MBO Flashcards
What 4 criteria define a malignant bowel obstruction?
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
Where is the ligament of Trietz located?
Suspension ligament between the duodenum and jejunum
What are some causes of a functional bowel obstruction?
paralytic ileus
peritonitis
bowel ischemia
hypokalemia
retroperitoneal hemorrhage
How can you distinguish between a paralytic ileus and a mechanical obstruction on exam and radiographically?
1) minimal or absent bowel sounds
2) uniform distribution of gas throughout the bowel
Intraluminal obstructions are more likely to occur in the large or small bowel?
Large bowel
Extraluminal compression is more likely to occur in the large or small bowel?
Small bowel
Proximal versus distal bowel obstruction:
Which is more likely to present with more vomiting?
Proximal bowel obstruction is more likely to present with vomiting.
Does a proximal bowel obstruction typically have less or more abdominal distension than a distal bowel obstruction?
Less abdominal distension
Overtime, will a malignant bowel obstruction typically progress to a complete bowel obstruction?
Yes
What diagnostic tool is simplest to diagnose a malignant bowel obstruciton?
Plain film of the abdomen
What are the classic features of a small bowel obstruction on xray?
1) dilated bowel
2) air fluid levels
What are potential surgical options in the management of MBO?
1) resection of the obstruction with or without re-anastomosis
2) intestinal stoma
3) bypass of the obstructed segment
4) venting gastrostomy
MBO:
What 9 parameters are associated with a low likelihood of a patient benefiting from surgical intervention?
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
Stenting is largely limited to what part of the bowel?
Large bowel and proximal duodenum.
Spontaneous resolution of malignant bowel obstruction will occur in what percentage of patients?
30%
What are risks of endoluminal wall stents?
Perforation
Migration
Reocclusion
What are some complications of long term nasogastric tube placement?
nasopharyngeal discomfort
nasal cartilage erosion
bleeding
otitis
aspiration pneumonia
esophagitis
What adjuvant medication could be helpful to relieve colicky pain?
hyoscine butylbromide (anticholinergic)- buscopan
What class of medication does ranitidine belong to?
histamine 2 antagonist
What is peritoneal carcinomatosis?
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
What 2 cancers are most commonly complicated by MBO?
1) Ovarian
2) Colorectal
What symptoms would lead you to consider surgical intervention for gastric outlet obstruction?
Persistent nausea
Vomiting
Belching
Early Satiety
Biliary obstruction:
What commonly becomes obstructed along the biliary tree?
What are possible complications in biliary malignant bowel obstruction?
pruritus
bleeding
liver failure
hyperbilirubinemia
