bowel obstruction

Question 1

commonest cause of small bowel obstructions

Answer 1

adhesions - following prev surgery

• 2nd = hernias

Question 2

definitive investigation for small bowel obstruction

Answer 2

CT !!!
- more sensitive, esp in early obstruction

Question 3

management of small bowel obstruction

Answer 3

nil by mouth
IV fluids
cyclizine - antiemetic
nasogastric tube with free drainage

Question 4

which antiemetic should be MEGA avoided in small bowel obstruction? why?

Answer 4

metoclopramide
- prokinetic agent - stimulates GI motility
-> worsen sx + lead to perforation

Question 5

commomnest cause of large bowel obstruction

Answer 5

tumour !! 60%

• volvulus
• diverticular disease

Question 6

first line ix for laaarge bowel obstruction

Answer 6

abdo xray !

CT scan

Question 7

which cases of large bowel obstruction may be eligible for conservative mx

Answer 7

diverticular strictures
slow onset obstructions

close observations essential
- no improvement in 48-72hrs - reevaluate for intervention

Question 8

when is emergency surgery required in large bowel obstruction

Answer 8

clinical/radiological signs of perforation or peritonitis

evidence of ischaemic bowel

rapid deterioration despite conservative measures

Question 9

surgical options for large bowel obstruction

Answer 9

bowel viable + patient stable = segmental resections +/- primary anastomosis

emergency = Hartmann’s (resection with end colostomy)

Question 10

management of Large bowel obstruction in palliative patient (metastatic bowel)

Answer 10

endoscopic stenting (colonic stent)
- self-expanding metallic stent (SEMS)

also used as a bridge to surgery - allows decompression + optimisation prior to elctive resection in high risk patients

Question 11

small bowel obstruction on abdo xray

Answer 11

valvulae conniventes = mucosal fold that traverse the full width of the small bowel lumen

• become more prominent + closer together

Question 12

postoperative ileus

Answer 12

reduced bowel peristalsis resulting in pseudoobstruction
- surgeries involving lots of handling of bowel

Question 13

other than handling of bowel, what else can contribute to development of postoperative ileus

Answer 13

derranged electrolytes
- check potassium, magnesium + phosphate

Question 14

postoperative ileus presentation

Answer 14

abdo distension/bloating
abdo pain
nausea/vom

inability to pass flatulence
inability to tolerate an oral diet

Question 15

management of postoperative ileus

Answer 15

nil by mouth
nasogastric tube if vomiting
IV fluids to maintain normovolaemia - additive to correct electrolyte disturbances

total parenteral nutrition
- prolonged / severe cases

Question 16

investigation in patient presenting with acute upper abdo pain

Answer 16

upright erect chest xray

–> perforated ulcer, free air under the diaphragm