Bowel Obstruction Flashcards Preview

Gastrointestinal Conditions > Bowel Obstruction > Flashcards

Flashcards in Bowel Obstruction Deck (15):
1

Bowel obstruction is of two kinds:

Functional (paralytic ileus)

Mechanical

2

Most patients admitted for bowel obstruction have obstruction of which part of the GIT?

Small bowel

3

Causes of small bowel obstruction:

Adhesions (75%; previous op)
Strangulated hernia
Volvulus
Paralytic ileus

4

Causes of large bowel obstruction:

Colorectal malignancy (most common)
Constipation
Diverticular disease
Sigmoid volvulus
Caecal volvulus
Paralytic ileus

5

What is paralytic ileus?

Functional obstruction of the GIT caused by absence of peristalsis

6

Causes of paralytic ileus:

Abdominal surgery
Localised peritonitis
Spinal injury
Hypokalaemia
Hyponatraemia
Uraemia
Peritoneal sepsis
Drugs (e.g. TCAs)

7

What is intestinal pseudo-obstruction:

Respembles mechanical obstruction but with no obstructing lesion

8

What is Ogilvie's syndrome?

Acute colonic pseudo-obstruction

Caused by:

* Puerperium
* Pelvic surgery
* Trauma
* Cardiorespiratory disorders
* Neurological disorders

9

Rare causes of GIT obstruction:

Crohn's strictures
Gallstone ileus
Intussusception
TB (esp. developing world)
Foreign body

10

Symptoms of GIT obstruction

Nausea
Vomiting
Early in SBO, late in LBO
Dysphagia
Abdo pain
Diffuse, central, colicky
Constipation
Absolute earlier in LBO
Absolute later in SBO

11

Signs of GIT obstruction

Abdominal distention
Progressive
Less in SBO
Tinkling bowel sounds
Tympany
dt. air filled stomach
Peritonism
strangulation
Pyrexia
?perforation/infarction
Tachycardia
Hypotension

12

Differential diagnosis of bowel obstruction:

* Infective gastroenteritis
* GIT ischaemia
* Acute pancreatitis
* Bowel perforation
* Atypical MI
* Ovarian cancer

13

Investigations in bowel obstruction:

1. Bloods: Amylase, FBC, U&E, group and X-match

2. Imaging: AXR. Erect CXR (?pneumoperitoneum), CT (?SBO)

3. Fluid charts: Monitor input and output

14

Management of bowel obstruction

Conservative
- Fluid resuscitation
- Electrolyte replacement
- Bowel rest (NBM)

Endoscopic
In uncomplicated cases
- Decompression
- Dilatation of strictures
- Stent placement

Surgical
- Laparotomy may be required

15

Complications of bowel obstruction:

* Ischaemia
* Perforation -> Peritonitis + sepsis
* Fluid/electrolyte balance
* Hypovolaemia
* AKI
* Circulatory collapse