Presentation, Diagnosis and treatment of bowel obstruction Flashcards
which part dilates in relation to an obstruction?
proximal to the obstruction
distal to obstruction = collapsed
how does composition of vomit indicate placement of obstruction?
bile = distal to ampulla of vater
semi digested food = gastric
more fully digested, brown = further down
what are some symptoms of bowel obstruction?
vomiting pain constipation distension complete obstruction incomplete obstruction
do symptoms develop more gradually in small or large bowel obstruction?
large
what are the signs of an incompetent ileo-caecal valve?
small bowel distension as well as large
higher chance of perforation if ileocaecal valve is competent, true or false?
true
what changes occur in incomplete obstruction?
bowel wall hypertrophy
physical signs of obstruction?
dehydration abdominal distension visible peristalsis relative lack of abdominal tenderness palpable mass in some often resonant "high pitched, tinkling bowel sounds" may be no sounds sometimes water sounds
what might tenderness in obstruction indicate?
ischaemia
bowel obstruction investigation?
supine AXR
- shows distension before obstruction and collapse after
- distended loops (small bowel lie in middle position, large bowel sits in normal place and haustra have coli)
Rarely erect AXR (would show fluid level)
CT
how is bowel obstruction managed?
nil by mouth
IV cannula and send bloods
resuscitate with fluids, electrolytes
pass NG tube to decompress the stomach, stop vomiting, measure how much coming out
what mechanical causes can result in bowel obstruction?
adhesions/bands (congenital/previous surgery) incarcerated abdominal wall hernia internal hernia volvulus . .
how are adhesion obstructions managed?
drip and suck
surgery sometimes
what is the most common site for a volvulus?
sigmoid colon
most common in frail elderly
how is a sigmoid volvulus managed?
untwist via colonoscope or sigmoidoscope
what is the risk of dilation behind the obstruction?
can perforate causing peritonitis
what are the most common causes of inflammatory strictures?
crohns
diverticulitis
how does crohns cause bowel obstruction?
inflammation causes stricture
what types of bolus can obstruct the bowel?
food bolus
impacted faeces
impacted gallstone ileus (rare)
trichobezoar (rare)
how does gallstone ileus occur?
fistula between bile duct - duodenum
gallstone travels into small intestine
travels down and gets stuck at ileocaecal valve
what is intussusception?
segment of bowel wall becomes telescoped into segment distal to it
usually initiated by mass in bowel wall (eg. hypertrophy)
what is bowel strangulation?
when obstructed bit of intestine gets trapped
venous return is obstructed (as its very low pressure so doesn’t take much)
intravascular pressure rises until so high that arterial supply cant get into the bowel segment
can result in ischaemia - death of tissue
name 2 types of adynamic bowel obstruction?
paralytic ileus
pseudo obstruction
what is paralytic ileus?
failure of peristalsis
risks = recent surgery and ….
often painless but same symptoms as obstruction
treat with drip and suck until it sorts itself
what is pseudo obstruction (Ogilivie’s syndrome)?
acute dilation of colon in absence of colonic obstruction in acutely unwell
