Intestinal obstruction Flashcards
1
Q
Risk factors for intestinal obstruction (4)
A
- Age
- Genetics (e.g. long mesentery)
- Drugs
- Chronic constipation
2
Q
Top 5 causes of small bowel obstruction
A
- Adhesions
- Neoplasms
- Hernias
- Crohn’s
- Pseudo-obstruction
3
Q
Top 5 causes of large bowel obstruction
A
- Neoplasms
- Diverticular disease
- Volvulus
- Hernias
- IBD
4
Q
Symptoms of SBO (3)
A
- Pain (sudden, epigastric, frequent colic)
- Distention
- Nausea and vomiting (sequential)
May have constipation
5
Q
Symptoms of LBO (3)
A
- Pain (gradual, lower abdomen, longer colic)
- Distention
- Constipation
May have nausea and later, faecalent vomiting
6
Q
Signs of bowel obstruction (2)
A
- Distention
- Hyperactive bowel sounds
Usually empty PR
Remember to assess for signs of peritonism
7
Q
Investigations for bowel obstruction (5)
A
- Bloods (FBE, UEC)
- AXR erect and supine (dilated bowel loops, fluid levels, gas in the bowel wall - gangrene, coffee bean sign - volvulus)
- Contrast CT (mesenteric whirl - sigmoid volvulus)
- US
- Colonoscopy
8
Q
Management of SBO
A
Drip and suck + symptomatic
- Resuscitation
- Nasogastric tube
- Antiemetics and analgesics
9
Q
Management of LBO
A
- Resuscitation
- Decompression (rigid sigmoidoscopy with rectal tube)
- Colectomy (cancer, necrosis)
10
Q
Complications of bowel obstruction (5)
A
- Dehydration and electrolyte disturbance from vomiting
- Aspiration pneumonia from vomiting
- Respiratory compromise from distention
- Strangulation, ischaemia, infarction, gangrene
- Perforation
11
Q
% mortality of non-ischaemic and ischaemic SBO
A
Non-ischaemic: 3-5%
Ischaemic: 30%
Note that surgery increases the risk of post-op adhesions!
