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GI > INTESTINAL OBSTRUCTION > Flashcards

INTESTINAL OBSTRUCTION Flashcards

1
Q

what are abdominal quadrants important for?

A
  • subdivide the anterolateral abdominal wall
  • allows for more precise localization of clinical findings
  • formed by the transumbilical line that crosses the umbilicus and the midline
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2
Q

what is the definition of an intestinal obstruction?

A

condition in which digested material is prevented from the passing normally though the bowel

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3
Q

what is intestinal obstruction classified by?

A
  • mechanical obstruction
  • functional obstruction
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4
Q

what is mechanical obstruction d/t?

A

physical blockage

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5
Q

what is functional obstruction d/t?

A

disruption of normal motility

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6
Q

where are the majority of intestinal obstructions?

A

small bowel (80%)

large is only 20%

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7
Q

what is a partial vs complete intestinal obstruction?

A

partial: some intestinal contents pass through
complete: no passage of luminal contents beyone obstruction point

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8
Q

what is the big 3 etiologies of mechanical obstruction?

A
  1. adhesions (post-surgical)
  2. tumors
  3. hernias
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9
Q

what are the other etiologies of mechanical SMALL BOWEL obstruction?

A

crohns
gallstones
volvulus
intussusception
foreign body ingestion

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10
Q

what are the big 2 etiologies of functional SMALL BOWEL obstruction?

A
  1. surgery
  2. medications: opiates, CCB, diuretics
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11
Q

what are the other etiologies of functional SMALL BOWEL obstruction?

A

peritonitis
trauma (pelvic, spinal fractures)
intestinal ischemia
electrolyte imbalance (hypokalemia)

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12
Q

what is the abc mnemonic for most common causes of SBO ?

A

A- adhesions
B- bulge (hernias)
C- cancer (tumor)

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13
Q

what are the big 2 etiologies of mechanical LBO?

A
  1. colorectal cancer: MOST COMMON CAUSE
  2. volvulus (sigmoid and cecal): MOST COMMON BENIGN CAUSE
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14
Q

what are the other etiologies of mechanical LBO?

A
  • metastatic cancers (ovarian, pancreatic, lymphoma)
  • strictures from: 1. prior colon resection, 2. inflammatory disease (diverticulitis, ischemic colitis, inflammatory bowel disease)
  • post-surgical adhesions
  • hernias
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15
Q

what are the 2 big etiologies of functional LBO?

A
  1. severe systemic illness
  2. surgery (most commonly from cesarean section or hip surgery)
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16
Q

what are the other etiologies of functional LBO?

A
  • trauma
  • spinal anesthesia
  • medications (opiates, anticholinergics, CCB)
17
Q

what is the pathogenesis of bowel obstruction?

A
  • ingested fluids and food, digestive secretions, and gas accumulate above the obstruction causing the proximal bowel to distend
  • bowel segment distal to obstruction collapses
  • secretory and absorptive functions become depressed and bowel becomes edematous and congested
  • distention is self- perpetuating and can lead to vascular compromise (venous then arterial)-> ischemia-> gangrene-> PERFORATION
18
Q

when do sx of SBO occur?

A

they occur shortly after onset

19
Q

what are the sx of SBO?

A

abdominal pain
- crampy or colicky in nature
- most often diffuse and intermittent
- severe and constant -> ischemia of perforation has developed
vomiting (bilious) - may report temporarily feels better because you relieve pressure
abd distention/bloating
obstipation

20
Q

what are the sings of SBO?

A

bowel sounds are hyperactive, and high pitched EARLY ON
bowel sounds are decreased or absent LATER ON
percussion reveals tympany or hyper-resonance; dullness if fluid filled

21
Q

what are the sx of LBO?

A
  • mild and develop gradually
  • abdominal pain usually below umbilicus that is crampy in nature
  • abdominal distention/bloating
  • vomiting (more common with right colon obstruction)
  • obstipation
22
Q

what are the signs of LBO?

A
  1. distended abdomen
  2. percussion: tympany
23
Q

what are the 2 dx studies done for SBO?

A
  1. supine and upright abdominal x-rays with upright chest x-ray
  2. CT abdomen/pelvis
24
Q

what dx study is usually adequate to dx obstruction?

A

supine and upright abdominal x-rays with upright chest x-ray

25
Q

what will you see on supine and upright abdominal x-rays with upright chest x-ray for SBO?

A

prox bowel dilation >3 cm
decompressed distal bowel (collapsed)
air-fluid levels with stacked small bowel loops in upright views

similar x-ray findings occur with an ileus (paralysis of intestine without obstruction

26
Q

when would a CT abdomen/pelvis be recommended>

A

if there are signs of inflammation or ischemia

CT used more often for SBO, especially in elderly

27
Q

what are the 2 dx studies done for LBO?

A
  1. supine and upright abdominal x-rays with upright chest x-ray
  2. barium enema
28
Q

what will you see on supine and upright abdominal x-rays with upright chest x-ray in LBO?

A

prox colonic distention of colon
- cecum >9 cm
- remaining colon >6 cm
collapse of colon distal to obstruction

29
Q

what is entailed in a barium enema?

A
  1. liquid barium inserted into colon through rectum
  2. enhances colon to locate and determine cause of obstruction
  3. can sometimes lead to resolution of obstruction
30
Q

what is the tc for intestinal obstruction?

A
  1. hospitalized
    - surg consult
    - supportive care
    > ng tube insertion for vomitting or abd distention
    > NPO
    > IV fluids
    > urinary cath to monitor output
  2. IV abx- rocephin, ceftriaxone
    - given for suspected bowel ischemia or perf
    - 3rd gen cephalosporin + metronidazole given before surgical exploration

GI (22 decks)

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