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GI/Gen surg AM > Bowel obstruction > Flashcards

Bowel obstruction Flashcards

(61 cards)

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1
Q

What is bowel obstruction?

A

Impaired flow of normal intestinal contents

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2
Q

Where do bowel obstructions happen?

A

80% small bowel

20% large bowel

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3
Q

What ate the 2 classes of cause of bowel obstruction?

A

Dynamic

Adynamic

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4
Q

What is a dynamic bowel obstruction?

A

Bowel obstruction with increasing peristalsis working against an obstructing agent

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5
Q

What are the causes of bowel obstruction in a newborn?

A

Imperforate anus
Congenital atresia or stenosis
Volvulus
Meconium ileus

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6
Q

What is the common cause of bowel obstruction in 2-3 month old?

A

Strangulated hernia

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7
Q

What is the common cause of bowel obstruction in 3-18 month old?

A

Intussuseption

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8
Q

What are the causes of bowel obstruction in children and young adults?

A

Strangulated hernia

Post op adhesions

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9
Q

What are the common causes of obstruction in adults?

A

Strangulated hernia
Post op adhesions
Maligancy
Volvulus

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10
Q

What is the most common cause of small bowel obstruction?

A

Adhesions

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11
Q

What is the most common cause of small bowle obstruction in a virgin abdomen?

A

Tumour

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12
Q

What is the most common cause of large bowel obstruction?

A

Tumour

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13
Q

What is an adynamic bowel obstruction?

A

Bowel obstruction with cessation of peristalsis and absence of true propulsive waves

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14
Q

What are the causes of adynamic bowel obstruction?

A

Mesenteric vascular occlusion
Paralytic ileus
Large bowel pseudo-obstruction

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15
Q

Who is mesenteric vascular occlusion seen in?

A

Those with PCV, atherosclerosis, AF

People who aren’t very well

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16
Q

What is the presentation of mesenteric vascular occlusion?

A

Pain of sudden onset, severe and out of proportion with physical signs
Co-morbidities
Very unwell

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17
Q

What investigations are done for mesenteric vascular occlusion?

A

CT angio

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18
Q

hat is paralytic ileus?

A

Cessation of peristalsis due to failure of neuromuscular mechanism

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19
Q

What are the common triggers of paralytic ileus?

A

Post op
Infection
Fluid and electrolyte abnormalities
Reflex to trauma

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20
Q

What is the presentation of paralytic ileus?

A

NO pain

Vomiting and distension

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21
Q

What is large bowel pseudo-obstruction?

A

Signs, symptoms and AXR appearance of LBO but no identifiable mechanical cause

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22
Q

What is the presentation of large bowel pseudo-obstruction?

A

Older person with co-morbidities, with progressive abdominal distension and absolute constipation

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23
Q

What investigations are done for large bowel pseudo-obstruction?

A

AXR

CT- bowel dilated but no transition point or identifiable obstruction

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24
Q

What is a simple bowel obstruction?

A

Obstruction of intestinal lumen without interference of its blood supply

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25
What causes a simple bowel obstruction?
``` Gallstones Impacted faeces Strictures Adhesions Tumours ```
26
What is the pathophysiology of a simple bowel obstruction?
Proximal- increased peristalsis, distension with gas and fluid Transition point Distal= collapsed and immobile bowel
27
What are the effects of simple bowel obstruction?
Dehydration from vomiting and third space losses Electrolyte imbalances Translocation of bacteria --> peritonitis
28
What are the causes of death in simple bowel obstruction?
Peritonitis | Fluid and electrolyte imbalance
29
What is a strangulating bowel obstruction?
Intestinal obstruction with persistent interference of blood supply
30
What are the causes of strangulated bowel obstruction?
``` Strangulated hernia Intussusception Adhesions Volvulus vascular occlusion ```
31
What is the pathophysiology of strangulated bowel obstruction?
Venous return impaired first- dark and congested bowel Serosanguinous fluid build up and increases pressure Increased pressure impairs arterial supply, causing necrosis
32
What are the causes of death in strangulated bowel obstruction?
Short segment= peritonitis | Long segment= peritonitis, hypovolaemia
33
What is a closed loop obstruction?
Affected bowel segment obstructed at both proximal and distal end
34
What can cause closed loop obstruction?
Obstructed hernia Volvulus Obstructed colon with competent ileocaecal valve
35
What is the presentation of an obstructed bowel with competent ileocaecal valve?
Abdo pain and distension, with vomiting after 24-36 hours | Caecum becomes dilated and can perforate
36
When are we worried about perforation of the caecum and why?
Thinnest part of bowel | When approaching 10cm
37
What is a Richter's hernia?
Incomplete obstruction due to partial herniation of bowel through small hernia, commonly femoral hernias
38
What are the features of small bowel obstruction, in order of appearance?
Pain Vomiting Abdo distension Absolute constipation
39
What are the features of large bowel obstruction in order of appearance?
Absolute constipation Abdo distension Pain Vomiting
40
Describe the pain in simple bowel obstruction?
Generalised colicky, relief between attacks | Attacks increase in frequency, severity and duration
41
What is the rule with vomiting in bowel obstruction?
The higher the obstruction, the worse and earlier the vomiting
42
When is vomiting seen in large bowel obstruction?
Faecal vomiting after 24-36 hours if incompetent ileocaecal valve
43
Describe the distension in a small bowel obstruction
The later the obstruction, the worse the distension | Ileal= central abdo distension
44
Describe the distension in large bowel obstruction
Distension in flanks
45
What is the presentation of a strangulated obstruction?
Pain is severe and never completely absent between attacks Tender rigid abdomen Temperature, tachycardia, unwell Early raised WCC NG suction for 1-2 hours doesn't relieve pain
46
What bloods are done in bowel obstruction?
``` FBC- low Hb= think cancer -High WCC early= strangulation -High WCC late= peritonitis U&Es LFTs ABG if unwell- metabolic acidosis in strangulation ```
47
What imaging is done for bowel obstruction?
AXR | CT
48
What s the AXR appearance in small bowel obstruction?
Transverse complete regular striations | Small bowel distension
49
What is the AXR appearance in large bowel obstruction?
Haustrations | Distension
50
What is the AXR appearance in a sigmoid volvulus?
Coffee bean sign
51
What is diagnostic of a bowel obstruction?
CT with transition point
52
What is the general management of bowel obstruction?
Drip and suck NG tube- symptomatic relief and reduce aspiration risk Resus fluids and electrolytes Treat cause
53
What are the indications for surgery in bowel obstruction?
``` Obstructed herna Suspected strangulation SBO in virgin abdomen Failure of conservative management in 48 in adhesions Obstructing tumours on CT ```
54
Where does intussusception normally occur?
Ileo-colic
55
What is the management of an intussusception?
Paeds- air enema | Adults- normally organic cause, surgical excision
56
What is the management f a volvulus?
``` Caecal= right hemicolectomy Sigmoid= emergency endoscopic decompression ```
57
What is the management of adhesive obstruction?
Conservative- NG, fluids, pain relief | Surgery if failure of conservative management after 48 hours or suspected strangulation
58
What is the management of gallstone ileus?
Enterotomy and removal of stone
59
What is the management of mesenteric vascular occlusion?
Young= surgery | Older, co-morbid= palliate
60
What is the management of paralytic ileus?
Treat underlying cause | Supportive
61
What is the management of large bowel pseudo-obstruction?
Supportive | Treat any remediable underlying cause

GI/Gen surg AM (28 decks)

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