Pseudo-Obstruction

Question 1

What is Pseudo-Obstruction also known as

Answer 1

Ogilvie syndrome

Question 2

What is pseudo-obstruction characterised by

Answer 2

Dilation of the colon due to an adynamic bowel in the absence of a mechanical dilation

Question 3

Which part of the GI tract does Pseudo-obstruction most commonly affect

Answer 3

Caecum and ascending colon

However has the ability to affect all the bowel

Question 4

What is the pathophysiology of Pseudo-obstruction

Answer 4

Thought to be due to an interruption of the autonomic nervous system supply leading to the absence of smooth muscle action in the bowel wall.

Question 5

untreated cases of Pseudo-obstructions increase the risk of what diseases

Answer 5

Toxic megacolon

Bowel ischaemia and perfs

Question 6

What are the causes of Pseudo-obstruction

Answer 6

Electrolyte imbalance/endocrine disorders ( hypercalcaemia, hypothyroidism)

Medication - opioids, CCBS

Recent surgery,severe illness or trauma - includes cardiac ischaemia

Neurological disease - PD, MS, Hirschsprung disease

Question 7

What are the clinical features of Pseudo-obstruction

Answer 7

Most patients just present with the clinical features of mechanical bowel obstruction

Abdominal pain

Abdominal distension

Constipation

Vomiting

Question 8

What are the differential diagnosis for Pseudo-obstruction

Answer 8

Mechanical obstruction
Paralytic ileus
Toxic megacolon

Question 9

What are the lab investigations that you would carry out for pseudo-obstruction

Answer 9

blood tests should be performed to assess for biocehmical or endocrine causes of pseudo-obstruction, including U&Es, Ca2+, Mg2+, and TFTs

Question 10

Which imaging modalities would you use for investigating Pseudo-Obstruction

Answer 10

AXR - shows if there is distended bowels ( will look the same as a mechanical obstruction however therefore not that useful)

CT abdo/pelvis with IV contrast - this will show dilation of the colon aswell as ruling out mechanical obstruction

Question 11

What is the conservative management of Pseudo-Obstruction

Answer 11

NBM
IV fluids
NG Tube insertion to aid decompression.

Question 12

What is the treatment of Pseudo-Obstruction that does not resolve in 24-48 hours

Answer 12

Endoscopic decompression - involves the insertion of a flatus tube

Also use IV neostigmine

Question 13

What surgical management is available for the treatment of Pseudo-Obstruction

Answer 13

Segmental resection +/- anastomosis
- the above will not be useful unless all affected areas are removed

Alternative procedures - long term caecostomy or ileostomy