bowel obstruction Flashcards
what
passage of food, fluid, gas through intestines becomes blocked
what kind of bowel obstruction is most common
small bowel obstruction is more common than large bowel
what does bowel obstruction result in
back pressure –> vomit and dilation of proximal intestine
gastrointestinal tract fluid can’t reach colon to be reabsorbed –> fluid loss from intravascular space to GIT and so hypovolaemia and shock (3rd spacing)
causes: the big 3
adhesions (small bowel)
hernias (small bowel)
malignancy (large bowel)
causes: other
volvulus
diverticular disease
strictures e.g. Crohn’s
intussuseption
adhesions
peices of scar tissue that bind abdo contents together
can cause kinking or squeezing of bowel , causing obstruction
more often small boewl
main causes of intestinal adhesions
abdo/pelvic surgery
peritonitis
abdo/pelvic infection
endometriosis
closed loop obstruction
there are 2 points of obstruction , meaning there is a middle section sandwhiched between
what might closed lop obsturction happen with
adhesions
hernias
volvulus
single point of obstruction of large bowel and incompetent ileocaecal valce
key features of bowel obstruction
vomit (esp bilious) abdo distension diffuse abdo pain absolute constipation tinkling bowel sounds
key x-ray finding
distended loops of bowel
key blood abnormalities
- electrolyte imbalance
- metabolic alkalosis (due to vomiting stomach acid)
- bowel ischaemia: riased lactate
initial management
nil by mouth
IV fluids
NG tube with free drainage
Ix
abdo X-ray
contrast abdo CT
surgical options
exploratory surgery - cause unclear
adhesiolysis - treat adhesions
hernia repair
emergency resection - tumour
