Pseudo-obstruction Flashcards
What is pseudo-obstruction?
Dilatation of the colon use to adynamic bowel, in the absence of mechanical obstruction
Where in the GI tract does pseudo-obstruction usually occur?
Caecum and ascending colon however can affect the whole bowel
What is the mechanism of pseudo-obstruction?
interruption of the autonomic nervous supply to the colon resulting in absence of smooth muscle action in the bowel
What are the complications of untreated pseudo-obstruction?
toxic megacolon, bowel ischaemia and perforation
What can cause pseudo-obstruction?
Electrolyte imbalances or endocrine disorders, medication, recent surgery, illness or trauma, cardiac events, parkinsons, Hirschsprung disease
What are the clinical features of pseudo-obstruction?
Abdominal pain, abdominal distention, constipation, vomiting (late feature)
What would examination show with pseudo-obstruction?
due to colonic specifically, bowel sounds should be present, tympanic due to distention, focal tenderness will show ischaemia
What are the differential diagnosis for Pseudo obstruction?
Mechanical obstruction, paralytic ileus, toxic megacolon
What initial blood tests should be done for Pseudo-obstruction?
blood tests looking for infective or electrolyte causes e.g. FBC, CRP, UandE, LFTs, Ca, Mg TFTs
What will AXR show for pseudo-obstruction?
bowel distension
What imaging should be done for Pseudo-obstruction?
abdominal-pelvis CT scan with IV contrast to show dilatation of the colon as well as excluding a mechanical obstruction and assessing for any complications
What is the management for Pseudo-obstruction?
conservative usually and treat acute illness, NBM, IV fluids, NG tube, endoscopic decompression if does not resolve in 24 hours, IV neostigmine (anti cholinesterase) nutritional support, if ischaemia or perforation then semimetal resection with anastomosis
