Bowel Obstruction Flashcards
(44 cards)
What are the two types of SBO (small bowel obstruction)?
functional
mechanical
Advanced obstruction leads to reduced ___ function ___ bowel dilation in relation to the site of obstruction, ___ of the borders, ___ of fluids to 3rd space. Fluids may also escape to the ___ space.
absorption proximal edema sequestration peritoneal
If significant, the obstruction leads to major dilation which in its turn may lead to ___ and __
necrosis
perforation
Closed loop obstruction is when the obstruction occurs in 2 places: __ and __. This type has higher chances for __ and __
proximal
distal
strangulation
perforation
SBO closed loop happens usually due to either ___ or ___
hernia
volvulus
Patients suffering from bowel obstruction suffer from ___ and must be treated with ___. The reason is loss to __ space.
hypovolemia
fluids
3rd
What are the leading 5 etiologies for paralytic ileus? \_\_ (60%) \_\_ (20%) \_\_ (10%) \_\_ (5%) \_\_ (5%)
post operational adhesion tumors hernias Crohn's abdominal abscess
SBO can be classified into 3 categories:
extra ___
intra ___
intra ___
mural
mural
luminal
What are the main reasons for extra mural SBO? (5)
post operational adhesion hernias mesenteric fibrosis (carcinoid) tumors intra abdominal abscess
What are the main reasons for intra mural SBO? (5)
inflammatory strictures (Crohn's) surgical strictures volvulus intussusception endometriosis
What are the main reasons for intra luminal SBO?
bezoar
parasites
What are the signs of SBO? (4)
- hyperperistaltic -> constipation -> obstipation
- hypovolemia
- intrabdominal pressure
- bacterial translocation
SBO patients will suffer from hypovolemia and vomiting, which in turn contribute to metabolic ___ and paradoxical ___
alkalosis
aciduria
Which symptoms are commonly seen in SBO patients? (4)
periumbilical colic pain
nausea and vomiting
distended abdomen
diarrhea/constipation/obstipation
SBO patients with periumbilical colic pain will
suffer every - minutes
4-5
The typical physical examination of patients with SBO will usually include: (4)
- tachycardia
- fever (strangulation?)
- surgical scars
- enlarged hypertympanic sensitive abdomen
In the first stages of SBO we may hear increased peristaltic abdomen, with typical __ like sounds = ___
metallic
borborygmic
The signs of strangulation include localized ___, more severe and __ (non colic) pain which do not pass (__ pain), tachycardia __,
and__ in the lab. If perforation occur- ___ signs and __
sensitivity stable ischemic fever leukocytosis peritoneal sepsis
The lab check up we should perform when dealing with an SBO patients include dehydration signs (hemo___, increased __/__), vomiting (hypo__ metabolic __ + urine __duria), hyop__.
concertation BUN/Cr chloremia alkalosis acidosis kalemia
Imaging test is the most important tool in the diagnosis of SBO - Perform __ (__ and __ position).
AXR
standing
lying
The acute AXR of an SBO patients will usually show dilated ileum ___ (___ sign). The __ will also be thickened. When standing- __-__ levels. There will be no air in the __. String of __ is also a classic image.
loops Ladder borders air-fluid rectum pearls
When perforation occur in an SBO patients, the AXR may show free air under the ___ or over the __ in the ___ position (__ side)
diaphragm
liver
decubitus
left
When the reason for the SBO is biliary (___ ileus), we may see air in the ___ tree (__)
gallstone
biliary
pneumobilia
If the diagnosis is unclear in an SBO patient, and the AXR was not conclusive- perform ___. It is more suitable to diagnose ___ SBO rather than __
abdominal CT
full
partial
