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Intestinal Obstruction Flashcards

1
Q

Intestinal obstruction is defined as a _______ or ________, ________ or _________ of the intestines that prevents the passage of its contents

A

partial or complete

mechanical or functional blockage

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2
Q

Intestinal obstruction can occur in any part of the intestine

T/F

A

T

From the duodenum to the large intestine

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3
Q

Obstruction occurs if anything interferes with factors that control normal passage of intestinal content:
1.________
2._________
3. Normal __________

A

Patency

Viability

contraction

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4
Q

Classification of Obstruction

Can be classified based on:

__________
____________
_________

A

Site
Mechanism
Clinical presentation

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5
Q

Intestinal obstruction

It can also be classified based on site:

✓_________ or _________

A

Small or large bowel obstruction

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6
Q

Classification of Intestinal obstruction

Based on mechanism:

✓________ obstruction by _______________________________

✓ _________________(__________) due to
_______ or _________ defect affecting
_________ and _________ of the intestine.

A

Mechanical; object from within or outside the wall

Non-mechanical (pseudo-obstruction)

ischaemic or neurological

viability and contractility

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7
Q

Classification of Intestinal obstruction

Based on Clinical presentation:
✓_____________
✓___________

A

acute

chronic

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8
Q

Common causes of Mechanical obstruction

List 6

A

• Hernias
• Adhesion
• Intussusceptions
• Volvulus
• Atresia
• Neoplasm

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9
Q

Common causes of Mechanical obstruction

Inflammatory or ishaemic strictures
e.g________,_________,_______

________disease

Obstruction by ______, ______,_______ foreign bodies.

A

Crohn’s disease., TB, Ulcerative
colitis

Diverticular

gall stone, faecoliths, worm [ascaris]

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10
Q

Causes of Non- mechanical [ ____________ ]
•________
• ___________ ileus
• ______itis
• Bowel ________.
• ________pathies
• Neuropathies (________ disease

A

pseudoobstruction

Cystic fibrosis.; paralytic

Periton; infarction

Hirchsprung’s

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11
Q

Hirchsprung’s disease due to ______________

A

absence of the parasympathetic ganglion

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12
Q

Paralytic ileus-causes

• Infections-e.g _________
• Toxins
•_______
• _________ complications
• Ishaemia
•_________’
•_______ failure
• Drugs-e.g _________

A

Gastroenteritis

Electrolyte imbalance

Post surgical

Peritonitis

Renal; narcotics

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13
Q

Small bowel obstruction-causes

•_________
•______
•_______
•_________
• Neoplasm
•______ disease
•__________
•_______ strictures
•__________ syndrome
• Foreign bodies
•________
• Atresia

A

Hernias

Adhesions

Intussusception

Volvulus; Crohn’s

Pseudo-obstruction

Ishaemic

Superior mesenteric artery

Ascariasis

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14
Q

Large bowel obstruction-causes

• Neoplasm-e.g.____________

•_________-
•_______________
•_________ ————-
•____________
• Endometriosis
•_______ impaction
•_______-obstruction
• Colonic ________
•__________ disease

A

colon carcinoma

Hernias; Diverticulitis

Ulcerative colitis

Adhesions; Faecal

Pseudo; volvulus

Hirchsprung’s

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15
Q

Congenital causes
• Congenital _____
•_______
•__________ ———-
•_____________

A

atresia

Bands

Imperforate anus

Cystic fibrosis

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16
Q

Pathophysiology of Intestinal Obstruction

The major concerns are effects
• General ____________ and ________
• Increased _________ on ________

A

body fluids & electrolyte loss

pressure on intestinal perfusion.

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17
Q

Pathophysiology of Intestinal Obstruction

Effects of obstruction depend on:
• Onset- whether it is ——— or ______
• Extent- ________ or ______
• Site- ______ in the gut
• Associated vascular obstruction- _______,_______, or ________

A

sudden or gradual

complete or partial

level

simple or strangulated or gangrenous.

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18
Q

Small intestinal and mechanical obstruction are more (acute or chronic?) in onset, (slowly or rapidly?) progressive and more likely to be (complete or incomplete?) .

A

Acute

Rapidly

Complete

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19
Q

Acute obstruction has 3 phases

List them

A

Phase of active peristalsis

Phase of stasis

Phase of anti or retro peristalsis

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20
Q

phases of Acute obstruction

Phase of active peristalsis :initially following obstruction, the part (above or below ?) it ___________

A

Above

contracts

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21
Q

phases of Acute obstruction

Phase of stasis:immobility or stasis results in ________ and ——- of the bowel due to accumulation of __________ and _________.

There is also increase _____, decrease ________ , ________ growth

A

distension and dilation

intestinal secretion and swallowed air

secretion; absorption; bacterial

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22
Q

phases of Acute obstruction

Phase of anti or retro peristalsis : fluid passes ______________ and _____ occurs .

Content of the vomiting depends on the ____________

A

back to the stomach and vomiting

level of obstruction

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23
Q

Acute obstruction
• Obstruction at the duodenum →loss of ______→ ________ →

• drowsiness, (slow or fast?) (shallow or deep?) respiration & tetany.

A

H+

alkalosis

Slow ; shallow

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24
Q

Acute obstruction

• At the level of ileum- vomitus contains _____ , ______ juice, ___________ secretion, ____________.

• Electrolytes- loss of _____,_____,_____

A

saliva; gastric

bile pancreatic

succus entericus

Na, K, CL.

25
Q

In acute obstructions at the ileum, there is acid base imbalance

A

No acid base imbalance.

26
Q

Major effects of acute obstruction

•_________ occurs from vomiting, bowel edema, and impaired __________→ _______ and ______

•________________ occurs - gastric potassium, hydrogen, and chloride ions,

A

Fluid loss; fluid absorption

hypovolemia and shock

Electrolyte inbalance

27
Q

In chronic obstruction

➢Obstruction is most often (complete or incomplete?) . Usually due to
stricture, tumour growth or pressure from outside
➢Occurs more commonly in the _____ intestine.

A

incomplete

large

28
Q

chronic obstruction

➢Local change is _____ of the muscle at the (proximal or distal?) part of the bowel.

➢Marked _______ of proximal bowel with accumulation, of _______ and _____

A

hypertrophy; proximal

distension

gas and fluid

29
Q

Effect of chronic obstruction

Effect→ anti peristalsis→ vomiting
•_________
• K loss→_______
• HCO3 →_______
• Pressure →impaired _______
• impaired ______,
• diffusion of toxic material into __________→ toxemia.

A

dehydration

muscle weakness

acidosis; blood supply ; viability

peritoneum

30
Q

Effect of chronic obstruction

Intestinal stasis leads to
• ________ of _______→ Bacterial ————- across the bowel wall→ ________ of wall→__________ → ___________ → Peritonitis and septicaemia

A

Overgrowth of intestinal flora

translocation; Inflammation

Ulceration; Perforation

31
Q

Clinical features
The hallmarks of intestinal obstruction include
◦_______ abdominal pain,
◦ Nausea and vomiting,
◦ Abdominal ______, and
◦ ________ of bowel movements and flatus

A

Colicky; distension

Cessation

32
Q

In distal obstruction, _______ and ________ are more marked than __________

A

pain and distension ; vomiting

33
Q

In proximal obstructions, ______ predominates, there is minimal
____________

A

vomiting

abdominal distension

34
Q

Features of _______ and or ______ may be present depending on the severity on the period of development of the
obtsruction

A

hypotension; dehydration

35
Q

Hernia
_____________ through an aperture. When it appears outside the body surface, it is called ______ hernia. Otherwise, its _______.

It usually occurs due to _____________ or _____________.

A

Protrusion of bowel

external; internal

local weakness or increased intra-abdominal
pressure

36
Q

Complications of hernia

initially its reducible, latter it becomes
irreducible →
➢ _______,
➢_________, and →
➢Gangrene,
➢ _______,
➢___________

A

Obstruction

Strangulation

peritonitis

septiceamia

37
Q

Intussusception

Occurs when one segment of the bowel becomes _______/_______ into the immediate ____________ of the bowel.

A

telescoped/ invaginated

distal segment

38
Q

Intussusception

It’s commoner in (children or adults?)

Patient is otherwise healthy though can have __________.

A

Children

lymphadenopathy

39
Q

Intussusception

It’s commoner in children

In adults , its initiated by _______ or _______

Sites: ________,______,_______

A

mass or tumour

ileocaecal valveIleocaecal, ileocolic

40
Q

Intussusception

Effects:
•interference with _________

•(Mechanical or Non-mechanical?) obstruction of the bowel→ _______ if not
reversed.

A

blood supply.

Mechanical

infarction

41
Q

Volvulus

(Complete or incomplete?) twisting of a loop of bowel about its ________ base of attachment up to about _________

A

Complete

mesenteric

180degrees

42
Q

Volvulus

Common sites: ________ followed by ————-,———— ,_______ TC

Effect: impaired __________ and obstruction.

A

sigmoid colon

caecum, SI, stomach

blood circulation

43
Q

Volvulus

Clinical features: are those of obstruction.

Abdominal ______ and ________, vomiting, constipation, obstipation

A

pain and distension

44
Q

Treatment of obstruction

• Depends on the cause, type and whether there is ____________

➢ ___________ for mechanical obstruction
➢_________ -Paralytic ileus and non mechanical types
➢Management of complications

A

superimposed complication

Immediate surgery

Conservative

45
Q

Obstipation

___________________

A

inability to pass stool

46
Q

Most common cause of SBO is??

A

Adhesions

47
Q

In Intussusception, Blood supply is compromised

T/F

A

T

48
Q

Intussusception

GI bleeding: “________” stool

A Medical emergency

A

Currant jelly

49
Q

Intussusception

Common in ________ (often ____ year old) Rare in _______
Often near the ___________

A

<1

children

Adults

ileocecal junction

50
Q

Underlying lesions often leads to intussusception

T/F

A

T

51
Q

Intussusception

• Intestine is _______ and ______ by ______

A

trapped and dragged; peristalsis

52
Q

Intussusception

Potential lead points
•_______ diverticulum
• Lymphoid hyperplasia (____________;____________)
• Strong association with enteric ________ infection
• In adults: _______

A

Meckel’s

Peyer’s patches; viral gastroenteritis

adenovirus

tumors

53
Q

Intussuscipens. (Receiver or giver?)

Intussusceptum ( receiver or giver?)

A

Receiver

Giver

54
Q

Volvulus

Occurs more in (children or elderly?) (mean age ____)

In children may be ______________

A

Elderly ; 70

2° Meckel’s diverticulum

55
Q

Hirschsprung’s Disease

Presentation
Failure to __________
Abdominal distention
_________ vomiting

Examination: ___________ in rectal vault

A

pass meconium

Bilious

no stool

56
Q

Hirschsprung’s Disease

Diagnosis and Treatment

Barium imaging
• “__________ zone”
•_____-shaped
• Proximal ______ bowel (normal)
• Distal bowel _____ (abnormal)

A

Transition

Cone; distended

small

57
Q

Hirschsprung’s Disease
Diagnosis and Treatment
Rectal “suction” biopsy
• Standard biopsy may only show ______
• Need to apply ________ to biopsy _________
• Absence of _______ cells

A

mucosa; suction

submucosa; ganglion

58
Q

In Hirschsprung’s Disease

________ is ALWAYS involved (other areas variable)

A

Rectum

59
Q

Hirschsprung’s Disease
Diagnosis and Treatment

Treatment: ___________
• Removal of _____ without _______

A

Colon resection

colon; ganglion cells

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