Bowel Obstructions, Ischemic Bowel, & Small Bowel Neoplasms

Question 1

a physical or functional blockage of the small or large intestines

Answer 1

bowel obstruction

Question 2

an obstruction that physically blocks the movement of bowel contents distal of the obstruction

Answer 2

mechanical obstruction

Question 3

what is the most common surgical disorder of the small intestines?

Answer 3

mechanical obstruction

Question 4

what is the most common cause of a small mechanical bowel obstruction?

Answer 4

surgical adhesions

Question 5

what is the most common cause of a large mechanical bowel obstruction?

Answer 5

neoplasms

Question 6

how to differentiate between complete and partial mechanical obstruction?

Answer 6

partial obstruction results in pure liquid and flatulence

complete obstruction results in obstipation (no gas/no bowel sounds)

Question 7

a clinical syndrome in which intestinal motility is impaired in the absence of a mechanical obstruction, characterized by symptoms and signs of a bowel obstruction without a physical obstruction

Answer 7

functional bowel obstruction

Question 8

what is a functional bowel obstruction also called?

Answer 8

ileus

Question 9

what is a major cause of morbidity in hospitalized patients?

Answer 9

functional bowel obstruction

Question 10

a patient presents with N/V (feculent emesis), colicky abdominal pain, abdominal distention, and hyperactive bowel sounds that progress to absent bowel sounds. Dx?

Answer 10

bowel obstruction

Question 11

what 3 symptoms are suggestive of bowel ischemia or infection d/t bowel obstruction?

Answer 11

pain disproportionate to exam
fever
tachycardia

Question 12

what is the diagnostic of choice to diagnose a bowel obstruction?

Answer 12

CT scan

Question 13

what diagnostic can be used in bowel obstruction to see air and fluid?

Answer 13

abdominal series xray

Question 14

what is the management for a mechanical bowel obstruction? (5)

Answer 14

IV hydration
judicial pain meds
NPO
NG tube for decompression
+/- surgery

Question 15

what is the non-surgical treatment option for a mechanical bowel obstruction?

Answer 15

frequent serial abdominal exams for non-closed loop obstructions (twisting)

Question 16

what is the management for a functional bowel obstruction? (6)

Answer 16

IV hydration
NPO
NG tube for decompression
judicial pain meds
correct underlying pathology
progress to liquids + solids

Question 17

what medication can be used to treat a functional bowel obstruction caused by opiates?

Answer 17

alvimopan (mu-opioid receptor antagonist)

Question 18

acute visceral artery insufficiency causing pain, tissue damage, and necrosis of the bowel

Answer 18

ischemic bowel disease

Question 19

what are the 3 etiologies of ischemic bowel disease?

Answer 19

embolic occlusion
primary thrombosis
nonocclusive vascular insufficiency

Question 20

a patient presents with severe abdominal pain that is out of proportion to the findings on the physical exam, and the pain is worsened by a meal. Dx?

Answer 20

acute ischemia

Question 21

a patient presents with a history of post-prandial abdominal pain, avoidance of eating d/t pain, and weight loss. Dx?

Answer 21

chronic ischemia

Question 22

what labs will be present in ischemic bowel disease? (2)

Answer 22

elevated WBCs
lactic acidosis

Question 23

what is the imaging of choice for ischemic bowel disease? (2)

Answer 23

CT angiography OR MRA

Question 24

what imaging should be avoided in ischemic bowel disease to prevent rupture?

Answer 24

colonoscopy

Question 25

what is the most common risk factor for acute ischemic bowel disease?

Answer 25

afib

Question 26

what is the surgical treatment for acute ischemia? (2)

Answer 26

general sx immediate exploration +/- resection

Question 27

what is the surgical treatment for chronic ischemia? (2)

Answer 27

vascular sx angioplasty, vessel stent, or arterial bypass

Question 28

what is the medical management for ischemic bowel disease? (6)

Answer 28

IV fluids + blood NPO oxygen heparin (anticoagulate) antibiotics NG tube for decompression

Question 29

aggressive neoplasm, mostly found in duodenum or proximal jejunum

Answer 29

adenocarcinoma

Question 30

neoplasm most commonly in the distal small intestine, majority is non-Hodgkin's B-cell

Answer 30

lymphoma

Question 31

what is the treatment for carcinoid tumor of the intestine?

Answer 31

local excision

Question 32

tumor that is commonly found in the stomach and intestines

Answer 32

carcinoid

Question 33

what is a symptom of early disease in adenocarcinoma and lymphoma?

Answer 33

fecal occult blood

Question 34

what are symptoms of late disease in adenocarcinoma and lymphoma? (6)

Answer 34

abdominal pain weight loss N/V distention anemia obstruction

Question 35

what imaging can be used for adenocarcinoma and lymphoma of the small intestines?

Answer 35

CT w/ contrast

Question 36

what gives a definitive diagnosis of adenocarcinoma and lymphoma of the small intestines?

Answer 36

biopsy

Question 37

what are 2 treatment options for adenocarcinoma and lymphoma of the small intestines?

Answer 37

surgical resection chemo +/- radiation

Question 38

what is the best indicator for poor prognosis of carcinoid of the intestines?

Answer 38

invasive growth / distant metastasis

Question 39

what is the size of most carcinoid tumors?

Answer 39

< 2cm

Question 40

what size carcinoid tumors are associated with metastasis?

Answer 40

> 2cm

Question 41

a patient presents with facial flushing, diarrhea, wheezing, lightheadedness, tachycardia, and hypotension. Dx?

Answer 41

carcinoid syndrome

Question 42

how do most patients with carcinoid tumors present?

Answer 42

asymptomatic

Question 43

carcinoid of the intestines have a slow rate of _____

Answer 43

metastases