Intestinal Obstruction & Ileus Flashcards
What is bowel obstruction?
Partial or complete blockage of the intestines, leading to proximal bowel dilatation and distal bowel collapse.
Which type of bowel obstruction is more common?
Small bowel obstruction.
Is bowel obstruction a surgical emergency?
Yes.
What are the two main types of bowel obstruction?
- Mechanical obstruction
- Functional obstruction
What causes mechanical bowel obstruction?
Physical blockage within the intestine.
What is functional bowel obstruction also known as?
Pseudo-obstruction.
What are the most common causes of mechanical bowel obstruction?
- Adhesions
- Hernias
- Tumours
What is closed-loop bowel obstruction?
Occurs when two points of obstruction along the bowel sandwich the middle portion.
What are the risk factors for functional bowel obstruction?
- Infection and sepsis
- Injury or physical trauma
- Post-operative
- CVD: MI, HF, stroke
- Parkinson’s, Alzheimer’s, MS
What is acute pseudo-obstruction also known as?
Ogilvie’s Syndrome.
What are the clinical features of bowel obstruction?
- Vomiting (green, bilious)
- Abdominal distension
- Diffuse abdominal pain
- Absolute constipation
- ‘Tinkling’ bowel sounds
What are signs of bowel ischaemia?
- Pain out of proportion to examination
- Fever
- Tachycardia
What are signs of bowel perforation with peritonitis?
- Severe abdominal pain
- Abdominal guarding
- Rebound pain
- Percussion tenderness
What does an abdominal x-ray show in bowel obstruction?
Distended bowel loops.
What are the upper limits of normal diameter for small bowel, colon, and caecum?
- Small bowel - 3cm
- Colon - 6cm
- Caecum - 9cm
What does the initial management of bowel obstruction include?
- ABCDE
- Nil-by-mouth
- IV fluids
- NG tube
What does ‘Drip and Suck’ refer to in the management of bowel obstruction?
- Drip - IV fluids
- Suck - nil-by-mouth and NG tube
What is the definitive management for adhesions in bowel obstruction?
Gastrografin (water-soluble contrast).
What is the management for sigmoid volvulus?
- Endoscopic decompression with flexible sigmoidoscopy
- Surgical decompression
What is the management for left-sided bowel tumour?
Endoscopic stenting as a bridge to surgery or palliation.
What is the management for strictures in bowel obstruction?
Endoscopic dilatation or stenting.
What should be done for pseudo-obstruction?
Treating the underlying cause.
What are indications for emergency surgery in bowel obstruction?
- Suspicion of complication (ischaemia or perforation)
- Closed loop obstruction
- Strangulated hernia
- Obstructing tumour (if not amenable to stenting)
- Failure of non-operative treatments (~72 hours)
What is often referred to as a postoperative ileus?
Paralytic ileus
A common consequence of abdominal surgery.
What causes paralytic ileus?
Reduced motility of the gastrointestinal tract due to failure of peristalsis
This is secondary to paralysis of the intestinal muscles.
What is the result of paralysis of intestinal muscles in paralytic ileus?
Functional bowel obstruction
How long does paralytic ileus typically take to resolve?
2-7 days with conservative management
What is important for resolving paralytic ileus?
Correction of underlying/contributory causes such as electrolyte abnormalities
True or False: Paralytic ileus is always a permanent condition.
False
Fill in the blank: Paralytic ileus occurs due to reduced motility of the gastrointestinal tract, secondary to a failure of _______.
peristalsis
What type of bowel obstruction is caused by paralytic ileus?
Functional bowel obstruction
