Large bowel obstruction: Clinical sciences Flashcards
What is Ogilvie syndrome or psuedo-obstruction large bowel obstruction?
Acute colonic pseudo-obstruction (ACPO), known as Ogilvie syndrome, is a distinct form of colonic dilatation occurring in the absence of underlying mechanical or anatomic etiology. Dilatation of the bowel is classically confined to the cecum and ascending colon with transition near the splenic flexure.
What is the pathogenesis of large bowel obstruction ?
Bowel dilation > ischemia> perforation and sepsis.
What is the clinical presentation of large bowel obstruction ?
Bloating, crampy or diffuse abdominal pain, Obstipation, nausea and vomiting.
What are the PE findinings in Large bowel obstruction?
Abdominal distention, tenderness to palpation, rebound pain and guarding.
What are the lab findings in LBO ?
leukocytosis, lactic acidosis
What is the supportive therapy in LBO?
IV fluid and electrolytes, broad spectrum antibiotics, bowel rest, vassopresser support, NGT for bowel decompression.
What are the X-ray findings in LBO ?
Northern exposure sign- dilation of a single loop of bowel above transverse colon.
* Coffe bean sign.
https://radiopaedia.org/articles/large-bowel-obstruction
* Pneumoperitonium and penumatosis and necrosis of the bowel.
What is the indication for impending large bowel perforation ?
Cecal diameter >12 cm.
Management of severe LBO ?
unstable patient and CT of the abdomin and pelvis showing signs of complicated bowel obstruction should be treated surgically.
What are the indications of LBO due to tumour in patients ?
Longer duration of symptoms with progressively narrow stool caliber. rectal bleeding and unintentional weight loss.
What is apple core sign ?
A segment of colon narrowed by annular mass lesion that has an appearance of apple core.
Whirl sign in CT abdomen ?
It is a sign of volvulus due to the twisting of bowel around the messenteric axis.
what is the pathgonomonic sign of complete bowel obstruction ?
inability to pass faltulus.
A__________trial is indicated for uncomplicated colonic pseudo-obstruction which persists despite supportive therapy.
A cholinesterase inhibitor (e.g. neostigmine)
