Surgical Tut - Bowel Obstruction

Question 1

when vomit with large vs. small bowel?

Answer 1

small - sooner

large - later

Question 2

what questions are negative with small bowel obstruction?

Answer 2

hurt when cough?
hurt with bumps?
not parietal

Question 3

red flag abdo pain?

Answer 3

peritonitis:
ischaemia: genealized CONSTANT pain.

Question 4

large bowel obstruction features?

Answer 4

no flatus
constipation
distension

Question 5

small or large more distension?

Answer 5

large more distension

Question 6

fever with bowel obstruction?

Answer 6

usually not unless perforation

Question 7

what condition can cause intraluminal strictures in bowel?

Answer 7

crohn’s

Question 8

adhesions more likely in large or small bowel?

Answer 8

small bowel

intraperitoneal

Question 9

what cancers can cause small bowel obstruction

Answer 9

ovarian/pelvic cancers

Question 10

what are small bowel primary cancers?

Answer 10

lymphoma

GIST: stromal tumours

Question 11

causes of small bowel obstruction

Answer 11

adhesions
hernias
intussception
extrinsic compression

Question 12

types of hernia?

Answer 12

femoral (skinny or ppl lose weight fast)
inguinal
incisional
umbilical
spegallian

Question 13

intusseption?

Answer 13

one lumen is telescoped within itself

Question 14

causes of large bowel obstruction

Answer 14

*cancer *
sigmoid volvulus
diverticular strictures
pseudoobstruction
severe constipation 2ndary to opiods

Question 15

toxic megacolon in what condition?

Answer 15

ulcerative colitis

Question 16

what is the narrowest point in GIT?

Answer 16

iliocaecal valve

Question 17

what is a pseudo-obstruction?

Answer 17

not mechanical obstruction but has symptoms of it.

Question 18

who get pseudo-obstruction?

Answer 18

ICU, electrolyte derangement
spinal patients, neuro
post-orthopaedic sx

Question 19

small bowel on xray complete rings are called?

Answer 19

plica circularis

Question 20

large bowel obstruction vomiting?

Answer 20

highly distended and vomit later if they have incompetent iliocaecal valve

Question 21

management of small bowel obstruction?

Answer 21

x-rays
can do conservative management unless red flags

then CT

Question 22

large bowel obstruction management?

Answer 22

CT

surgical intervention

Question 23

management of small bowel obstruction?

Answer 23

x-rays
can do conservative management unless red flags

then CT

Question 24

large bowel obstruction management?

Answer 24

CT

surgical intervention

Question 25

why not anastamose bowel and rectosigmoid junction after removal of affected large bowel? what is the procedure called?

Answer 25

distention
leak risk

Hartmann’s procedure

Question 26

what is anterior resection?

Answer 26

focused on recto sigmoid colon

Question 27

colostomy vs. iliostomy

Answer 27

iliostomy: tall and spouted due to skin irritation, larger volume
colostomy: can be flush

Question 28

management for small bowel

Answer 28

Admit the patient
NGT
nil by mouth
fluids electrolytes (potassium in particular)
analgesia