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GI > Obstruction > Flashcards

Obstruction Flashcards

1
Q

What can obstruction be

A

Complete (complete constipation)
Incomplete (passage flatus / stool 6-12 hours after symptom onset)
Simple = no interference with blood supply
Exntrinsic / extra-mural
Intramural
Intraluminal

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2
Q

What are common causes of large bowel obstruction

A

Colon cancer (60%)
Diverticulitis causing post infective stricture (20%)
Volvulus (5%)
Impacted stool

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3
Q

What are other structural causes

A

IBD stricture
Hernia
Adhesions - surgery / peritonitis / intra-abdo infection

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4
Q

What is an ileus

A

Temporary obstruction due to decreased motility / absence of peristaltic contractions
Will have no bowel sounds as no movement

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5
Q

What causes ileus

A 
Post-surgery
Infections
Electrolyte imbalances - hyponatraemia
Trauma 
Drugs
Pancreatitis
Peritonitis
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6
Q

What is Pseudo-obstruction

A

Resembles mechanical but no lesion

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7
Q

What can cause pseudo obstruction

A 
Parkinson's
MS
Nerve issue
Hypothyroid
Hirschprungs
Meconium ileus (CF)
Ogilvies
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8
Q

What is Olgivies and what puts you at risk

A

Obstruction
Raised WCC
Fever

Pelvic surgery / trauma / CVS and near disease

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9
Q

How does obstruction present

A 
Severe pain
Abdo distension
Diarrhoea early as increased peristalsis
Constipation - absolute in distal but less pronounced if high 
Nausea
Vomitnig = late sign
Decreased appetite / anorexia 
Borborygmi
High pitched bowel if early 
Silent abdomen if peritonitis 
Signs of dehydration / shock
Altered bowel
PR bleed
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10
Q

What does intermittent obstruction suggest

A

Volvulus

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11
Q

What puts you at increased risk of obstruction

A

Malignancy

Surgery

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12
Q

How do you Dx obstruction

A

Bloods
DRE
AXR = key in bowel obstruction
CT abdo = definite

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13
Q

What bloods

A 
FBC
U+E
LFT
Amylase as abode pain 
ABG or VBG shows clinical status
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14
Q

What will AXR show

A

Dilated bowel loops
Free air under diaphragm if perforates
Haustra 1/3 accross

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15
Q

What do you use to get cause

A

CT

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16
Q

What are other useful tests

A 
Gastograffin + AXR to look for perforation / anastomotic leak 
USS
Air or barium enema 
Colonoscopy 
CT iconography if unfit
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17
Q

When do you caution with colonoscopy

A

May perforation / distension worse

Used to untwist volvulus before surgery

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18
Q

How do you deal with obstruction

A 
ABCDE
NBM 
IV fluid
NGT to remove food and prevent vomiting 
Pain relief
Anti-emetic
Catheter
Enema 
Ax if aspiration 
Correct electrolyte abnormalities 
Surgery = definite
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19
Q

Why can obstruction cause chest signs

A

Distended abdo presses on lungs

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20
Q

What must you do if on NG tube or obstructed

A

Changes meds to IV or SC

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21
Q

What is common cause of small bowel obstruction

A

Adhesions x
Hernia x
Stricture - IBD / radiation
Malignancy

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22
Q

When are adhesions common

A

Post - surgery
Sepsis
Peritonoitis
Haemorrhage

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23
Q

What are other causes

A 
RT
Intussception
Ischaemia
Gallstone ileus
Paralytic ileus
Foreign body
TB
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24
Q

How does small bowel obstruction present

A 
Same 
Tend to have vomiting earlier
Pain higher in abdo
Distension less 
Central distension and increases as lower down 
Distension in flanks if colonic
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25
Q

What is important when looking at vomit

A

Bile = suggest past gall bladder
Bright green = proximal
Dark = distal

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26
Q

How do you Dx

A

AXR plays a key role in bowel obstruction
Gastrografin for level
CT abdo if unclear

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27
Q

What does AXR show in small bowel

A

Valvulae go all the way across

Dilated bowel

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28
Q

What does CT show

A

Dilated loops of small bowel

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29
Q

What else is important

A

U+E

ECG for electrolyte imbalance

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30
Q

Why is oxygen impaired

A

Distension
Ischaemia
Sepsis

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31
Q

What is general management

A 
ABC
Oxygen
Analgesia 
Correct hypovolaemia / electrolyte - IV fluid 
NG to reduce distension
NBM
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32
Q

What should you do regular

A

Assess fluid

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33
Q

What should you always do if vomiting

A

Abdo exam

Check for hernia

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34
Q

Complications of small bowel obstruction

A 
Inection
Sepsis
Necorsis
Hypovolaemia
3rd space fluid loss 
Shock
Increased hydrostatic pressure = oedema and ischaemia 
Increased mucosal permeability 
Fluid and Electrolyte disturbances
Dehydration leading to AKI 
Renal failure
Stragnualtion
Peritonitis
Perforation
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35
Q

What does dehydration cause

A

AKI

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36
Q

What is strangulation

A

Intestinal obstruction with persistent interference of blood supply

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37
Q

What causes strangulation

A 
Hernia
Intussception
Intestinal obstruction
Volvulus
Vascular occlusions
38
Q

What does internal strangulated hernia cause

A 
Pain more severe than you'd expect 
Never goes between attacks
Peritonism = cardinal sign 
Shcok
Localised tenderness and rebound
NG fails to relieve
39
Q

What does external strangulated hernia cause

A

Tense
Tender
Irreducible
No expansible impulse

40
Q

What causes intussception in adult

A

Polyp
Lipoma
Adhesions
Malignant tumour

41
Q

How do you Dx and Rx

A

Target sign on USS

Laparotomy and resection

42
Q

When is paralytic ileus common

A

Post-surgery
Drug
Electrolyte

43
Q

What suggest ileus and how do you Rx

A 
Lack of bowel sounds 
N+V
Distension 
Abdo tenderness
Dilated loops of bowel
Previous surgery now no bowel sounds
Fluid and electrolyte on bloods

Rx = NBM, NG tube, start IV fluid and recommence oral slowly
Mobilise to stimulate
TPN if long term

44
Q

What are complications of strangulation

A 
Bowel ishcaemia
Gangrene
Perforation
Peritonitis
Sepsis
Hypovolaemic shock
Dehydration
45
Q

What is best nutrition

A

Going through gut is always best

Try most natural

46
Q

When might enteral or parenteral nutrition be needed

A

Severe vomitnig or obstruction

47
Q

What does TPN require

A

Daily bloods - U+E

PICC or peripheral

48
Q

Complications of TPN

A 
Infection
Refeeding
Fluid balance
Phlebitis / thrombosis
Sepsis
Abnormal LFT
49
Q

How do you decrease risk of abnormal LFT

A

Lipid free days
Decreased duration
Altered content of bags but only do this in chronic
Watch glucose as liver may not cope

50
Q

What type of jaundice does TPN cause

A

Painless

Non-obstructive

51
Q

What is dioralyte used for

A

Dehydration and to increase salt content i.e. if high volume fistula / stoma
Pulls out electrolytes

52
Q

What is NG tube used for

A

Gastric outlet obstruction

Pseudo-obstrution / ileus

53
Q

What is refeeding syndrome

A

Body switching from catabolism to carb when food introduced

54
Q

What does it cause

A 
Low phosphate
Low K
Low Mg
Low B12
Abnormal fluid
Organ failure
55
Q

What can low Mg cause

A

Torsade de points

56
Q

How do you treat

A

Slow introduction

57
Q

Who is high risk

A 
Low BMI
Weight loss
Poor intake
Metabolic disturbance prior
Alcohol
58
Q

What occurs above obstruction

A

Peristalsis and distension

Increases the higher up

59
Q

What can occur at level

A

Perforation

60
Q

What occurs below obstruction

A

Immobile and pale bowel

61
Q

What type of distension if jejunal

A

Minimal

62
Q

Distension in ileal

A

Central

63
Q

Distension in colonic

A

Central

Flanks - colonic only

64
Q

When would obstruction present without constipation

A

Hernia
Pelvic abscess
Mesenteric vascular occlusion

65
Q

What do you do in examination

A 
Look for scars - adhesions? 
Hernia
PR
Palpation
Ausculate
66
Q

What do you hear on auscultation

A

Loud and high pitched in early

Silent if peritonitis

67
Q

What may erect CXR show

A

Free air if late perforation

68
Q

How much dilatation in SBO

A

> 3cm

69
Q

Does normal AXR exclude

A

No

70
Q

Summary high SBO

A

Early vomiting
Minimal distension
Minimal small bowel loops

71
Q

Summary low SBO

A

Late vomitng
Pain and distension
Dilated loops

72
Q

Symmary LBO

A

Lots of distension

Pain and vomit late

73
Q

What confirms the Dx of bowel obstruction

A

CT

74
Q

What is CT good for

A

Determining level
Find cause
Detecting ischaemia and perforation

75
Q

What will confirm resolution of SBO

A

Contrast in caecum in gastrograffin

76
Q

What always has absent bowel

A

Paralytic as no movement

77
Q

What is Olgivie associated with

A 
Elderly 
Recent surgery
Infection - WCC / fever
Severe pulmonary / CV disease
Severe electrolyte imabalnce
Drugs
78
Q

How can you get hypovolaemic -> AKI but have overall +ve fluid balance

A

Fluid lost into 3rd space

79
Q

In obstruction what occurs before signs

A

Fluid an electrolyte dsiturbance

Hypovolaemia

80
Q

What is a volvulus

A

Bowel twist abnormally

81
Q

Where does it occur

A

Sigmoid

Can occur in caecal

82
Q

What are RF

A 
Psychiatric disorder
Neuro disorder
Nursing home
Chronic constipation
Pelvic mass
Adhesion
83
Q

How does it present

A

Colicky pain
Constipation
Distension - asymmetric
Tender

84
Q

What are complications

A

Obstruction
Ischaemia
Perforation

85
Q

How do you Dx

A

Presents like obstruction
AXR - coffee bean sign
CT to confirm

86
Q

How do you Rx

A

Endoscopy decompression
Laparotomy
- Hartmann’s for sigmoid
- R-hemi-Colectomy for caecal

87
Q

What is an incisional hernia

A

Hernia that occurs at site of incision due to inadequate closure

88
Q

What increases risk

A

Bigger incision = bigger risk

Comorbid which cause poor heeling

89
Q

To Dx obstruction what is used

A

Will get AXR as quick
- Good for toxic megacolon
Almost always CT to define location

90
Q

What are other measures in obstruction

A

Octeoride as reduces gastric secretion and associated N+V

Steroid as stimulates bowel but can cause increased hunger when want NBM

GI (29 decks)

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