Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Unit 2 Clin Med III > L8: Bowel Obstruction > Flashcards

L8: Bowel Obstruction Flashcards

1
Q

Bowel obstruction pathophysiology

A

Obstruction→ bowel dilatation and retention of fluid within lumen proximal to obstruction, distal to obstruction bowel decompresses
Further distention→ from accumulation of swallowed air and gas from fermentation

Edematous bowel wall→ fluid sequestration→ volume depletion

Excessive dilatation→ compromised vascular supply→ poor perfusion→ ischemia→ necrosis→ perforation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Causes of bowel obstruction

A

Extrinsic/Extra-luminal
external to bowel

Intrinsic
within wall of bowel

Intraluminal
defect that prevents passage of GI contents

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Why would adults get intussusception

A

It’s rare, and usually due to tumor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

3 types of intestinal strangulation

A

Strangulated hernia
Volvulus
Intussusception

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Blood supply to the small bowel

A

Superior mesenteric artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Subdivisions of the small bowel and their role

A

Duodenum
Jejunum
Ileum
Digestion and absorption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Red flags in presentation/on exam of SBO

A

Obstipations
fever
tachycardia
hypotension
shock
Mild/moderate distress, lying motionless?
Peritoneal signs: guarding, rigidity, rebound tenderness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Etiology and risk factors for SBO

A

Adhesions (~ 65-75%)
Prior abdominal/pelvic surgery

Hernia (~10-20%)
Abdominal wall/groin hernia

Neoplasm (~10-20%)
Primary or metastatic tumor

Intestinal inflammation /Intra-abdominal abscess
Strictures
Inflammatory, Radiation, Ischemic,
Anastomotic
FB ingestion
Intussusception, Volvulus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

SBO presentation

A

+/- fevers/chills
Abdominal Pain
Initially may be periumbilical, intermittent, “cramping”
Focal and constant pain→ peritonitis (bad sign)
Abdominal bloating/distention
N/V/A/C
+/- hematochezia
Obstipation - inability to pass flatus or stool

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Indications for surgical exploration of SBO

A

Complicated bowel obstruction (ischemia, necrosis, perforation)
→ worsening abdominal pain, fever, tachycardia, leukocytosis, metabolic acidosis, peritonitis

Intestinal Strangulation

Worsening symptoms or unresolved symptoms with NG tube and bowel rest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Exam of SBO

A

+/- fever, tachycardia, hypotension, shock
Mild/moderate distress, lying motionless?
+/- decreased skin turgor, dry mucous membranes

Abdominal Exam:
Inspection: note distention, scars, hernias
Auscultation: High pitched “tinkling” bowel sounds (early phase) or hypoactive/absent (late phase) (bad sign)
Percussion: Tympany
Palpation: Diffuse or localized abdominal tenderness, mass?
Peritoneal signs: guarding, rigidity, rebound tenderness

DRE: gross or occult blood, fecal impaction or rectal mass?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

SBO Labs

A 
CBC
\+/- Increased H/H (hemoconcentration), +/- Leukocytosis, +/- anemia
CMP
\+/- Elevated BUN/Cr (dehydration), +/- lyte abnormalities
Amylase/Lipase
UA
\+/- elevated specific gravity (dehydration)
Lactate/LDH (tissue destruction)
Plain Abdominal Films→ Supine + Upright
Dilated loops of bowel, air fluid levels
Proximal bowel dilation, distal bowel
collapsed
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

SBO imaging

A

CXR→ free air from perforation
CT Scan with oral contrast
Location (transition point), severity (partial vs. complete), etiology , complications
Dilated proximal bowel with distal collapsed loops
Bowel wall thickening >3 mm
Submucosal edema
If X-ray and CT are contraindicated or there is need for further assessment consider:
Abdominal US
CT/MR enterography
UGI+SBFT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

If you really know it’s SBO, what’s the best imaging?

A

Call the surgeon and let them decide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

SBO is a surgical emergency when

A

Strangulated bowel leading to ischemia nad necrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Hypomotility of GI tract in absence of mechanical bowel obstruction

A

Ileus

17
Q

Causes of ileus

A

Postoperative abdominal surgery (> risk open & lower GI)
From inflammatory response to intestinal manipulation & trauma
→ Physiologic: benign, self-limited
→ Pathologic: no return
of bowel function 4-6 days post op
Nonsurgical causes Hypomotility agents: opioids, antispasmodics,anticholinergics

18
Q 
If a patient comes in with: 
Abdominal pain
Distention
Bloating
Gassiness
N/V
Inability to tolerate PO 
Think...
A

Ileus

19
Q

Ileus on exam

A

Distention
Tympany
Variable reduction in bowel sounds
Mild tenderness

20
Q

Imaging for ileus

A

Supine/upright films→ dilated loops of bowel but air still present in both small bowel & colon. No air fluid levels
Unsure→ CT

21
Q

Ileus management

A 
Supportive care with IV fluids
Lyte replacement
NSAIDs, avoid narcotics
Bowel rest (NPO/CL diet +/- nutrition support)
Persistent N/V → Bowel decompression with
NG tube
Serial abdominal exams
Ambulate
22
Q

Anatomy of the large intestine

A

Large intestine subdivided: Cecum, Ascending,
Transverse, Descending, Sigmoid Colon, Rectum
Vascular supply: SMA + IMA
Role: Right colon→ Absorbs water and
electrolytes, Left colon→ stores feces

23
Q

Etiology of LBO

A 
Adenocarcinoma→ commonly colon + rectum
Stricture due to diverticulitis/ischemia
Volvulus→ Sigmoid + Cecal
IBD
Fecal Impaction
Foreign bodies
24
Q

Presentation of LBO

A 
\+/- fever/chills
Crampy abdominal pain
Bloating, distention
Constipation/Obstipation
\+/- N/V
Normal to quiet bowel sounds
Abdominal tenderness
\+/- peritoneal signs
Hematochezia
DRE→ occult blood, impaction, rectal mass?
25
Q

History questions to ask LBO

A

Hematochezia, rectal bleeding, or change in stool caliber (diameter) (current or past)
Personal or family history of cancer?
LLQ pain with diarrhea?
Recent frank bloody stool with diarrhea?
Acute or chronic?
Chronic opioid use or chronic constipation?

26
Q

LBO that gets surgical resection

A

cancer
complete stricture
cecal volvulus >12 cm

27
Q

Intussusception (LBO) treatment

A

barium enema

28
Q

Fecal impaction (LBO) treatment

A

enema

29
Q

Treatment for sigmoid volvulus

A

sigmoidoscopy with reduction

30
Q

Diagnostics for LBO

A

CBC, CMP, UA, LDH/Lactate

Plain Abdominal Films Supine + Upright
Distended colon proximal to obstruction
Complete obstruction→ absence of air distally in rectum/sigmoid 
CXR→ free air under diaphragm? 
Xray unclear→ Gastrografin Enema
CT scan
31
Q

Abnormal twisting of a portion of the GI tract, usually the intestine→ impaired blood flow

A

Volvulus

32
Q

Sigmoid vs cecal volvulus: age groups

A

Sigmoid: 70 years
Cecal: 33-53 years

33
Q

Sigmoid vs cecal volvulus imaging

A

Both get:
Upright + abdominal Xray
CT

Sigmoid gets: 
Contrast enema (diagnostic and therapeutic)
34
Q

Sigmoid vs cecal volvulus: Xray

A

Sigmoid: distended colon, absence of air in rectum
Cecal: dilated cecum displaced medially superiorly

35
Q

Sigmoid volvulus management

A

Flex Sig→ decompress and de-rotate

Surgery→ resect redundant sigmoid colon and prevent recurrence

36
Q

Cecal volvulus management

A

Surgical

Unit 2 Clin Med III (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions