Flashcards in Bowel Obstruction Deck (38)
Partial vs complete bowel obstruction
Partial- fluid or air continue to pass
Complete- cessation of passage of stool or flatus
Categories of bowel obstruction causes
Extrinsic/extra luminal (external to bowel)
Intrinsic (within wall of bowel)
Intraluminal (defect that prevents passage of GI contents)
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)
Why are pts with an obstruction usually dehydrated?
Edematous bowel leads to fluid sequestration so depletes volume
How do complications result from bowel obstructions?
Dilatation--poor vascular supply and perfusion--ischemia--necrosis--perforation--peritonitis
Most common obstruction
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
What questions can be asked to determine if IBD associated with SBO?
N/v/d, constipation, hematochezia and length
Presentation of SBO
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)
Red flags to indicate peritonitis on SBO exam
Shock vitals (tachycardia and hypotension)
Hypoactive/absent bowel sounds (late phase)
Peritoneal signs (guarding, rigidity, rebound tenderness)
Diagnostics used in SBO
UA (and elevated specific gravity)
Plan abd films
Why is a CT scan helpful for SBO?
ID location, severity, etiology and complications
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
What is seen on CT abd for SBO?
Dilated proximal bowel with distal collapsed loops
Bowel wall thickening > 3 cm
What other imaging can be used for SBO when xray and CT are contraindicated (pregnant, kidney function, allergy)?
Management of SBO
Non operative (NPO, IVF, lytes, NG tube, anti-emetics)
Gastrograffin (diagnostic and therapeutic)
Monitor over 2-5 days
Indications for surgical exploration of SBO
Complicated bowel obstruction
Worsening sxs or unresolved with NG tube and bowel rest
Signs of complete bowel obstruction
Ischemia, necrosis, perf
Worsening abd pain, fever, tachycardia, leukocytosis, metabolic acidosis, peritonitis
Signs of peritonitis
Pts look sick, lie still to minimize discomfort, hypoactive/absent bowel sounds, peritoneal signs, significant pain with light bumps
Causes of intestinal strangulation
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)
Presentation of ileus
Abd pain, distention, bloating, gassiness, n/c, can't tolerate PO
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
Management for ileus
Support with IVF
Lyte management, pain (use NSAIDs), bowel rest (NPO/CL)
NG tube if persistent n/v
Causes of large bowel obstruction
Mostly adenocarcinoma (commonly colon and rectum)
Stricture due to diverticulitis/ischemia, volvulus, IBD, fecal impaction, FBs
Presentation of LBO
Similar to SBO
Fever/chills, pain, bloating, constipation, n/v, tenderness, peritoneal signs maybe, hematochezia
Diagnostics for LBO
CBC, CMP, UA, LDH/lactate
Plain abd films (supine and upright)
CXR for free air
What is seen on up right abd xrays for LBO?
Distended colon proximal to obstruction
Management for partial LBO
Surgical consult, NPO, IVF, abx, NG tube to decompress if vomiting
Avoid narcotics and anticholinergics