Obstruction Popcorn Flashcards
Blood supply to small bowel?
SMA
Blood supply to large bowel?
SMA & IMA
Innervation to small and large bowel?
Autonomic nervous system (ANS)
Digestion/Absorption of water, electrolytes, & nutrients
Small Bowel
Absorbs water & electrolytes from liquid stool –> right colon
Large Bowel
FAST transit time
Small Bowel
SLOW transit time
Large Bowel
Which study?
- used to see air fluid levels
Upright x-ray
Which study?
- used to see free air
PA chest x-ray
MC cause of SBO WORLDWIDE??
Hernias
MC cause of SBO in the UNITED STATES??
Post-operative surgical adhesions
SBO
- Small intestine dilates PROXIMAL or DISTAL to obstruction??
Proximal
MC finding in a patient’s Hx of has SBO??**
Prior abdominal surgery**
Which condition?
- Periumbilical pain (colicky, then steady)
- Crampy pain
- Gas in small intestine
SBO
SBO
- Which symptom is more pronounced is obstruction is DISTAL?
Distention
SBO
- Which symptom is more pronounced is obstruction is PROXIMAL?
Vomiting
Normal or Increased Bowel Sounds
SBO
Gastrografin if perforation is suspected
SBO
Rebound tenderness / pt laying still
Strangulation (advanced/late SBO)
Tachycardia
Hypotension
Dry membranes
Early obstruction: high pitched BS
Late obstruction: silent BS
SBO
Causes of what condition?
- narcotics
- bedrest
- trauma
- hypothryoid
- electrolyte abnormalities
- anesthesia
- sepsis
Paralytic Ileus
- Minimal abd pain*
- Decreased or Absent BS
- Gas in BOTH small & large intestine on x-ray**
Paralytic Ileus
Decreased bowel motility
Bowel distended WITHOUT mechanical obstruction
Paralytic Ileus
No transition zone appreciated***
Tx conservatively (NPO, NG tube, IV fluids)
Paralytic Ileus
Sigmoid colon MC site!
Adhesions are RARE!!
LBO
3 top causes of LBO
- Adenocarcinoma
- Scarring
- Volvulus
- Proximal colon distended
- Absence of air in rectum
- Competent ileocecal valve: closed loop & MASSIVE dilation of cecum
LBO plain film findings
Localized, tender, palpable mass
LBO
(consistent w/ strangulated closed loop)
Tx for Partial / Complete / Perforated LBO??
Partial: conservative (NG tube)
Complete: OR for laparotomy
Perforated: IMMEDIATE laparotomy w/ resection & colostomy
Abnormal twisting of intestine –> obstruction
Volvulus (LBO)
MASSIVE abd distention
MASSIVELY dilated sigmoid/cecum
LBO due to Volvulus
Loss of haustral markings***
Bird’s Beak on Barium Enema
LBO due to Volvulus
Tx for LBO due to Volvulus?
Reduced w/ sigmoidoscopy
