Obstruction of the bowel

Question 1

What are the symptoms of bowel obstruction?

Answer 1

• vomiting (can be faeculent)
• nausea
• anorexia
• constipation
• abdo distention
• no flatulenc
• tinkling bowel sounds

Question 2

What are the key features of a small bowel obstruction?

Answer 2

• vomiting earlier
• less distension
• pain higher in abdomen
• AXR shows central gas shadows and valvulae convientes that completely cross lumen and no gas in LB.

Question 3

What are the key features of large bowel obstruction?

Answer 3

• constant pain

- AXR shows peripheral gas shadows and haustra (that do not cross the bowel width)

Question 4

What is the sign of an ileus or mechanical bowel obstruction?

Answer 4

• no bowel sounds
• no pain

( obstruction do no reduced mobility)

Question 5

what are the features of a simple bowel obstruction?

Answer 5

• one obstruction point

- no vascular compromise

Question 6

What are the features of a closed loop bowel obstruction?

Answer 6

• obstruction at 2 points (e.g. sigmoid volvulus with coffee bean sign)
• forms a loop of grossly distended bowel at risk of perforation.

Question 7

What are the features of strangulated bowel obstruction?

Answer 7

• blood supply compromised
• patient is very ill
• sharper, more constant, localised pain
• peritonism
• fever and raised WCC
• raised bicarbonate

Question 8

what types of bowel obstruction require immediate surgery?

Answer 8

• large bowel

- strangulation

Question 9

What is the immediate management for a bowel obstruction?

Answer 9

1) NG tube and IV fluids
2) analgesia
3) blood tests (amylase, FBC, U&E)
4) AXR
5) Erect CXR
6) catheterise to monitor fluids

Question 10

What AXR signs do you look for in bowel obstruction?

Answer 10

Small bowel

• valvulae convientes (lines across bowel)
• gas in central abdomen

Large bowel

• haustra (do not cross bowel)
• gas on the outskirts

Question 11

What is the measurements of bowel in small, large and caecal obstruction?

Answer 11

SB >3cm
LB > 6cm
Caecum >9cm