Intestinal obstruction

Question 1

define intestinal obstruction?

Answer 1

obstruction of the normal movement of bowel contents. Classified according to the site
o Small or Large bowel
o Partial or Complete obstruction
o Simple or Strangulated

Question 2

what are the most common small bowel causes of obstruction?

Answer 2

adhesions and hernias

Question 3

what are the most common large bowel causes of obstruction?

Answer 3

malignancy, diverticular disease and volvulus

Question 4

epidemiology of intestinal obstruction?

Answer 4

• COMMON

* More common in the ELDERLY due to increasing incidence of adhesions, hernias and malignancy

Question 5

presenting symptoms in intestinal obstruction?

Answer 5

• Severe central colicky pain with periods of ease
• Abdominal distension
• Frequent vomiting (it may be bile-stained or faeculent)
• Absolute constipation

Question 6

signs of intestinal obstruction?

Answer 6

• Abdominal distension with generalised tenderness
• May see visible peristalsis
• Tinkling bowel sounds
• Peritonitis
• Inspect for hernias
• Look for abdominal scars
• Inspect for abdominal mass

Question 7

what is the first line investigation for obstruction?

Answer 7

• AXR is first line investigation

Question 8

what is the definitive investigation for obstruction?

Answer 8

• Abdomen CT for definitive diagnosis

Question 9

what is seen in a normal small bowel AXR?

Answer 9

Maximum normal diameter = 35 mm

Valvulae conniventes extend all the way across

Question 10

what is seen in a normal large bowel AXR?

Answer 10

Maximum normal diameter = 55 mm

Haustra extend about a third of the way across

Question 11

what other investigations might be used to investigate obstruction?

Answer 11

• Water-Soluble Contrast Enema

* Barium follow through

Question 12

conservative management plan for intestinal obstruction?

Answer 12

o Gastric aspiration via NG tube if the patient is vomiting (drip and suck)
o IV fluids
o Electrolyte replacement
o Monitor vital signs, fluid balance and urine output

Question 13

surgical management for intestinal obstruction?

Answer 13

o Emergency laparotomy in acute obstruction

Question 14

complications of intestinal obstruction?

Answer 14

• Dehydration
• Bowel perforation
• Peritonitis
• Toxaemia
• Gangrene of ischaemic bowel wall

Question 15

prognosis for patients with intestinal obstruction?

Answer 15

• Variable