Intestinal obstruction and ileus Flashcards
Causes of small bowel obstruction
Adhesions (most common)
Hernias
Features of small bowel obstruction
Diffuse, central abdominal pain
Nausea and vomiting (typically bilious)
Constipation
Abdominal distension (particularly with lower levels of obstruction)
Tinkling bowel sounds
Small bowel obstruction imaging
Adbo xray first line
Distended small bowel loops with fluid levels
CT is definitive investigation and more sensitive
Valvulae conniventes extend all the way across
Management of small bowel obstruction
NBM
IV fluids
NG tube with free drainage
Some settle with conservative management and others require surgery
Causes of large bowel obstruction
Tumour (60% of cases)
Volvulus
Diverticular disease
Clinical features of large bowel obstruction
Absence of passing flatus or stool
Abdo pain
Abdo distension
Nausea and vomiting are late symptoms
Peritonism if perforation
Management for large bowel obstruction
NBM
IV fluids
NG tube
If the cause doesn’t require surgery, conservative management for 72 hours
75% eventually require surgery
IV antibiotics if perforation suspected or surgery planned
Large bowel obstruction surgery
Emergency surgery of peritonitis or bowel perforation
Irrigation of abdominal cavity, resection of perforated segment and ischaemic bowel, and address underlying cause of the obstruction
Imaging in large bowel obstruction
Haustra extend about a third of the way across
Postoperative ileus
Common complication after surgery
Reduced bowel peristalsis resulting in pseudo-obstruction
Features of postoperative ileus
Abdominal distension/bloating
Abdominal pain
Nausea/vomiting
Inability to pass flatus
Inability to tolerate an oral diet
Deranged electrolytes can contribute to development of postoperative ileus
Management of postoperative ileus
NBM initially
NG tube if vomiting
IV fluids to maintain normovolaemia
TPN for prolonged/ severe cases
