Intestinal Obstruction

Question 1

Define Intestinal Obstruction (small and large)

Answer 1

SBO-mechanical disruption in the potency of GI tract-emesis, absolute constipation and abdominal pain-complete=emergency
LBO-mechanical obstruction of GI tract
-emergency

can be partial or complete-partial can be managed medically

Question 2

Aetiology and risk factors of Intestinal Obstruction (small and large)

Answer 2

Mechanical disruption can mean anything-blockage, twisting, foreign body, volvulus, or chronic inflammation leading to loss of function, gallstone ileum
SBO common causes-Previous surgery, Crohns, hernias, Malignancy. LBO will in turn cause SBO

LBO causes-cancer (60%), diverticulitis (20%), volvulus (sigmoid-older, caecal-younger)

Risk factors for both
Cancer, Fhx of colon cancer/small bowel cancer
crohns
Hernias
diabetes
Age-higher
Male
Obesity
appendicits
foreign body (SBO>LBO)

Question 3

Epidiemology of Intestinal Obstruction (small and large)

Answer 3

LBO accounts for 20% of all obstructions
SBO-5% of everyone will have it during life. Over 60% if previous surgery. 25% with Crohns

BO accounts for 20% of all acute abdomens (80% SBO, 20% LBO)

Question 4

Signs and Sx of Intestinal Obstruction (small and large)

Answer 4

Complete and patial will be different (partial-flatus and occasional stool)

Complete-unable to pass stool AND flatus
Intermittent abdo pain-cramping, severe
abdo tenderness
abdo distention
peritonitis in emergency (perforation)

Pyrexia, tachycardia-inflam origin (infection, ischemia)
Look for reducible hernias all over

SBO>LBO-nausea/vom (faecal vom)

PR-EMPTY rectum
Hard stools (faecal impacted), Soft stool (partial)

FLAWS for malignancies

signs its v bad-peritonitis, leukocytosis, dehydration, and pre-renal acute kidney injury
Sepsis
organ failure

Question 5

Investigations of Intestinal Obstruction (small and large)

Answer 5

AXR-dilated bowels (3-6-9 rules) -3cm SBO, 6-LBO , 9 caecum (SB-volvus convinientes (lines go all around, interior, LB-haustra-half cut lines, exterior)–out of fashion now cause CT better
See large amounts of faeces all around

CT-great to see where it is, why its happened. can predict strangulation -gold standard

ABG-lactate raised as hypoxia, metabolic acidosis

FBC-WBC can indicate inflammation. Heamatocrit for bleed/necrosis
U&E-low potassium
dehydration is common

differential-amylase, LFT

signs its all going bad-peritonitis, leukocytosis, dehydration, and pre-renal acute kidney injury

Question 6

Management of Intestinal Obstruction (small and large)

Answer 6

Involve surgery early if suspect it

signs for emergency surgery-strangulation, ischemia, peritonitis (any nausea, fever, tachycardia, low BP, etc)

medically-manage shock signs immediatly

FLUIDS, shock management, NG tube bowel decompression (both SBO/LBO), Nil by mouth in case of emergency surgery (if at any time, signs of ischemia, strangulation etc-> surgery)
CT imagery, contrast barium swallow imagery

adhesion (most common SBO cause-try non surgical if can), hernia-repair, S/LBO malignancy-tumour resection
opiate related-not surgical

LBO-often need to remove parts of colons+stoma (sigmoid volvu-hartmans procedure, caecal volvulus-colonic hemiectomy)

same with SBO

Question 7

Complications of Intestinal Obstruction (small and large)

Answer 7

for both
high risk 
-necrosis-
Sepsis
perforation

necrosis-> perforation-> sepsis-> organ failure

surgery can lead to SB syndrome-change nutrition
or loss of LB-> stoma

Question 8

Prognosis of Intestinal Obstruction (small and large)

Answer 8

If necrosis/strangulation/ischemia-how quickly can they go to surgery
shorter any issue is noticed, better survival rate

LBO-nearly 10% death after sigmoid volvulus, 15% caecal. malignancy also has bad 5 year survival rate

SBO-treated with a timely manner is good
if its due to adhesions-reccurent
if due to other diseases-depends of their management of that one