obstruction of justice Flashcards
What is the most common cause of a small bowel and a large bowel obstruction?
small = adhesions, previous surgery (2nd is incarcerated hernias) large = tumour (2nd is volvulus)
What are other causes of small bowel obstruction?
- strictures
- mets
- tumour
- foreign body impaction
- ileus
What are other causes of large bowel obstruction?
- strictures
- foreign bodies impaction
- diverticulitis
- adhesions
- faecal impaction
- ileus
Tell me some symptoms of a small bowel obstruction.
- colicky abdo pain
- vomiting large amounts billious
- late onset obstipation
- tingling/absent bowel sounds
- dehydration
- diffuse abdo tenderness
Tell me some symptoms of a large bowel obstruction.
- colicky abdo pain
- large distended abdomen
- diffuse tenderness
- nausea w/ vomiting later
- tingling/absent bowel sounds
- NO flatulence or faeces
What investigations would you want in a query obstruction case?
- ABG/bloods to look for acidosis and associated electrolyte abnormalities
- CT - best diagnostic test - tells you where and how
- AXR can be helpful
- USS can be helpful
What’s the treatment of bowel obstruction?
- fluid resus
- prophylactic ABX
- bowel rest, nil by mouth
- pain control
- Nasogastric tube for decompression
- Surgery as required
What are the causes of ischaemic colitis ?
- thromboembolism
- hypovolaemia (sepsis, haemorrhage, dehydration, low output HF)
- cardiac surgery
- vasoconstrictive drugs
What’s the difference between ischaemic colitis and mesenteric ischaemia?
- ischaemic colitis is large bowel damage due to decreased tissue perfusion
- mesenteric ischaemia is small bowel damage due to decreased tissue perfusion
What are the symptoms of ischaemic colitis?
- sudden onset abdo pain
- pain progresses to guarding and rebound tenderness
- loose bloody stools
- can progress to obstipation
- bloating
- signs of septic shock
How does the pain in mesenteric colitis differ from that in ischaemic colitis?
-in mesenteric ischaemia the pain is periumbilical and far out weighs the examination findings of a soft and non-tender abdomen
What other symptoms of mesenteric ischaemic are there?
- currant jelly stool (bloody diarrhoea)
- N&V
- rectal bleeding
- signs of shock
Other than surgical interventions, what else would you do for a patient with an ischaemic bowel?
- fluids
- ABX
- anticoagulate
- alter atherosclerotic RF - smoking, HTN, diet, lipids.
What is chronic mesenteric ischaemia?
The progressive stenosis of 2 or more major blood vessels that supply the small bowel. Leading to a perfusion demand mismatch of the small bowel post prandially.
Typically how does a patient with chronic mesenteric ischaemia present?
- abdominal angina
- Dull epigastric pain within 1 hour of eating
- RECURRENT
- leads to a fear of eating which leads to weight loss and malabsorption disorders
