Bowel obstruction Flashcards
Pathophysiology
Any part of GI tract
Dilatation of bowel proximal
Peristalsis is disrupted
Upper small bowel obstruction
Acute presentation
Hours of onset
Large volumes vomited
Distal small bowel/large bowel obstruction
Colicky abdominal pain and distension
Vomiting
Intestinal obstruction
Vomiting
Pain
Constipation
Distension
Vomit
Semi-digested food = gastric outlet obstruction Bile = small upper bowel Thick brown (faecal) = distal
Initial management
Nil by mouth
IV cannula and send blood
Resuscitate with IV fluids, replacing electrolyte loss
Pass a NG tube to decompress stomach
Mechanical causes of bowel obstruction
Adhesions Hernia Volvulus Tumour Inflammatory srictures Bolus obstruction Intussusception
Intussusception
Segment of bowel wall becomes telescoped into segment distal to it
Common in kids
Bowel strangulation
Segment of bowel becomes trapped
Venous return obstructed
Arterial inflow compromised
Adynamic bowel obstruction
Paralytic ileus
Psuedo-obstruction
Paralytic Ileus
Disruption of normal propulsive activity of GI tract due to failure of peristalsis
Risk factors of paralytic ileus
Recent GI surgery
Inflammation with peritonitis
Diabetic keto acidosis
Treatment of paralytic ileus
Drip and suck
Wait for restoration of peristalsis
Psudeo-obstruction
Ogilvie’s syndrome
Acute dilatation of colon in absence of colonic obstruction in acutely unwell patients
Risk factors for psuedo-obstruction
Hip replacement
CABG
Pneumonia
Elderly
