MBO

Question 1

What 4 criteria define a malignant bowel obstruction?

Answer 1

1) clinical evidence of a bowel obstruction (exam, history, radiological)
2) bowel obstruction beyond the ligament of treitz
3) intra-abdominal primary cancer with incurable disease OR
4) non intra-abdominal primary cancer with clear intraperitoneal disease

Question 2

Where is the ligament of Trietz located?

Answer 2

Suspension ligament between the duodenum and jejunum

Question 3

What are some causes of a functional bowel obstruction?

Answer 3

paralytic ileus
peritonitis
bowel ischemia
hypokalemia
retroperitoneal hemorrhage

Question 4

How can you distinguish between a paralytic ileus and a mechanical obstruction on exam and radiographically?

Answer 4

1) minimal or absent bowel sounds
2) uniform distribution of gas throughout the bowel

Question 5

Intraluminal obstructions are more likely to occur in the large or small bowel?

Answer 5

Large bowel

Question 6

Extraluminal compression is more likely to occur in the large or small bowel?

Answer 6

Small bowel

Question 7

Proximal versus distal bowel obstruction:

Which is more likely to present with more vomiting?

Answer 7

Proximal bowel obstruction is more likely to present with vomiting.

Question 8

Does a proximal bowel obstruction typically have less or more abdominal distension than a distal bowel obstruction?

Answer 8

Less abdominal distension

Question 9

Overtime, will a malignant bowel obstruction typically progress to a complete bowel obstruction?

Answer 9

Yes

Question 10

What diagnostic tool is simplest to diagnose a malignant bowel obstruciton?

Answer 10

Plain film of the abdomen

Question 11

What are the classic features of a small bowel obstruction on xray?

Answer 11

1) dilated bowel
2) air fluid levels

Question 12

What are potential surgical options in the management of MBO?

Answer 12

1) resection of the obstruction with or without re-anastomosis
2) intestinal stoma
3) bypass of the obstructed segment
4) venting gastrostomy

Question 13

MBO:
What 9 parameters are associated with a low likelihood of a patient benefiting from surgical intervention?

Answer 13

1) complete small bowel obstruction
2) non-gynecological cancer
3) ascites
4) depressed serum albumin
5) abnormal total white blood cell count
6) age >65
7) extensive peritoneal carcinomatosis
8) multi-level obstruction
9) poor functional status

Question 14

Stenting is largely limited to what part of the bowel?

Answer 14

Large bowel and proximal duodenum.

Question 15

Spontaneous resolution of malignant bowel obstruction will occur in what percentage of patients?

Answer 15

30%

Question 16

What are risks of endoluminal wall stents?

Answer 16

Perforation
Migration
Reocclusion

Question 17

What are some complications of long term nasogastric tube placement?

Answer 17

nasopharyngeal discomfort
nasal cartilage erosion
bleeding
otitis
aspiration pneumonia
esophagitis

Question 18

What adjuvant medication could be helpful to relieve colicky pain?

Answer 18

hyoscine butylbromide (anticholinergic)- buscopan

Question 19

What class of medication does ranitidine belong to?

Answer 19

histamine 2 antagonist

Question 20

What is peritoneal carcinomatosis?

Answer 20

Peritoneal cancer is the invasion of the serous membrane lining the peritoneal cavity by malignant cells. The malignant cells originate de novo in the mesothelioma or disseminate from other primary tumor sites. It represents an advanced stage of cancer with a poor prognosis

Question 21

What 2 cancers are most commonly complicated by MBO?

Answer 21

1) Ovarian
2) Colorectal

Question 22

What symptoms would lead you to consider surgical intervention for gastric outlet obstruction?

Answer 22

Persistent nausea
Vomiting
Belching
Early Satiety

Question 23

Biliary obstruction:
What commonly becomes obstructed along the biliary tree?

Answer 23

Question 24

What are possible complications in biliary malignant bowel obstruction?

Answer 24

pruritus
bleeding
liver failure
hyperbilirubinemia