Bowl Obstruction Flashcards
(27 cards)
What is bowel obstruction?
Interruption to the normal intraluminal flow through the intestines
What are the two types of bowel obstruction?
- Mechanical
- Functional (Ileus)
Compare a partial and complete bowl obstruction
Partial - Liquid stool + flatus passed
**Complete **- constipation and no flatus
What characterizes a functional bowel obstruction (aka. Ileus)?
Disruption of peristalsis
What are some risks for bowel obstruction?
- Prior abdominal surgeries
- Abdominal disease e.g. IBD
- Known hernia
What are the complications of bowel obstruction?
- Dehydration
- Loss of electrolytes
- ** Bowel ischemia** and transmural infarction
- Perforation
- Peritonitis
- Sepsis
What are general symptoms of bowel obstruction?
- Cramping and abdominal pain
- Bloating
- Constipation
- Nausea and vomiting
- Abdominal distention
- Respiratory distress (SOB, cyanosis, tachypnea)
- Shock (sepsis)
What are common signs of bowel obstruction during an exam?
- Inspection: scars, hernia, abdominal distention
- Tenderness to palpation
- Rebound pain and guarding
- Tachycardia
- Peritonitis
- Hypotension
What imaging is performed for unstable patients with suspected bowel obstruction?
Upright abdominal x-ray
Erect CXR - perforation - pneumoperitoneum
What imaging is performed for stable patients with suspected bowel obstruction?
Abdominal and pelvic CT with oral and IV contrast or ultrasound (for patients with contraindications)
What is the 3/6/9 rule in bowel obstruction imaging?
XR finings, shows bowl dilatation if SB > 3cm, LB >6cm and ceacum >9cm
What indicates a complete large bowel obstruction?
Large Bowel:
* Vomiting less common (feocal)
* Lower abdominal pain - less frequent w/ longe bouts
What indicates an small bowel obstruction?
Small Bowel:
* Vomiting more common in SBO (biliary)
* Pain: periumbilical, cramping + intermittent w/ bouts Flatus is present
Are bowl sound spresent in bowl obstruction?
Often no!
What surgical intervention is required for unstable patients with bowel obstruction?
Emergency laparotomy
What conditions in stable small bowel obstruction cases require surgery?
- Primary small bowel tumor
- Internal/external hernia
- Gallstone ileus
- Injected foreign body
- Intussusception
What is the difference between a competent and incompetent ileocecal valve in bowel obstruction?
- Competent: closed loop LBO (worse, causes ballooning)
- Incompetent: open loop LBO (better, no ballooning)
What conditions do NOT require surgery in bowel obstruction?
- Single transition point
- No bowel ischemia/perforation
- No obstruction
- E.g. IBD, metastatic tumor, radiation enteritis
What is conservative management for bowel obstruction?
- Fluid and electrolyte repletion
- Bowel decompression (drip and suck)
- Serial history and examination
What types of mechanical bowel obstruction affect the small bowel?
- Postoperative adhesions
- Hernias
- Tumors
- Adhesion (most common)
What types of mechanical bowel obstruction affect the large bowel?
- Colorectal cancer
- Strictures
- Extrinsic compression (e.g., tumor compression)
- Volvulus
What is the CT sign for colorectal cancer?
Apple core sign - segment of colon narrowed by annular mass
What is the most common cause of intussusception?
Telescoping, most common in children under 2 years
What characterizes functional bowel obstruction?
Decreased smooth muscle contractility, leading to colon dilation
