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General Surgery > GI obstruction > Flashcards

GI obstruction Flashcards

1
Q

What are the three broad anatomical types of GI obstruction?

A
  • Gastric outlet obstruction
  • Small bowel obstruction
  • Large bowel obstruction
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2
Q

Name three causes of gastric outlet obstruction

A
  • Peptic ulcer disease
  • Gastric cancer; gastric polyps
  • Ingestion of caustic substances
  • Pyloric stenosis
  • Pancreatic malignancy; pancreatic pseudocysts
  • Duodenal cancer; ampullary cancer
  • Cholangiocarcinoma; Bouveret syndrome
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3
Q

What are the cardinal symptoms of gastric outlet obstruction?

A
  • Nausea
  • Vomiting
    • Post-prandial
    • Non-bilious; undigested food
  • Epigastric pain
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4
Q

What is Bouveret syndrome?

A

Subgroup of gallstone ileus

Cholecystoduodenal fistula allows the passage of a stone which impacts in the duodenum and causes gastric outlet obstruction

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5
Q

Outline the management of gastric outlet obstruction

A
  • ‘Drip and suck’
    • Maintain hydration and electrolyte balance (esp Cl-)
    • Gastric decompression using NG tube
  • Treat underlying causes where possible:
    • If PUD ➔ IV omeprazole or Lansoprazole
    • Gastric polyps ➔ endoscopic excision
    • Pyloric stenosis ➔ Pyloromyotomy
    • Malignant causes ➔ metallic stenting
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6
Q

What electrolyte imbalance is associated with gastric outlet obstruction?

A

Metabolic alkalosis due to vomiting

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7
Q

What are the cardinal features of intestinal obstruction?

A
  • Colicky pain
  • Vomiting: bilious or faeculent
  • Distension
  • Absolute constipation
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8
Q

What is ‘faeculent’ vomiting?

A

Vomiting of faeces due to bacterial fermentation of intestinal content in established obstruction

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9
Q

What are the two types of obstruction?

A
  • Ileus (functional): reduced bowel motility
  • Mechanical obstruction
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10
Q

What radiographic features are seen in Gallstone ileus?

A

Rigler’s triad:

  • Opacity in RIF
  • Dilated small bowel
  • Air in biliary tree
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11
Q

Name four presenting features of small bowel obstruction

A
  • Abdominal pain: paroxysmal colicky
  • Faeculent vomiting
  • Obstipation; failure to pass flatus
  • Abdominal distension
  • Visible peristalsis; hernia; scar
  • High-pitched tinkling bowel sounds
  • Dehydration; peritonitis
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12
Q

Name three causes of small bowel obstruction

A
  • Adhesions
    • 60-70% of adhesional SBO is self-limiting
  • Hernias
  • Tumours: eg. GI stromal tumour; carcinoid tumour; lymphoma
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13
Q

Name two causes of adhesions

A
  • Surgery
    • Extensive surgery may cause more adhesions
    • May appear many years after a surgical procedure
  • Trauma
  • Intra-abdominal infection: eg. salpingitis, appendicitis
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14
Q

Which hernias commonly cause obstruction?

A
  • Femoral hernia: narrow femoral canal
  • Inguinal hernia: high prevalence
  • Some parastomal or incisional hernias
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15
Q

On x-ray, when is the small bowel considered obstructed?

A

Small bowel dilation >3cm

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16
Q

On x-ray, when is the large bowel obstructed?

A

Large bowel dilation >6cm

17
Q

On x-ray, when is the caecum obstructed?

A

Caecum dilation >9cm

18
Q

Differentiate the presentation of large bowel obstruction vs small bowel obstruction

A

Similar signs and symptoms

  • Large bowel:
    • Vomiting occurs later
    • Intervals between paroxysms of pain are longer
    • PR exam may show mass
  • Small bowel:
    • Vomiting occurs earlier
    • Distension is less
    • Pain higher in abdomen.
19
Q

Differentiate the small bowel and the large bowel on x-ray

A
  • Small bowel:
    • Central
    • Valvular conniventes
    • Gas or fluid
  • Large bowel:
    • Peripheral
    • Haustral folds
    • Gas or faeces
20
Q

Name three complications of small bowel obstruction

A
  • Intestinal perforation
  • Intestinal necrosis
  • Sepsis; multi organ failure
  • Intra-abdominal abscess
  • Short bowel syndrome
21
Q

What is short bowel syndrome?

A

Malabsorption disorder due to either the physical or functional loss of small bowel

22
Q

What are the indications for surgery in adhesional small bowel obstruction?

A

Majority of adhesional SBO is self-resolving

Indications for surgery include:

  • Fever
  • Peritonitis
  • Perforation on imaging
  • Failure of resolution
23
Q

Which bowel obstructions require emergency surgery?

A

Strangulation or Closed loop obstruction

Both carry risk of perforation and peritonitis

24
Q

Outline the initial management of mechanical bowel obstruction

A
  • ‘Drip and suck’
    • Maintain hydration and electrolyte balance (esp Cl-)
    • Gastric decompression using NG tube
  • Treat underlying causes where possible
25
Q

Name three causes of large bowel obstruction

A
  • Colorectal carcinoma
  • Diverticular disease
  • Volvulus
26
Q

Where are the commonest locations for volvulus?

A
  • Sigmoid: due to its mesentery
  • Caecum: non-fixed
27
Q

How is sigmoid volvulus obstruction treated?

A

Flatus tube or flex-sigmoidoscopy to decompress the obstruction

28
Q

How does an ileus differ from mechanical obstruction on examination?

A
  • Ileus:
    • No pain
    • Absent bowel sounds
  • Mechanical obstruction:
    • Pain
    • Higher-pitched tinkling bowel sounds
29
Q

Which two causes of obstruction are not managed operatively?

A
  • SBO: Adhesions without peritonitis
  • LBO: Sigmoid volvulus without peritonitis

General Surgery (23 decks)

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