E2: Bowel Obstruction Flashcards Preview

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Flashcards in E2: Bowel Obstruction Deck (21)
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1
Q

What is a bowel obstruction?

A

-Blockage of the bowel that occurs when the normal flow of intraluminal contents is interrupted

2
Q

What is the difference between a partial and complete bowel obstruction?

A
  • partial: fluid and air continue to pass

- complete: cessation of passage of stools and gas

3
Q

What are the 3 major causes of bowel obstruction?

A
  • extrinsic/extra-luminal (external to bowel, such as adhesions and intra-abdominal abscess)
  • Intrinsic (within the wall of the bowel, such as neoplasm and stricture)
  • Intraluminal (fecal impaction, FB)
4
Q

What is the pathophysiology of a bowel obstruction?

A

-Obstruction leads to bowel dilation and retention of fluid within the lumen proximal to obstruction, while distal to the obstruction, the bowel decompresses

5
Q

What are the main complications of bowel obstruction?

A

Ischemia -> necrosis -> perforation

6
Q

What kind of obstruction accounts for 80% of obstructions?

A

SBO

7
Q

What is the most common cause of SBO?

A

Adhesions

8
Q

Patient presents with abdominal pain and constipation. On PE, you hear high pitched “tinkling” bowel sounds. What are you concerned about?

A

SBO

9
Q

What will you see on supine and upright abdominal XRs if the patient has an SBO?

A
  • Dilated loops of bowel with air fluid levels

- proximal bowel dilation with distal bowel collapse

10
Q

What will you see on CT if the patient has an SBO?

A
  • Dilated proximal bowel with distal collapsed loops
  • bowel wall thickening >3mm
  • submucosal edema
11
Q

What are the indications for surgical exploration for an SBO?

A
  • Complicated bowel obstruction as evidenced by worsening pain, fever, tachycardia, leukocytosis, metabolic acidosis, and peritonitis
  • intestinal strangulation
  • worsening symptoms
12
Q

What is the non-operative management of SBO?

A
  • NPO
  • volume resuscitation
  • electrolyte monitoring and replacement
  • bowel decompression with NG tube
  • Anti-emetics
  • Gastrograffin (diagnostic and therapeutic)
13
Q

What is an ileus?

A

Hypomotility of the GI tract in the absence of a mechanical bowel obstruction, often secondary to postoperative abdominal surgery

14
Q

What will you see on abdominal XR if the patient has an ileus?

A

Dilated loops of bowel but air is present in both small and large bowel. No air fluid levels

15
Q

What is the management of an ileus?

A

-Supportive care with IV fluids, lyte replacement, pain management, bowel rest, bowel decompression with NG tube if persistent N/V

16
Q

What is the most common etiology of a large bowel obstruction?

A

Adenocarcinoma

17
Q

What will you see on supine and upright abdominal Xr if patient has an LBO?

A

Distended colon proximal to the obstruction

18
Q

What is the management of a partial LBO?

A
  • Surgical consult
  • NPO
  • IV fluids
  • ABX
  • decompression with NG tube
  • Avoid narcotics and anticholinergics
19
Q

What is the management of a complete LBO?

A
  • Cancer: surgical resection
  • complete stricture: surgical resection
  • intussusception: Pneumatic reduction
  • Fecal impaction: enema
20
Q

What is a volvulus?

A
  • Abnormal twisting of a portion of the GI tract, usually the intestine which can impair blood flow
  • can be sigmoid (most common) or cecal
21
Q

What is the management of a sigmoid volvulus?

A

-Flex sig to decompress and de-rotate, surgery to respect redundant sigmoid colon and prevent recurrence