Bowel obstruction - Week 8

Question 1

Dilation of the bowel occurs in which direction from the obstruction?

Answer 1

Proximal to the obstruction

Question 2

What would the presentation of upper small intestinal obstruction be?

Answer 2

large volumes of gastric, pancreatic and biliary secretions regurgitated into the stomach and vomited

Question 3

How does distal small bowel/large bowel obstruction present?

Answer 3

Colicky abdominal pain and distension.

Vomiting (possibly ‘faeculent’)

Question 4

Give some symptoms of intestinal obstruction.

Answer 4

Vomiting
Pain
Constipation
Distension

Question 5

Semi-digested food eaten a day or two previously (no bile) suggests…

Answer 5

Gastric outlet obstruction

Question 6

Copious bile-stained fluid suggests…

Answer 6

upper small bowel obstruction, distal to ampulla of Vater

Question 7

Thicker, brown, foul-smelling vomitus (‘faeculent’) suggests…

Answer 7

Distal small bowel or large bowel obstruction

Question 8

What is the cause of colicky pain in intestinal obstruction?

Answer 8

Distension and on peristalsis

Question 9

What is meant by ‘Absolute constipation’?

Answer 9

neither faeces or flatus passed rectally

Question 10

Distension of the large and small intestine suggests….

Answer 10

Large bowel obstruction with incompetent ileo-caecal valve

Question 11

Distension of the large intestine suggests….

Answer 11

Large bowel obstruction with competent ileo-caecal valve

Question 12

What is meant by ‘closed loop obstruction’?

Answer 12

Rupture of the caecum as a result of build-up of gas due to competent ileo-caecal valve

Question 13

Chronic incomplete obstruction leads to…

Answer 13

gradual hypertrophy of the muscle of the bowel wall proximally

Question 14

Give some physical signs of intestinal obstruction.

Answer 14

Dehydration
Abdominal distention
Visible peristalsis
Relative lack of abdominal tenderness

Question 15

Bowel sounds in intestinal obstruction are traditionally described as….

Answer 15

high-pitched and tinkling

Question 16

Which imaging should be ordered if large bowel obstruction is suspected?

Answer 16

supine abdominal X-ray

Question 17

Which scan is used once intestinal obstruction is confirmed?

Answer 17

CT scan

Question 18

What is the purpose of a CT scan in intestinal obstruction?

Answer 18

Find the cause

Question 19

How is intestinal obstruction initially managed?

Answer 19

Nil by mouth.
Insert IV cannula and send blood
Resuscitate with IV fluids, replacing electrolyte losses.
Pass a nasogastric tube to decompress the stomach.

Question 20

What is the acronym for causes of intestinal obstruction?

Answer 20

BATH VIPS

Question 21

What does BATH VIPS stand for?

Answer 21

bolus, adhesions, tumour, hernia, volvulus, intersussception, pseudo-obstruction, stricture.

Question 22

What is the treatment of bowel obstruction due to adhesions?

Answer 22

Drip & suck

May require surgery – divide adhesion

Question 23

Volvulus most commonly occurs in…

Answer 23

Sigmoid colon, caecum

Question 24

Which type of tumour most commonly causes intestinal obstruction?

Answer 24

Colon cancer

Question 25

Which conditions may cause formation of stricures?

Answer 25

Crohn’s disease

Diverticular disease

Question 26

In which location do most strictures occur in Crohn’s disease?

Answer 26

Small intestine

Question 27

Give 4 sources of bolus obstruction

Answer 27

Food bolus
Impacted faeces
Impacted ‘gallstone ileus’
Trichobezoar

Question 28

How does impacted gallstone ileus occur?

Answer 28

fistula between gallbladder & duodenum, stone passes & impacts in ileum

Question 29

What is meant by Trichobezoar?

Answer 29

Hair ball bolus

Question 30

What is meant by Intussusception?

Answer 30

a segment of bowel wall telescopes internally into the segment distal to it

Question 31

Give 2 causes of Intussusception.

Answer 31

enlargement of lymphatic tissue (common) or tumour

Question 32

Which group of patients are at greatest risk of Intussusception?

Answer 32

Children

Question 33

What is meant by bowel strangulation and what is the risk of this?

Answer 33

A segment of bowel becomes trapped

Venous flow obstructed –> increased preesure —> lowered arterial flow –> Infarction

Question 34

Which sign may suggest that a hernia is being strangled?

Answer 34

Pain over hernia

Question 35

What is the treatment for bowel strangulation?

Answer 35

Urgent surgical intervention

Question 36

What are the 2 types of Adynamic bowel obstruction?

Answer 36

Paralytic ileus

Pseudo-obstruction

Question 37

What is meant by paralytic ileus?

Answer 37

Disruption of the normal propulsive activity of the GI tract, due to failure of peristalsis

Question 38

Give some risk factors for paralytic ileus.

Answer 38

Recent GI surgery
Inflammation with peritonitis
Diabetic keto acidosis

Question 39

What is the treatment for paralytic ileus?

Answer 39

‘drip and suck’ while awaiting restoration of peristalsis

Question 40

What is meant by pseudo-obstruction?

Answer 40

Acute dilatation of the colon in the absence of colonic obstruction in acutely unwell patients

Question 41

Pseudo-obstruction is associated with…

Answer 41

Hip replacement surgery
Coronary Artery Bypass Grafts
Spinal #
Pneumonia
Frail / elderly patients

Question 42

Pseudo-obstruction is also called…

Answer 42

Ogilvie’s Syndrome

Question 43

Pseudo-obstruction may be treated with…

Answer 43

colonoscopic decompression