MDT BO and Peritonitis Flashcards
Which bowel obstruction for which intestine?
Small = Small Large = Large
What are the two main subcategories of intestinal obstruction?
- Mechanical Obstruction (physical blockage)
- Adynamic Ileus (Paralytic ileus) (dysfunction of intestinal tracts)
What are the two most common causes of Small Bowel Obstruction?
- Adhesions (scar tissues can serve as pivotal point to wrap around)
- Hernias (incarceration and/or strangulation of loops of small bowel)
Classic signs and symptoms of mechanical small bowel obstruction?
- Crampy, intermittent abdominal pain
- Pt’s typically feel the urge to move
- Abdominal distension
- Vomiting
- Possible diarrhea
- Constipation
- Tympanic membrane on percussion
- May produce active high pitched bowel sounds “rushes”
- Can be intrinsic or extrinsic
Paralytic Ileus S/Sx’s of small bowel obstruction?
- Same as mechanical but less intense pain that is more constant
- Tend to present with constipation with diminished bowel sounds
Gold standard for Small bowel obstruction?
Upright abdominal X-ray
Management/treatment of bowel obstruction?
- NPO to include water/medication
- D/c meds that inhibit bowel motility
- NG tube insertion
- Two site IV access
Management/treatment of mechanical small bowel obstruction?
IV antibiotics
Surgery needed for small bowel obstruction?
- Gangrene or necrosis suspected (WBC >20K)
- Intrinsic mechanical cause (carcinoma)
- Failure of conservative therapy
Disposition of small bowel obstruction?
- MEDEVAC all pt’s suspected to have mechanical obstruction
- MEDAVICE minimum for paralytic ileus
- Gen surg consult
How are almost all large bowel obstruction?
Caused intrinsically, with large majority to be from adenocarcinoma
Presentation of large bowel obstruction?
- Constant diffuse lower abdominal pain
- Bloating, distention
- Constipation or inability to pass flatus
- Possible feculent vomitus
What is peritonitis?
Inflammation of the localized or generalized peritoneum, the lining of the inner wall of the abdomen, and cover of abdominal organs
- Typically peritonitis means secondary peritonitis
Primary peritonitis?
Inflammation of the peritoneal surface without intra-abdominal process
- known as Spontaneous Bacterial Peritonitis (SBP)
- usually associated with ascites (less common)
Secondary Peritonitis?
Develops as a result of inflammation of another intra-abdominal structure or association with another intra-abdominal disease process
