tumors
Worms
Impacted faeces
Bezoars
Gallstones
Faecolith

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5
Q

Intramural causes of obstruction

A

Tumors
Atresias
Anorectal anomalies
Aganglionic megacolon
Intussusception

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6
Q

Extramural causes of obstruction

A

Hernia
Adhesions / bands
Volvulus

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7
Q

Pathophysiology of simple obstruction

A

Distal segment obstruction

Proximal segment distension with accumulation of fluid, food and gases (loss of absorption , increase in secretion ) , increase in intraluminal pressure (wall edema, integrity loss, bacteria translocation, venous stasis and occlusion, arterial stasis )

Collapse of distal segment

Dehydration and electrolyte imbalance with loss of GI secretion (accumulation in lumen and vomiting +loss in peritoneum and bowel wall ) leading to hypokalemia , Hyponatremia , hypochloremia , metabolic alkalosis or acidosis and kidney affected

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8
Q

Closed loop obstruction pathophysiology

A

No content entering or leaving segment in the loop
Shows same pathophysiology as simple obstruction

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9
Q

Complication in closed loop if rapid distension

A

Rupture

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10
Q

Example of disease causing closed loop obstruction

A

Hernias
Adhesions
Volvulus
Obstructing colonic mass with competent IC valve

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11
Q

Can you have an obstruction that is simple, closed loop, and strangulated

A

Yes

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12
Q

Strangulation obstruction pathophysiology

A

Sequestration of blood leading to hypovolemia

Dilatation of intramural lymph channels bacteria and toxins diffusion can lead to peritonitis, septicemia, endotoxin shock

Bleeding into lumen , wall , peritoneal cavity

Bowel wall infarction leading to anaerobic organisms multiplication

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13
Q

Causes of death in bowel obstruction

A

Shock
Dehydration
Electrolyte imbalance and metabolic disturbance
Peritonitis
Septicemia
Renal failure
Respiratory failure
Multiple organ failure

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14
Q

main symptoms and signs

A

Pain (colicky if mechanical )
Vomiting
Constipation
Abdominal distension

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15
Q

Vomiting occurs early in disease in low or high bloackage

A

High blockage

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16
Q

Type of constipation in intestinal obstruction

A

Absolute with no faeces nor flatus

17
Q

Constipation occurs early in low or high blockage

A

Low blockage

18
Q

History of presenting complaints

A

Onset
Relationship between vomiting , abdominal distension, constipation, abdominal pain
Progression of pain , constipation

19
Q

Systemic enquiry important findings

A

Fever
Weight loss

20
Q

Important past medical history

A

Previous surgery (adhesions, anastomotic structure )
Spinal injury
Retroperitoneal hemorrhage
Electrolyte imbalance (hypokalemia , hypomagnesemia )

21
Q

General features found on examination

A

Dehydration
Shock presentation

22
Q

Examination inspection findings

A

Abdominal distension
Asymmetry
Visible peristalsis
Scars
Hernia orifices

23
Q

Palpation findings on examination

A

Hernia orifices
Tenderness
Rebound tenderness

24
Q

Percussion findings on examination

A

Tympanitic

25
Q

Auscultation findings on examination

A

Bowel sounds
Increased volume or pitch possible

26
Q

Rectal examination findings

A

Feeling of faeces
Tumors

27
Q

Investigations

A

Plain X ray
CT scan
CHest x ray
Urea and electrolytes
FBC
Barium enema

28
Q

Position of patients on plain x ray

A

Erect
Supine

29
Q

Differential diagnosis of intestinal obstruction

A

Causes of mechanical obstruction
Causes of paralytic ileus
Acute pancreatitis
Severe constipation
Pseudo obstruction
Other causes of acute abdomen

30
Q

Treatment of intestinal obstruction

A

Resuscitation (fluid and electrolyte imbalance correction )
Bowel decompression with NG tube

Antibiotics
Pain relief and sedation

31
Q

Factors affecting prognosis

A

Interval between onset and treatment
Level of obstruction
Causes of obstruction
Age of patient
Adéquation of rescusitation
Viability of bowel
Pre existing disease

1- GIT Medicine (20 decks)

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