Intestinal Obstruction Flashcards
Define Intestinal Obstruction?
Obstruction of the normal movement of bowel contents
What is Intestinal Obstruction classified according to?
The Site
How is Intestinal Obstruction classified?
Small or Large bowel
Partial or Complete Obstruction
Simple or Strangulated
What are the Extramural Intestinal Obstructions?
Hernia
Adhesions
Bands
Volvulus
What are the Intramural Intestinal Obstructions?
Tumours Inflammatory strictures (e.g. Crohn's strictures, diverticulitis)
What are the Intraluminal Intestinal Obstructions?
Pedunculated tumours Foreign body (e.g. bezoars, gallstones)
What is the epidemiology of Intestinal Obstructions?
COMMON
More common in the ELDERLY due to increasing incidence of adhesions, hernias and malignancy
What are the presenting symptoms of Intestinal Obstructions?
Severe gripping colicky pain with periods of ease Abdominal distension Frequent vomiting (it may be bile-stained or faeculent) Absolute constipation
What are the signs of Intestinal Obstructions on physical examination?
Abdominal distension with generalised tenderness
May see visible peristalsis
Tinkling bowel sounds
Peritonitis Signs
Inspect for hernias
Look for abdominal scars
Inspect for abdominal mass (e.g. intussusception, carcinoma)
What are the signs of Peritonitis for Intestinal Obstructions?
Absent bowel sounds
Guarding
Rebound tenderness
What investigations would you do for Intestinal Obstructions?
AXR
Water-Soluble Contrast Enema
Barium follow through
Why do we do an AXR for Intestinal Obstructions?
Assists diagnosis and localisation
Check for valvulae conniventes (small bowel) or haustra (large bowel)
What is the general management plan for Intestinal Obstructions?
Gastric aspiration via NG tube if the patient is vomiting
IV fluids
Electrolyte replacement
Monitor vital signs, fluid balance and urine output
What is the Surgical management plan for Intestinal Obstructions?
Emergency laparotomy in acute obstruction
What are the possible complications of Intestinal Obstructions?
Dehydration Bowel perforation Peritonitis Toxaemia Gangrene of ischaemic bowel wall
