Pathology of intestinal obstruction Flashcards
what are the three ways that an intestine can become blocked
intraluminal obstruction
intramural obstruction
extraluminal obstruction
what are the different causes of intraluminal obstruction?
tumour eg carcinoma or lymphoma
diaphragm disease
meconium ileus
gallstone ileus
what is the cause of diaphragm disease?
fibrosis due to recurrent ulceration eg due to NSAIDs
what is the cause of gallstone ileus?
gall bladder gets inflamed and sticks onto the small intestine and then the gallstone erodes through the small bowel
what are the causes of intramural obstruction?
inflammatory eg crohn’s disease and diverticulitis
tumours
neural eg Hirschprung’s disease
what is the characteristic histological feature of crohn’s?
granulomas
there are also deep fissuring ulcers
in which part of the bowel diverticular disease most common?
sigmoid colon
explain the pathophysiology of diverticulitis
every so often in the muscularis there is a gap for blood vessels to enter the submucosa
increased pressure in the colon due to hard stools leads to the mucosa being pushed into the gaps in the muscularis propria
faeces can stay in the diverticuli and cause diverticulitis
the diverticuli can rupture causing peritonitis OR can get more fibrosis and obstruction in the bowel if it doesn’t rupture
radiologically, how does Hischprung’s look?
normal sized aganglionic segment in the bowel which causes distal obstruction and dilation
what are the causes of extraluminal obstruction?
adhesions
volvulus
tumour - either benign or malignant, peritoneal deposits
with regard to adhesions what should you ask a pt when they come in with bowel obstruction?
have you had any previous surgery eg in the abdomen, OBG etc
give an example of a tumours that can spread to the peritoneum and cause peritoneal tumours
ovarian cancer
