Intestinal Obstruction Flashcards
Intestinal obstruction is defined as a _______ or ________, ________ or _________ of the intestines that prevents the passage of its contents
partial or complete
mechanical or functional blockage
Intestinal obstruction can occur in any part of the intestine
T/F
T
From the duodenum to the large intestine
Obstruction occurs if anything interferes with factors that control normal passage of intestinal content:
1.________
2._________
3. Normal __________
Patency
Viability
contraction
Classification of Obstruction
Can be classified based on:
__________
____________
_________
Site
Mechanism
Clinical presentation
Intestinal obstruction
It can also be classified based on site:
✓_________ or _________
Small or large bowel obstruction
Classification of Intestinal obstruction
Based on mechanism:
✓________ obstruction by _______________________________
✓ _________________(__________) due to
_______ or _________ defect affecting
_________ and _________ of the intestine.
Mechanical; object from within or outside the wall
Non-mechanical (pseudo-obstruction)
ischaemic or neurological
viability and contractility
Classification of Intestinal obstruction
Based on Clinical presentation:
✓_____________
✓___________
acute
chronic
Common causes of Mechanical obstruction
List 6
• Hernias
• Adhesion
• Intussusceptions
• Volvulus
• Atresia
• Neoplasm
Common causes of Mechanical obstruction
Inflammatory or ishaemic strictures
e.g________,_________,_______
________disease
Obstruction by ______, ______,_______ foreign bodies.
Crohn’s disease., TB, Ulcerative
colitis
Diverticular
gall stone, faecoliths, worm [ascaris]
Causes of Non- mechanical [ ____________ ]
•________
• ___________ ileus
• ______itis
• Bowel ________.
• ________pathies
• Neuropathies (________ disease
pseudoobstruction
Cystic fibrosis.; paralytic
Periton; infarction
Hirchsprung’s
Hirchsprung’s disease due to ______________
absence of the parasympathetic ganglion
Paralytic ileus-causes
• Infections-e.g _________
• Toxins
•_______
• _________ complications
• Ishaemia
•_________’
•_______ failure
• Drugs-e.g _________
Gastroenteritis
Electrolyte imbalance
Post surgical
Peritonitis
Renal; narcotics
Small bowel obstruction-causes
•_________
•______
•_______
•_________
• Neoplasm
•______ disease
•__________
•_______ strictures
•__________ syndrome
• Foreign bodies
•________
• Atresia
Hernias
Adhesions
Intussusception
Volvulus; Crohn’s
Pseudo-obstruction
Ishaemic
Superior mesenteric artery
Ascariasis
Large bowel obstruction-causes
• Neoplasm-e.g.____________
•_________-
•_______________
•_________ ————-
•____________
• Endometriosis
•_______ impaction
•_______-obstruction
• Colonic ________
•__________ disease
colon carcinoma
Hernias; Diverticulitis
Ulcerative colitis
Adhesions; Faecal
Pseudo; volvulus
Hirchsprung’s
Congenital causes
• Congenital _____
•_______
•__________ ———-
•_____________
atresia
Bands
Imperforate anus
Cystic fibrosis
Pathophysiology of Intestinal Obstruction
The major concerns are effects
• General ____________ and ________
• Increased _________ on ________
body fluids & electrolyte loss
pressure on intestinal perfusion.
Pathophysiology of Intestinal Obstruction
Effects of obstruction depend on:
• Onset- whether it is ——— or ______
• Extent- ________ or ______
• Site- ______ in the gut
• Associated vascular obstruction- _______,_______, or ________
sudden or gradual
complete or partial
level
simple or strangulated or gangrenous.
Small intestinal and mechanical obstruction are more (acute or chronic?) in onset, (slowly or rapidly?) progressive and more likely to be (complete or incomplete?) .
Acute
Rapidly
Complete
Acute obstruction has 3 phases
List them
Phase of active peristalsis
Phase of stasis
Phase of anti or retro peristalsis
phases of Acute obstruction
Phase of active peristalsis :initially following obstruction, the part (above or below ?) it ___________
Above
contracts
phases of Acute obstruction
Phase of stasis:immobility or stasis results in ________ and ——- of the bowel due to accumulation of __________ and _________.
There is also increase _____, decrease ________ , ________ growth
distension and dilation
intestinal secretion and swallowed air
secretion; absorption; bacterial
phases of Acute obstruction
Phase of anti or retro peristalsis : fluid passes ______________ and _____ occurs .
Content of the vomiting depends on the ____________
back to the stomach and vomiting
level of obstruction
Acute obstruction
• Obstruction at the duodenum →loss of ______→ ________ →
• drowsiness, (slow or fast?) (shallow or deep?) respiration & tetany.
H+
alkalosis
Slow ; shallow
Acute obstruction
• At the level of ileum- vomitus contains _____ , ______ juice, ___________ secretion, ____________.
• Electrolytes- loss of _____,_____,_____
saliva; gastric
bile pancreatic
succus entericus
Na, K, CL.
In acute obstructions at the ileum, there is acid base imbalance
No acid base imbalance.
Major effects of acute obstruction
•_________ occurs from vomiting, bowel edema, and impaired __________→ _______ and ______
•________________ occurs - gastric potassium, hydrogen, and chloride ions,
Fluid loss; fluid absorption
hypovolemia and shock
Electrolyte inbalance
In chronic obstruction
➢Obstruction is most often (complete or incomplete?) . Usually due to
stricture, tumour growth or pressure from outside
➢Occurs more commonly in the _____ intestine.
incomplete
large
chronic obstruction
➢Local change is _____ of the muscle at the (proximal or distal?) part of the bowel.
➢Marked _______ of proximal bowel with accumulation, of _______ and _____
hypertrophy; proximal
distension
gas and fluid
Effect of chronic obstruction
Effect→ anti peristalsis→ vomiting
•_________
• K loss→_______
• HCO3 →_______
• Pressure →impaired _______
• impaired ______,
• diffusion of toxic material into __________→ toxemia.
dehydration
muscle weakness
acidosis; blood supply ; viability
peritoneum
Effect of chronic obstruction
Intestinal stasis leads to
• ________ of _______→ Bacterial ————- across the bowel wall→ ________ of wall→__________ → ___________ → Peritonitis and septicaemia
Overgrowth of intestinal flora
translocation; Inflammation
Ulceration; Perforation
Clinical features
The hallmarks of intestinal obstruction include
◦_______ abdominal pain,
◦ Nausea and vomiting,
◦ Abdominal ______, and
◦ ________ of bowel movements and flatus
Colicky; distension
Cessation
In distal obstruction, _______ and ________ are more marked than __________
pain and distension ; vomiting
In proximal obstructions, ______ predominates, there is minimal
____________
vomiting
abdominal distension
Features of _______ and or ______ may be present depending on the severity on the period of development of the
obtsruction
hypotension; dehydration
Hernia
_____________ through an aperture. When it appears outside the body surface, it is called ______ hernia. Otherwise, its _______.
It usually occurs due to _____________ or _____________.
Protrusion of bowel
external; internal
local weakness or increased intra-abdominal
pressure
Complications of hernia
initially its reducible, latter it becomes
irreducible →
➢ _______,
➢_________, and →
➢Gangrene,
➢ _______,
➢___________
Obstruction
Strangulation
peritonitis
septiceamia
Intussusception
Occurs when one segment of the bowel becomes _______/_______ into the immediate ____________ of the bowel.
telescoped/ invaginated
distal segment
Intussusception
It’s commoner in (children or adults?)
Patient is otherwise healthy though can have __________.
Children
lymphadenopathy
Intussusception
It’s commoner in children
In adults , its initiated by _______ or _______
Sites: ________,______,_______
mass or tumour
ileocaecal valveIleocaecal, ileocolic
Intussusception
Effects:
•interference with _________
•(Mechanical or Non-mechanical?) obstruction of the bowel→ _______ if not
reversed.
blood supply.
Mechanical
infarction
Volvulus
(Complete or incomplete?) twisting of a loop of bowel about its ________ base of attachment up to about _________
Complete
mesenteric
180degrees
Volvulus
Common sites: ________ followed by ————-,———— ,_______ TC
Effect: impaired __________ and obstruction.
sigmoid colon
caecum, SI, stomach
blood circulation
Volvulus
Clinical features: are those of obstruction.
Abdominal ______ and ________, vomiting, constipation, obstipation
pain and distension
Treatment of obstruction
• Depends on the cause, type and whether there is ____________
➢ ___________ for mechanical obstruction
➢_________ -Paralytic ileus and non mechanical types
➢Management of complications
superimposed complication
Immediate surgery
Conservative
Obstipation
___________________
inability to pass stool
Most common cause of SBO is??
Adhesions
In Intussusception, Blood supply is compromised
T/F
T
Intussusception
GI bleeding: “________” stool
A Medical emergency
Currant jelly
Intussusception
Common in ________ (often ____ year old) Rare in _______
Often near the ___________
<1
children
Adults
ileocecal junction
Underlying lesions often leads to intussusception
T/F
T
Intussusception
• Intestine is _______ and ______ by ______
trapped and dragged; peristalsis
Intussusception
Potential lead points
•_______ diverticulum
• Lymphoid hyperplasia (____________;____________)
• Strong association with enteric ________ infection
• In adults: _______
Meckel’s
Peyer’s patches; viral gastroenteritis
adenovirus
tumors
Intussuscipens. (Receiver or giver?)
Intussusceptum ( receiver or giver?)
Receiver
Giver
Volvulus
Occurs more in (children or elderly?) (mean age ____)
In children may be ______________
Elderly ; 70
2° Meckel’s diverticulum
Hirschsprung’s Disease
Presentation
Failure to __________
Abdominal distention
_________ vomiting
Examination: ___________ in rectal vault
pass meconium
Bilious
no stool
Hirschsprung’s Disease
Diagnosis and Treatment
Barium imaging
• “__________ zone”
•_____-shaped
• Proximal ______ bowel (normal)
• Distal bowel _____ (abnormal)
Transition
Cone; distended
small
Hirschsprung’s Disease
Diagnosis and Treatment
Rectal “suction” biopsy
• Standard biopsy may only show ______
• Need to apply ________ to biopsy _________
• Absence of _______ cells
mucosa; suction
submucosa; ganglion
In Hirschsprung’s Disease
________ is ALWAYS involved (other areas variable)
Rectum
Hirschsprung’s Disease
Diagnosis and Treatment
Treatment: ___________
• Removal of _____ without _______
Colon resection
colon; ganglion cells
