Intestinal obstruction and ileus Flashcards
What is an ileus?
1 - uncoordinated bowel movements
2 - lack of peristalsis
3 - increased peristalsis
4 - chronic diarrhoea associated with ileum
2 - lack of peristalsis
- common effect following GIT surgery
What is a functional GIT obstruction?
1 - physical blockage of the GIT
2 - partial blockage of the GIT
3 - no blockage of GIT but no GIT movements
4 - increased GIT movements
3 - no blockage of GIT but no GIT movements
- despite the obvious blockage, there is no movement of GIT contents
What is a mechanical GIT obstruction?
1 - physical blockage of the GIT
2 - partial blockage of the GIT
3 - no blockage of GIT but no GIT movements
4 - increased GIT movements
1 - physical blockage of the GIT
Is functional or mechanical blockage of the GIT more common?
- mechanical
- GIT obstruction causes proximal bowel distension and disruption of peristalsis, called paralytic ileus
The causes of intestinal obstruction can be subdivided into extrinsic, bowel wall problems or luminal problems. Which of the following is not a common cause of a luminal obstruction?
1 - gallstones
2 - caliculi
3 - foreign bodies
4 - phytobezoars (trapped mass of undigested food)
5 - trichobezoar (trapped mass of undigested hair)
2 - caliculi
- kidney stones are normally isolated to the kidneys
The causes of intestinal obstruction can be subdivided into extrinsic, bowel wall problems or luminal problems. Which of the following is NOT a common cause of a intraluminal/bowel wall problem obstruction?
1 - tumours
2 - inflammatory/fibrotic strictures
3 - ischaemia
4 - crohn’s
5 - paralytic ileus
4 - crohn’s
The causes of intestinal obstruction can be subdivided into extrinsic, bowel wall problems or luminal problems. Which of the following is NOT a common cause of an extrinsic GIT obstruction?
1 - gallstones
2 - volvulus (twisting of bowels)
3 - hernia (small bowel)
4 - adhesions/scar tissue
5 - abdominal masses
1 - gallstones
What is the most common cause of a small bowel obstruction?
1 - ischaemia
2 - gallstones
3 - adhesions
4 - hernias
3 - adhesions
- 80% associated with adhesions
- 10-15% associated with hernias
The presentations of an obstruction depends on the completeness of an obstruction and where the obstruction is. Secreted/consumed fluid proximal to the obstruction can also cause what?
- pain as bowels begin to distend proximally to obstruction
Although it can be hard to identify the location of the obstruction based on physical examination, the location of pain can be guided based on what?
1 - embryological development (fore, mid and hing gut)
2 - patients descriptions
3 - physical appearance of patients
1 - embryological development (fore, mid and hing gut)
If an obstruction is incomplete, or becomes a chronic incomplete obstruction what can happen to the bowel walls proximal to the obstruction?
1 - atrophy
2 - paralytic ileus
3 - hypertrophy and stronger peristalsis
4 - neoplasia
3 - hypertrophy and stronger peristalsis
- also leads to pain
In an absolute obstruction is anything able to pass?
- no
- sign of complete obstruction is no wind or stool will be passed
If you have been able to identify that a patient has a bowel obstruction that is caused by adhesions, what % of these settle spontaneously?
1 - 9%
2 - 19%
3 - 49%
4 - 90%
4 - 90%
- if malignant it will rarely settle
What is gastric outlet obstruction?
1 - obstructed lower oesophageal sphincter
2 - obstructed pylorus
3 - obstructed fundus
4 - obstructed antrum
2 - obstructed pylorus
Gastric outlet obstruction, which is when there is an obstruction of the stomach, most commonly at the pylorus. Is this more common in men or women?
- men
- 3-4 times more likely
Gastric outlet obstruction, which is when there is an obstruction of the stomach, most commonly at the pylorus. What is the most common cause, accounting for 50-80% of obstructions?
1 - peptic ulcers
2 - malignancy
3 -foreign bodies
4 - crohns stricture
5 - gastric volvulus
6 - pancreatitis
7 - gastroparesis (motility issues)
2 - malignancy
- peptic ulcers account for 5%
- the rest can cause the problem but are rare
If a patient presents with vomiting, early satiety, weight loss and succession splash, where the the obstruction most likely to be?
1 - proximal to 2nd part of duodenum
2 - pylorus of stomach
3 - jejunum
4 - ileum
1 - proximal to 2nd part of duodenum
What is the imaging modality of choice can be used to diagnosis and therapy in a patient with suspected gastric outlet obstruction?
1 - CT
2 - endoscopy
3 - MRI
4 - interventional radiology
2 - endoscopy
In a patient with suspected gastric outlet obstruction what might we expect to see from an ABG?
1 - metabolic acidosis with hyperkalaemia
2 - reduced ph
3 - metabolic alkalosis with hyperkalaemia
4 - increases HCO3-
3 - metabolic alkalosis with hyperkalaemia
- due to vomiting
- in addition kidneys secrete K+ in an attempt to retain H+ due to alkalosis
In a patient with confirmed gastric outlet obstruction, why is an NG tube useful?
1 - can take samples to help diagnose
2 - aspirate gastric contents and reduce pain
3 - useful if patient needs feeding
4 - helpful in taking biopsies
2 - aspirate gastric contents and reduce pain
In a patient with confirmed gastric outlet obstruction, which of the following is NOT part of initial treatment?
1 - NBM
2 - IV fluids (due to dehydration)
3 - fluid output monitoring
4 - NSAIDs
5 - high dose PPI
6 - endoscopic balloon dilation
7 - Helicobacteria pylori
4 - NSAIDs
- can have a detrimental effect
If a conservative approach to treating gastric outlet obstruction fails, what are the 2 main surgical alternatives?
1 - resection
2 - gastric stoma
3 - bypass surgery
4 - percutaneous removal of blockage
1 - resection
3 - bypass surgery
- stenting may also be an option
What is the incidence of small bowel obstruction?
1 - 1-2/100,000
2 - 10-20/100,000
3 - 100-200/100,000
4 - 1000-2000/100,000
2 - 10-20/100,000
- more common in patients who have previously had surgery, likely due to adhesions
In a patient with confirmed Crohns disease, do they have an increased or decreased risk of small bowel obstruction?
- increased
- 250 / 100,000 compared to 10-20 / 100,000 in non-Crohns patients
- patients are likely to have multiple strictures
What is the most common cause of small bowel obstruction, accounting for 80-90% of cases?
1 - adhesions
2 - hernias
3 - paralytic ileus
4 - gallstones ileus
5 - tumours
6 - small bowel strictures (seen in Crohns disease)
1 - adhesions
- hernia is next most common, accounting for 10-15% of cases
When investigating a patient who is vomiting, why is it important to ask about the contents and colour of the vomit?
1 - infers severity of obstruction
2 - helps identify where obstruction is
3 - helps identify if malignancy is likely
4 - infers if adhesions is cause
2 - helps identify where obstruction is
- green bile = duodenum
- undigested food = stomach
- stool like = colon
In a patient with suspected small bowel obstruction, where is the pain likely to be located?
1 - left or right lumbar region
2 - epigastric
3 - umbilical region
4 - colicky across central abdomen
4 - colicky across central abdomen
There are large volumes of secretions into the GIT each day. What volume is secreted on average?
1 - 100ml
2 - 1L
3 - 5L
4 - 10L
4 - 10L
- this is why patients can continue to vomit even if they are NBM
When palpating a patients abdomen would we expect the abdomen to be tender in a patient with suspected obstruction?
- no
- if tender then suggests strangulation and/or perforation