volvulus Flashcards
can you use the drip and suck approach for volvulous?
no, better to undergo emergency surgery because there is no open area to drain and decompress
what is the presentation of volbulous?
Vomiting (particularly green bilious vomiting)
Abdominal distention
Diffuse abdominal pain
Absolute constipation and lack of flatulence
“Tinkling” bowel sounds may be heard in early bowel obstruction
who is typically affected by sigmoid volvulus?
typically affects elderly patients, as well as those with chronic constipation or neuropsychiatric conditions, such as Parkinson’s disease and schizophrenia
who is more likely affected by caecal volvulus?
- associated with adhesions
- more common in women- e.g. pregnancy
- can occur at any age
what does the coffee been sign on abdominal X-ray suggest?
caecal volvulus
which bloods should you request and why?
- FBC: elevated white cell count with neutrophilia
- U&Es: assess for pre-renal acute kidney injury secondary to hypovolaemia (third spacing)
- CRP: raised as part of the general inflammatory response
Venous blood gas: to assess the degree of metabolic acidosis and lactate level, which may be suggestive of bowel ischaemia
Group and save: patients may go for surgery and require blood products
which imaging would you request?
- abdominal XRAY
- if abmbigious request CT abdomen which is the gold standard
- erect chest xray to look for any pneumoperitoneium
what is the management for a sigmoid volvulus?
rigid sigmoidoscopy with flatus tube insertion
- 60% risk of reoccurrence
if perotinitic can do a Hartmans procedure, which is removal of the rectosigmoid colon with a colostomy
what is the management for a caecal volvulus?
right hemicollectomy
how can you reduce the risk of an aspiration pneumonia in bowel obstruction?
decompression with an NG tube
what is the initial management?
- nil by mouth
- drip and suck-> fluid and NG tube
- IV antibiotics
- analgesia and antiemetics
