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Junior Surgery- General > Obstruction > Flashcards

Obstruction Flashcards

1
Q

What is a bowel obstruction?

A

Mechanical blockage of the bowel, causing gross dilatation of the proximal bowel.

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2
Q

What does a bowel obstruction lead to?

A

Secretion of electrolyte-rich fluid into the lumen

Third spacing

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3
Q

What is a closed loop obstruction?

A

When there is a second obstruction proximal to the first, causing closed section of bowel in the middle to keep expanding until it perforates.

(Surgical emergency)

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4
Q

What are the three most common causes of SBO?

A
  • Adhesions
  • Hernias
  • Cancer
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5
Q

What are the three most common causes of LBO?

A
  • Cancer
  • Diverticulosis
  • Volvulus
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6
Q

What are the clinical features of SBO?

A
  • Abdo pain and distension
  • Vomiting early
  • Constipation late (Absolute)
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7
Q

What are the clinical features of LBO?

A
  • Abdo pain and distension
  • Constipation early (Absolute)
  • Faeculant vomiting late
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8
Q

What examinations are vital in obstruction?

A

Abdo and PR

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9
Q

What should patients NOT have on examination in bowel obstruction?

A

Guarding

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10
Q

What does abdominal guarding suggest in bowel obstruction?

A

Bowel ischaemia

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11
Q

What bloods are important in bowel obstruction?

A
  • UsEs (Third space losses)
  • G+S
  • VBG/ABG
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12
Q

What imaging is now first line in bowel obstruction?

A

CT with IV contrast

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13
Q

What is seen on AXR in bowel obstruction?

A

Distended bowel loops

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14
Q

What are the maximum widths of each type of bowel on AXR?

A

Small 3cm

Large 6cm

Caecum 9cm

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15
Q

What features seen on AXR suggest small bowel obstruction?

A

Central distribution

Valvulae conniventes

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16
Q

What features seen on AXR suggest large bowel obstruction?

A

Peripheral location

Haustra (Halfway)

17
Q

What other imaging may be used in SBO?

A

Water-soluble contrast (Gastrograffin)- contrast should reach colon in 6 hours max

18
Q

What initial management is used in bowel obstruction?

A

Drip and Suck

  • IV Fluids and NBM
  • NG drainage and anti-emetic
  • Analgesia
  • Catheter and fluid balance
19
Q

How is adhesional SBO treated in the first instance?

A

Conservatively (80% success in 24 hours- water soluble contrast study if not)

20
Q

How is bowel obstruction that’s not adhesional usually managed?

A

Laparotomy and correction e.g. fixing volvulus

21
Q

What are the complications of bowel obstruction?

A
  • Bowel perforation
  • Bowel ischaemia
  • Dehydration and renal impairment

Junior Surgery- General (17 decks)

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