Intestinal Obstruction Flashcards by Iseoluwa Ojo

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

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Intestinal obstruction can occur in any part of the intestine

T/F

From the duodenum to the large intestine

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Obstruction occurs if anything interferes with factors that control normal passage of intestinal content:
1.________
2._________
3. Normal __________

Patency

Viability

contraction

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Classification of Obstruction

Can be classified based on:

__________
____________
_________

Site
Mechanism
Clinical presentation

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Intestinal obstruction

It can also be classified based on site:

✓_________ or _________

Small or large bowel obstruction

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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

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Classification of Intestinal obstruction

Based on Clinical presentation:
✓_____________
✓___________

acute

chronic

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Common causes of Mechanical obstruction

List 6

• Hernias
• Adhesion
• Intussusceptions
• Volvulus
• Atresia
• Neoplasm

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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]

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Causes of Non- mechanical [ ____________ ]
•________
• ___________ ileus
• ______itis
• Bowel ________.
• ________pathies
• Neuropathies (________ disease

pseudoobstruction

Cystic fibrosis.; paralytic

Periton; infarction

Hirchsprung’s

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Hirchsprung’s disease due to ______________

absence of the parasympathetic ganglion

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Paralytic ileus-causes

• Infections-e.g _________
• Toxins
•_______
• _________ complications
• Ishaemia
•_________’
•_______ failure
• Drugs-e.g _________

Gastroenteritis

Electrolyte imbalance

Post surgical

Peritonitis

Renal; narcotics

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Small bowel obstruction-causes

•_________
•______
•_______
•_________
• Neoplasm
•______ disease
•__________
•_______ strictures
•__________ syndrome
• Foreign bodies
•________
• Atresia

Hernias

Adhesions

Intussusception

Volvulus; Crohn’s

Pseudo-obstruction

Ishaemic

Superior mesenteric artery

Ascariasis

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Large bowel obstruction-causes

• Neoplasm-e.g.____________

•_________-
•_______________
•_________ ————-
•____________
• Endometriosis
•_______ impaction
•_______-obstruction
• Colonic ________
•__________ disease

colon carcinoma

Hernias; Diverticulitis

Ulcerative colitis

Adhesions; Faecal

Pseudo; volvulus

Hirchsprung’s

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Congenital causes
• Congenital _____
•_______
•__________ ———-
•_____________

atresia

Bands

Imperforate anus

Cystic fibrosis

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Pathophysiology of Intestinal Obstruction

The major concerns are effects
• General ____________ and ________
• Increased _________ on ________

body fluids & electrolyte loss

pressure on intestinal perfusion.

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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.

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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

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Acute obstruction has 3 phases

List them

Phase of active peristalsis

Phase of stasis

Phase of anti or retro peristalsis

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phases of Acute obstruction

Phase of active peristalsis :initially following obstruction, the part (above or below ?) it ___________

Above

contracts

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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

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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

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Acute obstruction
• Obstruction at the duodenum →loss of ______→ ________ →

• drowsiness, (slow or fast?) (shallow or deep?) respiration & tetany.

H+

alkalosis

Slow ; shallow

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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

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

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