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GI > Obstruction > Flashcards

Obstruction Flashcards

1
Q

How does SBO present?

A

Colicky pain
N+V
Constipation w complete obstruction, may not be absolute w higher obstruction
Distension

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2
Q

What are the causes of SBO in adults?

A 
Adhesions - prev surgery 
Hernias
Crohns
Malignancy 
Appendicitis
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3
Q

What are the causes of LBO?

A

colon ca
constipation
diverticular stricture
volvulus - sigmoid or caecal

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4
Q

how does presentation of SBO differ to LBO

A 
SBO:
- Vomiting occurs early
- less distension
- pain higher in abdo
LBO:
- pain more constant
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5
Q

How does AXR differ in SBO and LBO?

A

SBO: valvulae conniventes extend all the way across
LBO: haustra that do NOT cross width

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6
Q

What are the upper limit of normal diameter of the small bowel, colon and caecum?

A

3
6
9 cm
369 rule

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7
Q

What is paralytic ileus?How does it present?

A

acute functional small bowel obstruction from reduced motility - no pain and bowel sounds are absent

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8
Q

What is simple obstructed bowel?

A

one obstructing point and no vascular compromise

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9
Q

What is closed loop obstruction? Give examples

A

Obstruction at two points forming a loop of grossly extended bowel at risk of perforation
e.g. sigmoid volvulus, distension w competent ileocaecal valve

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10
Q

How does strangulation present?

A
  • Pt more ill than u would expect
  • Sharper more constant and localised pain
  • Peritonism (cardinal sign)
  • Fever and raised WCC
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11
Q

What type of obstruction can usually be managed conservatively?

A

incomplete small bowel obstruction (hernia or adhesions)

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12
Q

what obstructions require emergency surgery?

A

strangulation

closed loop obstruction

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13
Q

What is the immediate management of bowel obstruction?

A

drip and suck
NBM and IV fluids
Nasogastric tube for SBO or vomiting to minimise risk of aspiration
Pain relief

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14
Q

What investigations would u carry out

A

blood: fbc, amylase, u+e
AXR
erect CXR

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15
Q

When is a CT indicated?

A

if clinical and radiographic findings are inconclusive

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16
Q

What can lead to paralytic ileus?

A

abdo surgery
pancreatitis or any localised peritonitis
spinal surgery

17
Q

What is pseudo-obstruction? what is acute colonic pseudo-obstruction also known as?
What can be used to treat it?

A

like mechanical GI obstruction but no cause for obstruction found
acute colonic pseudo obstruction - Ogilvie’s syndrome
treatment - neostigmine or colonoscopic decompression

18
Q

What is sigmoid volvulus?

A

Bowel twists on its mesentery ->severe rapid strangulated obstruction

19
Q

In who does sigmoid volvulus tend to occur?

A

Elderly constipated and comorbid pt

20
Q

How is sigmoid volvulus managed?

A

Sigmoidoscopy and insertion of flatus tube

Sigmoid colectomy may be required

21
Q

What is the characteristic sign seen on AXR w sigmoid volvulus?

A

coffee bean sign

22
Q

What can sigmoid volvulus lead to if left untreated?

A

perforation and fatal peritonitis

23
Q

What are causes of SBO in children?

A

appendicitis
intussusception
Intestinal atresia
Volvulus

24
Q

What are the symptoms of SBO?

A
  1. Pain - intermittent and crampy, severe
  2. Failure to pass flatus or stool
  3. Vomiting - after pain, bilious?
  4. Distension
  5. Tenderness - ischaemia
  6. Mass - if malignancy
  7. Peritonitis - if perforation or ischaemia/necrosis
25
Q

What are the cardinal features of intestinal obstruction?

A
  1. Vomiting
  2. Colic - occurs early
  3. Constipation - may be absolute in distal, less pronounced if obstruction is high
  4. Abdo distension - ↑ as the obstruction progresses with active, ‘tinkling’ bowel sounds
26
Q

what is ileus?

A

functional obstruction due to reduced bowel motility

27
Q

What are the features of ileus

A

absent bowel sounds

less pain

28
Q

What is the immediate action of bowel obstruction?

A 
DRIP AND SUCK - NGT + IVI
Analgesia
Bloods - amylase, FBC, U&E
Catheter for fluid status 
AXR, erect CXR (pneumoperitoneum)
29
Q

What further imaging would u do in bowel obstruction?

A

CT - oral gastrografin helps identify obstruction and help ease it
Consider colonoscopy but beware perforation

30
Q

What surgical options are there for bowel obstruction? what cases is surgery indicated?

A

Strangulation - emergency surgery
Closed loop - surgery or endoscopic decompression
Malignancy - endoscopic palliation

31
Q

What cause of obstruction rarely leads to surgery ?

A

SBO due to adhesions

GI (16 decks)

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