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Flashcards in Bowel Obstruction Deck (38)
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1

Partial vs complete bowel obstruction

Partial- fluid or air continue to pass
Complete- cessation of passage of stool or flatus

2

Categories of bowel obstruction causes

Extrinsic/extra luminal (external to bowel)
Intrinsic (within wall of bowel)
Intraluminal (defect that prevents passage of GI contents)

3

What is happening in the bowel during an obstruction?

Bowel dilatation and retention of fluid within lumen proximal to obstruction while distal the bowel decompresses (swallowed air and gas from fermentation contribute to distention)

4

Why are pts with an obstruction usually dehydrated?

Edematous bowel leads to fluid sequestration so depletes volume

5

How do complications result from bowel obstructions?

Dilatation--poor vascular supply and perfusion--ischemia--necrosis--perforation--peritonitis

6

Most common obstruction

SBO

7

Most common causes of SBO

Adhesions MOSTLY (from prior abdominal/pelvic surgery)
Hernia (abd wall/groin)
Neoplasm (primary or metastatic tumor)
Or intestinal inflammation/abscess, strictures, FB ingestion, intussusception, volvulus

8

What questions can be asked to determine if IBD associated with SBO?

N/v/d, constipation, hematochezia and length

9

Presentation of SBO

Maybe fevers/chills
Abd pain (initially can be periumbilical, intermittent and crampy) and more focal can be peritonitis
Bloating/distention, anorexia, n/v, hematochezia, obstipation (can't pass)

10

Red flags to indicate peritonitis on SBO exam

Shock vitals (tachycardia and hypotension)
Lying motionless
Hypoactive/absent bowel sounds (late phase)
Peritoneal signs (guarding, rigidity, rebound tenderness)

11

Diagnostics used in SBO

CBC/CMP
Amylase/lipase
UA (and elevated specific gravity)
Lactate/LDH
Plan abd films

12

Why is a CT scan helpful for SBO?

ID location, severity, etiology and complications

13

What is seen on a supine and upright abd x-rays for SBO?

Dilated loops of bowel with air fluid levels
Proximal bowel dilatation with distal bowel collapse
Look for free air consistent with perforation

14

What is seen on CT abd for SBO?

Dilated proximal bowel with distal collapsed loops
Bowel wall thickening > 3 cm
Submucosal edema

15

What other imaging can be used for SBO when xray and CT are contraindicated (pregnant, kidney function, allergy)?

Abd u/s
CT/MR enterography
UGI/SBFT

16

Management of SBO

Admit
Non operative (NPO, IVF, lytes, NG tube, anti-emetics)
Gastrograffin (diagnostic and therapeutic)
Monitor over 2-5 days

17

Indications for surgical exploration of SBO

Complicated bowel obstruction
Intestinal strangulation
Worsening sxs or unresolved with NG tube and bowel rest

18

Signs of complete bowel obstruction

Ischemia, necrosis, perf
Worsening abd pain, fever, tachycardia, leukocytosis, metabolic acidosis, peritonitis

19

Signs of peritonitis

Pts look sick, lie still to minimize discomfort, hypoactive/absent bowel sounds, peritoneal signs, significant pain with light bumps

20

Causes of intestinal strangulation

Strangulated hernia
Volvulus
Intussusception

21

What is an ileus?

Hypomotility of GI tract in absence of mechanical bowel obstruction often secondary to post op abd surgery
Can be physiologic or pathologic (no return of function in 4-5 days)
Can be nonsurgical causes (hypomotility agents)

22

Presentation of ileus

Abd pain, distention, bloating, gassiness, n/c, can't tolerate PO

23

What is seen on supine/upright abd films of ileus?

Dilated loops of bowel but air present in both small bowel and colon
No air fluid levels

24

Management for ileus

Support with IVF
Lyte management, pain (use NSAIDs), bowel rest (NPO/CL)
NG tube if persistent n/v

25

Causes of large bowel obstruction

Mostly adenocarcinoma (commonly colon and rectum)
Stricture due to diverticulitis/ischemia, volvulus, IBD, fecal impaction, FBs

26

Presentation of LBO

Similar to SBO
Fever/chills, pain, bloating, constipation, n/v, tenderness, peritoneal signs maybe, hematochezia

27

Diagnostics for LBO

CBC, CMP, UA, LDH/lactate
Plain abd films (supine and upright)
CXR for free air
Gastrograffin enema
CT scan

28

What is seen on up right abd xrays for LBO?

Distended colon proximal to obstruction

29

Management for partial LBO

Surgical consult, NPO, IVF, abx, NG tube to decompress if vomiting
Avoid narcotics and anticholinergics

30

Management for complete LBO (based on cause)

Cancer/stricture-resection
Intussusception- barium enema
Fecal impaction-enema
Volvulus (sigmoid is resection and sigmoid is reduction)