Intestinal obstruction

Question 1

What are the cardinal features of bowel obstruction? (4)

Answer 1

Vomiting
Colic
Constipation
Abdominal distension

Question 2

Bowel sounds in obstruction?

Answer 2

Active/tinkling bowel sounds

Question 3

Commoner causes of bowel obstruction? (5)

Answer 3

Constipation
Obstructed hernias
Adhesions from previous surgery
Tumours
Volvulus

Question 4

AXR picture in small bowel obstruction?

Answer 4

Central gas shadows with valvulae conniventes (projections which cross the lumen)

Question 5

AXR picture of large bowel obstruction?

Answer 5

Peripheral gas shadows proximal to the blockage, with haustra (which do not cross the width of the lumen)

Question 6

When might pain be felt over the RLQ?

Answer 6

if the ileo-caecal valve is competent i.e. doesn’t allow reflux of air

Question 7

Adynamic bowel due to lack of peristalsis?

Answer 7

Paralytic ileus

Question 8

Features of a strangulated obstruction? (3)

Answer 8

Localized pain, sharp severe and constant
Peritonism
Fever and leucocytosis

Question 9

Immediate management of bowel obstruction?

Answer 9

NG tube and IV fluids (“drip and suck”)

NBM

Question 10

Inverted loop of bowel resembling a coffee bean?

Answer 10

Sigmoid volvulus

Question 11

What group of patients does sigmoid volvulus tend to affect?

Answer 11

Old, co-morbid and constipated

Question 12

What pattern of obstruction does caecal volvulus give?

Answer 12

Small bowel