Bowel Obstruction & Volvulus

Question 1

What gases small bowel obstruction?

Answer 1

Fluid, gas

Question 2

What are features of small bowel obstruction?

Answer 2

Colicky, central pain
Absolute constipation 
Vomiting
Burping 
Abdominal distension

Question 3

Fluid and gas in small bowel obstruction dilates the bowel ______ and disrupts?

Answer 3

proximally

peristalsis

Question 4

In complete bowel obstruction there is no ________ passed

Answer 4

flatus or stool

Question 5

What are risk factors for small bowel obstruction?

Answer 5

Adhesions
Strangulated hernia
Malignancy
Caecal volvulus 
Diverticular disease
Stricture

Question 6

How does a small bowel obstruction present?

Answer 6

Acute diffuse abdominal pain of colicky nature
Early vomiting
Late constipation
Tinkling bowel sounds

Question 7

If there is semi-digested food (eaten 1-2 days ago) in vomitus it indicates?

Answer 7

Gastric outlet obstruction

Question 8

Copious bile stained vomit indicates?

Answer 8

Upper small bowel obstruction

Question 9

Thicker, brown foul-smelling (faeculent) vomit indicates?

Answer 9

More distal obstruction

Question 10

How do you investigate bowel obstruction?

Answer 10

AXR

Question 11

Symptoms of a small bowel obstruction have _____ onset than large bowel obstruction

Answer 11

faster

Question 12

How do you treat a small bowel obstruction?

Answer 12

Bowel rest
NG tube - drip and suck
Correct electrolyte imbalance

Question 13

What is meant by “drip and suck”?

Answer 13

ABC
Analgesia 
Fluids with potassium
Catheterise
NG tube (suck not feed)
Anti-thromboembolism measures

Question 14

How long should you drip and suck for?

Answer 14

Up to 72 hours

Question 15

After 72 hours of drip and suck it is recommended to?

Answer 15

Operate

Question 16

When should you intervene and operate for a small bowel obstruction?

Answer 16

If strangulation, perforation +/- ischaemia

Question 17

What causes large bowel obstruction?

Answer 17

Most commonly CRC but can be same cause as SBO

Question 18

What happens in large bowel obstruction if the ileocaecal valve stays competent?

Answer 18

Backwards flow of accumulated bowel prevented
Caecum progressively distends with swallowed air
Eventually rupture

Question 19

What happens in large bowel obstruction if the ileo-caecal valve is incompetent?

Answer 19

Small bowel distends delaying onset of symptoms

Question 20

What are the mechanical causes of large bowel obstruction?

Answer 20

Adhesions or bands
Incarcerated abdominal wall hernia
Volvulus
Tumour
inflammatory strictures
Bowel Strangulation
Intussusception
Dynamic bowel obstruction

Question 21

What are causes of adhesions or bands in the large bowel?

Answer 21

Congenital
post-surgery
Peritonitis

Question 22

What is the sign of volvulus on AXR?

Answer 22

Coffee-bean sign

Question 23

What are causes of inflammatory strictures of large bowel?

Answer 23

Crohn’s +/- Diverticular disease

Question 24

What is intussusception?

Answer 24

Segment of boel wall becomes telescoped into segment distal to it - usually initiated by mass in bowel wall

Question 25

What are subtypes of adynamic bowel obstruction?

Answer 25

Paralytic ileus | Pseudo-obstruction (Ogilvie's Syndrome)

Question 26

What is a paralytic ileus?

Answer 26

Failed peristalsis

Question 27

What is a pseudo-obstruction? (large bowel)

Answer 27

Acute dilation of colon without obstruction in the acutely unwell

Question 28

What is pseudo-obstruction of large bowel associated with?

Answer 28

``` Hip replacement CABG Spinal Pneumonia Frail/elderly patients ```

Question 29

How do you investigate a pseudo-obstruction? (large bowel)

Answer 29

AXR/CT

Question 30

How do you treat a pseudo-obstruction? (large bowel)

Answer 30

May require colonoscopy to decompress

Question 31

How does a large bowel obstruction present?

Answer 31

Early constipation, late vomiting - otherwise like SBO | Symptoms tend to develop more slowly

Question 32

How do you investigate a large bowel obstruction?

Answer 32

Supine AXR

Question 33

What would be seen on AXR with a bowel obstruction?

Answer 33

Bowel proximal to obstruction distended

Question 34

What are AXR features of distended small bowel?

Answer 34

Central with circular folds (coin-stacking)

Question 35

What are AXR features of distended large bowel?

Answer 35

Normal anatomical position (hausfrau)

Question 36

What are treatment options for large bowel obstruction?

Answer 36

CT, decompression via flatus tube or endoscopy, surgery | Drip and suck

Question 37

What is a volvulus?

Answer 37

Piece of bowel twists on its mesentery

Question 38

Which pieces of bowel are usually involved in volvulus?

Answer 38

Caecum | Sigmoid colon

Question 39

Volvulus leads to a loop of bowel full of faeces and distention - this is called a?

Answer 39

Closed loop obstruction

Question 40

What are risk factors for Volvulus?

Answer 40

``` Elderly Debilitated Cosntiaption Megacolon Congenitally elongated colon ```

Question 41

How does a volvulus present?

Answer 41

Sudden onset of colicky lower abdominal pain with gross abdominal distension and a failure to pass flatus or stool

Question 42

How do you investigate a volvulus?

Answer 42

Tympanic (bell-sounding) abdomen on percussion | Coffee-bean sign on AXR

Question 43

How do you manage volvulus?

Answer 43

Flatus tube Decompression via flexible sigmoidoscopy Surgical resection