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Gastrointestinal > intestinal obstruction > Flashcards

intestinal obstruction Flashcards

1
Q

Three types of intestinal obstruction

A

In the lumen
Within the wall
Extraluminal

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2
Q

what can cause intraluminal obstructiobn

A

tumour
diaphgram disease
meconium ileus
gallstone ileus

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3
Q

what is diaphgram disease

A

condition wherein the bowel lumen is divided into a series of short compartments by circular membranes of mucosa and submucosa, leading to a pinhole lumen and subsequent obstruction.

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4
Q

what can cause intramural obstruction

A

-inflammatory- crohns, diverticulitis
- tumors
-neural

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5
Q

what can cause extraluminal obstruction

A

adhesions
volvulus
tumour/ malignancy

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6
Q

where would adhesions appear

A

between the loops of bowel

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7
Q

what is volvulus

A

twisting of bowel

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8
Q

what is maelena

A

black stool

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9
Q

what is considered an upper GI bleed

A

up until the duodenum

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10
Q

most common cause of an upper gi bleed

A

peptic ulcer

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11
Q

what is ABCDE

A

Airway
Breathing
Circulation
Disability
Exposure

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12
Q

what is TXA and what is it used for

A

Tranexamic acid
to prevent excessive blood loss

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13
Q

Management for patient with variceal bleed

A

suspect in patients with a history of liver disease
antibiotics and terlipressin reduce mortality
endoscopy within 12 hrs

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14
Q

management of non- variceal bleed

A

Consider proton pump inhibitors.

Endoscopy within 24 hours.

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15
Q

what is variceal bleeding

A

refers to bleeding of varices found throughout the gastrointestinal tract, such as in the esophagus, stomach, and rectum

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16
Q

What is SBO

A

mechanical blockage of small intestine
Small bowel obstruction

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17
Q

what occurs in SBO

A

form of Intestinal failure (IF)
the inability of the gut to absorb necessary water, macronutrients ,micronutrients, and electrolytes sufficient to sustain life and requiring intravenous supplementation or replacement

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18
Q

MOST common cause of SBO

A

Adhesions- usually due to previous abdo/ pelvic surgery

19
Q

pathophysiology of SBO

A
  • Obstruction of bowel leads to distension above the blockage due to a build up of fluid and contents
  • This causes increased pressure which pushes blood vessels within the bowel wall causing them to become compressed
  • The compressed vessels cannot supply blood , results in ischaemia, necrosis and eventually perforation
20
Q

3 main Causes of SBO

A

Adhesions
hernia
cancer

21
Q

common sites of obstruction

A

femoral and inguinal canal

22
Q

clinical presentation of SBO

A

Pain - initially colicky but then diffuse, pain is higher in the abdo than LBO
-Profuse vomitting following pain 🤮
-tenderness
-constipations
-increased bowel sounds

23
Q

what would make you think SBO rather than LBO

A

-PAIN is higher in the abdomen
- vomiting occurs earlier
- constipation with no passage of gas occurs late

24
Q

diagnosis for SBO

A

HISTORY
assesment
investigations

25
Q

what is a colic pain

A

cant get comfortable
comes and goes in severance

26
Q

what would you ask in a SBO history

A
  • Colic
  • Bilious vomiting
  • Bloating/distension
  • Sudden vs gradual onset
  • Previous surgery
  • Last eat and drink
  • Medical comorbidities
27
Q

1st line examination of SBO

A

Abdominal x ray
shows central gas shadows
no gas seen in large bowel

28
Q

what investigations would you do for SBO

A

Full blood count
* Urea and electrolytes
* Lactate
* C-reactive Protein
* CT scan

29
Q

why would you do a CT scan for
SBO

A

3D representation of problem
* Localises site of obstruction
* Indicates cause
* Tells you if bowel is ischaemic

30
Q

treatment foR SBO

A
  • Manage pain: Analgesia
  • Assess fluid balance: Nasogastric tube,
    urinary catheter
  • Resuscitate: IV Fluids
  • Alleviate nausea: Nasogastric tube, select
    antiemetics
  • Nutrition: If >5 days without intake, may
    need parenteral feed
31
Q

WHAT is part of the early management of SBO

A

IV fluids
nasogastric tube
urinary catheter
analgesia

32
Q

what is the most common complication of SBO

A

Renal failure

33
Q

when would you advise surgery in adhesive SBO

A

signs of ischaemia on a CT scan

34
Q

causes of LBO

A

Malignancy - 90%
volvulus
diverticulitis
crohns

35
Q

clinical presentation of LBO

A

Abdo pain
increased abdo distension
normal bowel sounds initially then increased
palpable mass
vomiting

36
Q

1st line investigation for LBO

A

aBDO X RAY

37
Q

INVESTIGATIONS for LBO

A

digitall rectal exam
FBC
CT-
abdo x ray

38
Q

maangement of LBO

A

-Aggressive fluid resuscitation
- Decompression of bowel
- analgesia and anti - emetics for symptoms
-antibiotics
- surgery to remove obstruction

39
Q

are pseudo bowel obstructions more common in LBO or SBO

A

Present identically to both

40
Q

aetiology of pseudo bowel obstruction

A
  • intra abdo trauma
  • intro abdo sepsis
  • drugs
  • electrolyte imbalances
    UNDERLYING CAUSE TREATED
41
Q

Would haematamesis indicate upper or lower gi bleed

A

Upper

42
Q

Would haemotochezia indicate upper or lower gi bleed

A

Lower

43
Q

Contraindicative medication for SBO and LBO

A

metoclopramide - gets it moving

Gastrointestinal (13 decks)

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