Obstruction

Question 1

Causes of obstruction

Answer 1

• Adhesions
• Hernias
• Malignancy

Question 2

Presentation of obstruction

Answer 2

• Increasing abdominal distension and diffuse pain
• Absolute constipation
• Vomiting

Question 3

Initial management of obstruction

Answer 3

• NBM
• IV fluids
• NG tube on free drainage

Question 4

Investigation of obstruction

Answer 4

• Abdominal X-ray
  
  • Distended loops of bowel
    
    • Limits of normal are 3cm small bowel, 6cm colon, 9cm caecum
    • Valvulae conniventes are present in small bowel, and are mucosal folds that form lines tha extend across the full width of the small bowel
    • Haustra are like pouches formed by the muscles in the walls of the large bowel, and form lines that do now extend the full width of the small bowel
• CT can confirm diagnosis and guide surgical intervention

Question 5

Surgical intervention

Answer 5

• Correct underlying cause
• Exploratory laparotomy in patients with unclear underlyng cauyse
• Adhesiolysis to treat adhesions
• Repair of hernia
• Emergency resection of tumour