Bowel Obstructions Flashcards
(48 cards)
Causes of small bowel obstruction outside the bowel
Adhesions - previous operations, intraabdominal hernias
Causes of small bowel obstruction from the bowel wall
Crohn’s, appendicitis
Causes of SBO inside the bowel
Malignancy, foreign body ingestion, gallstone ileus
Common causes of SBO in children
Intussusception, volvulus, intestinal atresia, appendicitis
Presentation of SBO
Initial colicky pain which becomes continuous, distention, vomiting (bilious), failure to pass stool, tympanic high pitched bowel sound, empty rectum, fever, fluid depleted
Blood results in SBO
FBC showing leukocytosis and anaemia, U&E’s showing organ dys and hypovolaemia, high lactate for bowel ischaemia or necrosis, amylase
Imaging in SBO
Sit upright to look for pneumoperitoneum, absence of air in rectum
What are signs of emergency in SBO
Signs of peritonitis
Investigations to conduct if the patient is stable with SBO
CT abdo and pelvis for best diagnosis, contrast SB using gastrogaffin, MRI, US, diagnostic laparotomy
Management of SBO
Correct of fluid and electrolyes, fluid resus, NG tube to aspirate content for decompression, sugery if conservative measurements fail
Presentation of large bowel obstruction
Abdominal cramping pain, bloating, absolute constipation, nausea, vomiting in late stages
Causes of LBO
Colonic tumour, strictures from IBD or diverticular disease, vovulus, hernias, adhesions
Investigations into LBO
Abdominal Xr and CT
Management of LBO
Analgesia, fluids, antiemetics, decompression of sigmoid volvulis, 70% require surgical intervention.
Definition of Diverticular disease
Clinical conition resulting from the presence of diverticular which are outpouchings of the mucosa and submucosa, typically sigmoid colon
What is diverticulitis
Inflammation of diverticular, typically age >50
Presentation of diverticular disease
Constipation, LLQ pain, some rectal bleeding
Presentation of diverticulitis
Acutely with LLQ pain, fever, nausea, vomiting, pyrexia
Complications of diverticulitis
Abscess formation, perforation (if diffuse tenderness/peritonitis), fistulas (especially colovesical fistulas)
Management of diverticular disease
Increased dietary fibre, hydration, analgeisa
Management of diverticulitis
Initially managed with oral antibiotics - 7 day amoxiclav
Indications for surgery in diverticular disease
Option if rectal bleeding uncontrolled, unresponsive to anti-biotics, abscess, perfoartion, stricture or obstruction
Definition of diverticulosis
Diverticula found incidentally
What is vovulus
Twisting of a loop of intestine around its mesenteric attachment, resulting in a closed loop bowel obstruction.
