intestinal obstruction Flashcards
Three types of intestinal obstruction
In the lumen
Within the wall
Extraluminal
what can cause intraluminal obstructiobn
tumour
diaphgram disease
meconium ileus
gallstone ileus
what is diaphgram disease
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.
what can cause intramural obstruction
-inflammatory- crohns, diverticulitis
- tumors
-neural
what can cause extraluminal obstruction
adhesions
volvulus
tumour/ malignancy
where would adhesions appear
between the loops of bowel
what is volvulus
twisting of bowel
what is maelena
black stool
what is considered an upper GI bleed
up until the duodenum
most common cause of an upper gi bleed
peptic ulcer
what is ABCDE
Airway
Breathing
Circulation
Disability
Exposure
what is TXA and what is it used for
Tranexamic acid
to prevent excessive blood loss
Management for patient with variceal bleed
suspect in patients with a history of liver disease
antibiotics and terlipressin reduce mortality
endoscopy within 12 hrs
management of non- variceal bleed
Consider proton pump inhibitors.
Endoscopy within 24 hours.
what is variceal bleeding
refers to bleeding of varices found throughout the gastrointestinal tract, such as in the esophagus, stomach, and rectum
What is SBO
mechanical blockage of small intestine
Small bowel obstruction
what occurs in SBO
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
MOST common cause of SBO
Adhesions- usually due to previous abdo/ pelvic surgery
pathophysiology of SBO
- 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
3 main Causes of SBO
Adhesions
hernia
cancer
common sites of obstruction
femoral and inguinal canal
clinical presentation of SBO
Pain - initially colicky but then diffuse, pain is higher in the abdo than LBO
-Profuse vomitting following pain 🤮
-tenderness
-constipations
-increased bowel sounds
what would make you think SBO rather than LBO
-PAIN is higher in the abdomen
- vomiting occurs earlier
- constipation with no passage of gas occurs late
diagnosis for SBO
HISTORY
assesment
investigations
what is a colic pain
cant get comfortable
comes and goes in severance
what would you ask in a SBO history
- Colic
- Bilious vomiting
- Bloating/distension
- Sudden vs gradual onset
- Previous surgery
- Last eat and drink
- Medical comorbidities
1st line examination of SBO
Abdominal x ray
shows central gas shadows
no gas seen in large bowel
what investigations would you do for SBO
Full blood count
* Urea and electrolytes
* Lactate
* C-reactive Protein
* CT scan
why would you do a CT scan for
SBO
3D representation of problem
* Localises site of obstruction
* Indicates cause
* Tells you if bowel is ischaemic
treatment foR SBO
- 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
WHAT is part of the early management of SBO
IV fluids
nasogastric tube
urinary catheter
analgesia
what is the most common complication of SBO
Renal failure
when would you advise surgery in adhesive SBO
signs of ischaemia on a CT scan
causes of LBO
Malignancy - 90%
volvulus
diverticulitis
crohns
clinical presentation of LBO
Abdo pain
increased abdo distension
normal bowel sounds initially then increased
palpable mass
vomiting
1st line investigation for LBO
aBDO X RAY
INVESTIGATIONS for LBO
digitall rectal exam
FBC
CT-
abdo x ray
maangement of LBO
-Aggressive fluid resuscitation
- Decompression of bowel
- analgesia and anti - emetics for symptoms
-antibiotics
- surgery to remove obstruction
are pseudo bowel obstructions more common in LBO or SBO
Present identically to both
aetiology of pseudo bowel obstruction
- intra abdo trauma
- intro abdo sepsis
- drugs
- electrolyte imbalances
UNDERLYING CAUSE TREATED
Would haematamesis indicate upper or lower gi bleed
Upper
Would haemotochezia indicate upper or lower gi bleed
Lower
Contraindicative medication for SBO and LBO
metoclopramide - gets it moving
