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Y4 Cancer Care > Small / Large Bowel Obstruction > Flashcards

Small / Large Bowel Obstruction Flashcards

1
Q

What is a bowel obstruction?

A

Mechanical blockage of the bowel

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2
Q

What are the causes of SBO? (2 things)

A
  1. Adhesions
  2. Hernias
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3
Q

What are the causes of LBO? (3 things)

A
  1. Malignancy
  2. Diverticular disease
  3. Volvulus (bowel twisting on itself)
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4
Q

What are the clinical features of BO? (3 + 2 things)

A
  1. Vomiting
  2. Abd pain / distension
  3. Constipation

@ exam

  1. Tympanic (hollow) sound on percussion
  2. Tinkling bowel sounds on ausc
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5
Q

What are the features of abd pain in BO? (3 things)

A
  1. Colicky & cramping
  2. Localised tenderness
  3. Guarding + rebound @ palpation
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6
Q

What does HIGHER up abd pain suggest in suspected BO?

A

SBO

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7
Q

What does LOWER down abd pain suggest in suspected BO?

A

LBO

Lower pain = Large bowel

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8
Q

What does EARLY vomiting suggest in suspected BO?

A

Proximal obstruction (SBO)

Remember: vomiting is from da mouth so da nearer obstruction is to da mouth da earlier it will present

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9
Q

What does LATE vomiting suggest in suspected BO?

A

Distal obstruction (LBO)

Remember: vomiting is from da mouth so da nearer obstruction is to da mouth da earlier it will present

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10
Q

What causes the abd pain in BO?

A

Peristalsis

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11
Q

Which BO has MORE significant abd distension?

A

LBO

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12
Q

What causes abdominal distension in BO?

A

Third spacing

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13
Q

What is third spacing?

A

Movement of fluid from blood –> spaces between cells

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14
Q

What does EARLY constipation suggest in suspected BO?

A

Distal obstruction (LBO)

Remember: pooing is from da bunda so da nearer da obstruction is to da bunda da earlier it willl present

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15
Q

What does LATE constipation suggest in suspected BO?

A

Proximal obstruction (SBO)

Remember: pooing is from da bunda so da nearer da obstruction is to da bunda da earlier it willl present

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16
Q

What are the types of BO? (3 things)

A
  1. Simple
  2. Closed loop
  3. Strangulated
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17
Q

What is simple BO? (2 things)

A
  1. 1 obstruction point
  2. NO vasc compromise
18
Q

What is closed loop BO?

A

2 obstruction points –> u get a loop of distended bowel –> risk of perforation

19
Q

What is a strangulated BO? (4 things)

A
  1. Vasc compromise
  2. Pain = sharper + constant + more localised
  3. Peritonism signs
  4. Mesenteric ischaemia signs
20
Q

What are the signs of mesenteric ischaemia? (3 things)

A
  1. Fever (+ high WBC)
  2. Pain worse @ movement
  3. Localised tenderness

If dey have dese signs in BO den send dem for URGENT surgery cah is strangulated

21
Q

What are some other differentials that present similarly to BO?

A
  1. Pseudo-obstruction
  2. Paralytic ileus
  3. Constipation
22
Q

What is a pseudo-obstruction?

A

Resembles mech GI obstruction but NO real obstructing lesion

23
Q

What is the treatment for pseudo-obstruction? (2 things)

A
  1. Neostigmine (myasthenia gravis treatment)
  2. Colonoscopic decompression
24
Q

What is paralytic ileus?

A

Impaired peristalsis of bowel

25
Q

What causes paralytic ileus? (3 things)

A
  1. Abd / spinal surgery
  2. Pancreatitis
  3. Elec imb. (low Na / K)
26
Q

How do you differentiate between pseudo-obstruction / paralytic ileus VS BO? (2 things)

A

Pseudo-obstruction / paralytic ileus =

  1. ABSENT bowel sounds
  2. LESS pain
27
Q

What lab tests should be done for suspected BO? (5 things)

A
  1. FBC
  2. VBG
  3. U&E
  4. LFT
  5. CRP
  6. G&S
28
Q

What may a FBC show in suspected BO? (4 things)

A
  1. High Hb = cancer
  2. Low Hb = dehydration
  3. Leucocytosis (inf / inflamm)
  4. Anaemia = cancer
29
Q

What may a VBG show in suspected BO?

A

High lactate = ischaemia

30
Q

What may U&Es show in suspected BO? (2 things)

A
  1. Elec imb (low Na / K)
  2. Met alk (vomiting)
31
Q

Why should you do LFT’s in suspected BO?

A

To exclude biliary / hepatic pathologies

32
Q

Why should you do G&S for suspected BO?

A

They might need surgery

33
Q

What is the gold standard imaging for suspected BO?

A

Abd / pelvis CT w IV contrast

34
Q

Why is CT > AXR for suspected BO? (4 things)

A
  1. More sensitive for BO
  2. Can differentiate between mech obst vs pseudo-obst
  3. Shows SITE + CAUSE of obst
  4. Shows any METASTASES

3+4 = useful for operative planning

35
Q

What would a AXR show in SBO? (3 things)

A
  1. Changes in CENTRAL abdomen
  2. Dilated bowel (3+ cm)
  3. Valvulae conniventes (lines COMPLETELY crossing bowel)
36
Q

What would a AXR show in LBO? (3 things)

A
  1. Changes in PERIPHERAL abdomen
  2. Dilated bowel (6+ cm / 9+ cm @ caecum)
  3. Haustra (lines that only cross bowel Halfway)
37
Q

If clinical features suggest bowel perforation in BO what scan should you do and why?

A

Erect XR

To check for air under diaphragm

38
Q

What determines the management methods for BO?

A

Cause / site / obst completeness / complications

39
Q

What are the indications for surgery in BO? (4 things)

A
  1. Closed loop / strangulated BO
  2. Ischaemia signs
  3. LBO
  4. Conservative not helping for 48+ hours
40
Q

What is the conservative management for BO called?

A

Drip & Suck

41
Q

What is the conservative management for BO? (6 things)

A
  1. DRIP: IV fluids (rehydrate + correct elec imb)
  2. SUCK: NG Tube (decompress bowel prox to obst)
  3. NBM
  4. Analgesia
  5. Anti-emetics
  6. Urinary catheter
42
Q

What is the surgical management for BO? (2 things)

A
  1. Laparatomy
  2. Bowel resection + stoma insertion

Y4 Cancer Care (17 decks)

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