Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Year 3 - Met3a > Intestinal Obstruction > Flashcards

Intestinal Obstruction Flashcards

1
Q

What are the features of intestinal obstruction

A
  • Vomiting
  • nausea and anorexia
  • colicky abdominal pain - occurs early, decreases in long standing obstruction
  • abdominal distension - increases as the obstruction progresses with active tickling bowel sounds
  • abdominal constipation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the surgicial conditions that mimick intestinal obstruction

A
  • acute pancreatitis
  • leaking AAA
  • acute cholecystitis
  • peptic ulcer perforation
  • acute appendicitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What medical conditions mimick intestinal obstruction

A
  • MI
  • Pneumonia
  • Diabetes mellitus
  • electrolyte imbalance
  • parkinson’s, hypothyroidism
  • post delivery
  • drugs (opiates, anti-depressants, loperamide)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What presentation of intestinal obstruction should make you worried

A
  • high volume vomitus
  • degress of abdominal distention
  • absolute constipation
  • Shock
  • Constant pain - means the patient has perforated
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What should you do in intestinal obstruction

A
  • ABC resuscitation
  • drip and suck
  • urinary catheter
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What tests do you carry out in intestinal obstruction

A

UBEXS

  • urine
  • blood tests
  • ECG
  • X ray (erect CXR and AXR)
  • special investigations (CT, gastrografin, oral contrast, IV contrast )
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Why do you do the radiolgoical tests

A
  • These tests tell us whether it is a mechnical or functional dysfunction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Name functional obstruction conditions

A
  • Pseudo-obstruction (ogilvie’s sydnrome)
  • Paralytic ileus
  • Motility disorders
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are lines in the small intestine indicate a small bowel obstruction

A
  • Valvulae conniventes - significes a small bowel obstruction
  • present in the centre of the AXR
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What indicates large bowel obstruction

A
  • Haustrations

- periperhal bowel distension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what is penumoperiotneum

A
  • air under the diaphragm
  • air inside the peritoneum cavity
  • this means that there is a perforation somewhere in the abdomen
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what is the commonest cause of intestinal obstruction - small bowel obstruction

A
  • adhesions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the commonest cause of intestinal obstruction - large bowel obstruction

A
  • Neoplasm 86%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the high risk site of colon cancer

A
  • sigmoid colon

- rectum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is closed loop obstruction

A
  • happens when you have both ends closed on

- happens in an illeo-caecal valve is competent as the contents cannot be moved back into the small intestine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is closed loop obsturction with an incompotent illeo-caecal valve

A
  • Happens when one end is closed so the cotents goes back through the illeo-caecal valve and into the small intestine
  • presents with vomiting and more slowly than closed loop obstruction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the treatment of mechanical obstruction

A
  • Usually surgery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the differential diagnosis of Bowel obstruction

A
  • Paralytic ileus
  • toxic megacolon
  • Constipation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the complications of Bowel obstruction

A
  • Bowel ischaemia
  • Bowel perforation, leading to faecal peritonitis
  • dehydration and renal impairment
20
Q

What is the difference between small bowel and large bowel obstruction

A
  • Small bowel obstruction - vomiting occurs early, distension is less, pain is higher in the brown
  • Large bowel obstruction - pain is more constant
21
Q

What does a small bowel obstruction look like on an AXR

A
  • dilated bowel >3cm
  • central gas shadows
  • valvular conniventes (lines that completely cross the lumen)
  • no gas in the large bowel
22
Q

What does a large bowel obstruction look like on an AXR

A
  • dilated bowel >6cm or >9cm if caecum
  • peripheral gas shadows proximal tot he blockage but not in the rectum
  • Haustral lines (do not completely cross the lumen)
23
Q

What does a sigmoid volvulus look like

A
  • characteristic inverted U loop that looks like a coffee bean
24
Q

what is a paralytic ileus

A
  • functional obstruction from decreased bowel mobility; bowel sounds are absent, pain tends to be less
25
Q

What re the contributing factors to a paralytic ileus

A
  • abdominal surgery
  • pancreatitis
  • spinal injury
  • Hypokalaemia
  • hyponatraemia
  • uraemia
  • peritoneal sepsis
  • drugs (e.g. TCAs)
26
Q

What questions should you ask when looking at bowel obstruction

A
  1. is it obstruction of the small or large bowel
  2. Is there an ileus or mechanical obstruction
  3. is the obstructed bowel simple or closed loop or strangulated
27
Q

What is a simple bowel obstruction

A

one obstructing point and no vascular compromise

28
Q

What is a closed loop bowel obstruction

A

obstruction at two points (e.g. sigmoid volvulus) forming a loop of grossly distended bowel at risk of perforation

29
Q

What is a strangulated bowel obstruction

A
  • blood supply is compromised and the patient is more ill than you would expect
30
Q

What does a strangulated bowel obstruction look like

A
  • pain is sharper, more constant and more localised
  • peritoneum is the cardinal sign
  • there may be fever and increased WCC with other signs of mesenteric ischaemia
31
Q

What are the causes of small bowel obstruction

A
  • adhesions

- hernias

32
Q

What are the causes of large bowel obstruction

A
  • colon cancer
  • constipation
  • diverticular stricture
  • volvulus
  • sigmoid volvulus
  • caecal
33
Q

Name some rarer causes of bowel obstruction

A
  • Crohn’s stricture
  • Gallstone ileus
  • Intussusception
  • TB
  • foreign body
34
Q

When does a sigmoid volvulus occur

A
  • Occurs when the bowel twists on its mesentery which can produce severe rapid, strangulated obstruction
  • tends to occur in the elderly, constipated and co-mordbid patient
35
Q

How do you manage a sigmoid volvulus

A
  • managed by insertion of a flatus tube or sigmoidoscopy, sigmoid colectomy is sometimes required
36
Q

What happens if a sigmoid volvulus is not treated successfully

A
  • can progress to perforation and fatal peritonitis
37
Q

What is the management of bowel obstruction

A
  • NBM + NG tube – to decompress the bowel (‘suck’)

IV fluids (‘drip’) – to rehydrate and correct electrolyte imbalance

  • Being NBM does not give adequate rest for the bowel because it can produce around 8L of fluid a day (~4 litres above pylorus and 4 litres below)
  • 1.5L saliva
  • 2.5L stomach secretions
  • 1L biliary and pancreatic secretions (250ml bile + 750ml pancreatic)
  • 3L small intestine
  • Urinary catheter and fluid balance
  • Analgesia + anti-emetics
  • Bloods – amylase, FBC, U&E
  • AXR, erect CXR
38
Q

what bowel obstruction require surgery

A
  • strangulation

- large bowel obstruction

39
Q

What bowel obstruction can be managed conservatively

A
  • ileus

- incomplete small bowel obstruction can be managed conservatively

40
Q

What would you use CT as in bowel obstruction

A

CT - to establish cause of obstruction, may show dilated, fluid filled bowel and a transition zone at the site of obstruction
- Oral Gastrografin prior to CT can help identify level of obstruction and may have mild therapeutic action against mechanical obstruction

41
Q

what in CT can help identify the level of obstruction

A
  • Oral Gastrografin prior to CT can help identify level of obstruction and may have mild therapeutic action against mechanical obstruction
42
Q

what are the complications that can arise from large bowel obstruction

A
  • Ischaemia
  • perforation
  • biochemical derangement
43
Q

When is surgical intervention used in bowel obstruction

A
  • suspicion of intestinal ischaemia or closed loop bowel obstruction
  • cause that requires surgical correct (such as a strangulated hernia or obstructing tumour)
  • if patients fail to improve with conservative measures (typically after >48 hours)
44
Q

What are the consequences of large bowel resection

A
  • Stoma
45
Q

Name the surgical procedures that take place in large bowel obstruction

A
  • Colostomy - segmental or subtotal
46
Q

What are the complications after large bowel obstruction

A
  • anastomotic leaks
  • peritonitis
  • wound infections
  • small bowel obstruction
  • postoperative bleeding

Year 3 - Met3a (43 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions