intestinal obstruction

Question 1

Three types of intestinal obstruction

Answer 1

In the lumen
Within the wall
Extraluminal

Question 2

what can cause intraluminal obstructiobn

Answer 2

tumour
diaphgram disease
meconium ileus
gallstone ileus

Question 3

what is diaphgram disease

Answer 3

condition wherein the bowel lumen is divided into a series of short compartments by circular membranes of mucosa and submucosa, leading to a pinhole lumen and subsequent obstruction.

Question 4

what can cause intramural obstruction

Answer 4

-inflammatory- crohns, diverticulitis
- tumors
-neural

Question 5

what can cause extraluminal obstruction

Answer 5

adhesions
volvulus
tumour/ malignancy

Question 6

where would adhesions appear

Answer 6

between the loops of bowel

Question 7

what is volvulus

Answer 7

twisting of bowel

Question 8

what is maelena

Answer 8

black stool

Question 9

what is considered an upper GI bleed

Answer 9

up until the duodenum

Question 10

most common cause of an upper gi bleed

Answer 10

peptic ulcer

Question 11

what is ABCDE

Answer 11

Airway
Breathing
Circulation
Disability
Exposure

Question 12

what is TXA and what is it used for

Answer 12

Tranexamic acid
to prevent excessive blood loss

Question 13

Management for patient with variceal bleed

Answer 13

suspect in patients with a history of liver disease
antibiotics and terlipressin reduce mortality
endoscopy within 12 hrs

Question 14

management of non- variceal bleed

Answer 14

Consider proton pump inhibitors.

Endoscopy within 24 hours.

Question 15

what is variceal bleeding

Answer 15

refers to bleeding of varices found throughout the gastrointestinal tract, such as in the esophagus, stomach, and rectum

Question 16

What is SBO

Answer 16

mechanical blockage of small intestine
Small bowel obstruction

Question 17

what occurs in SBO

Answer 17

form of Intestinal failure (IF)
the inability of the gut to absorb necessary water, macronutrients ,micronutrients, and electrolytes sufficient to sustain life and requiring intravenous supplementation or replacement

Question 18

MOST common cause of SBO

Answer 18

Adhesions- usually due to previous abdo/ pelvic surgery

Question 19

pathophysiology of SBO

Answer 19

• Obstruction of bowel leads to distension above the blockage due to a build up of fluid and contents
• This causes increased pressure which pushes blood vessels within the bowel wall causing them to become compressed
• The compressed vessels cannot supply blood , results in ischaemia, necrosis and eventually perforation

Question 20

3 main Causes of SBO

Answer 20

Adhesions
hernia
cancer

Question 21

common sites of obstruction

Answer 21

femoral and inguinal canal

Question 22

clinical presentation of SBO

Answer 22

Pain - initially colicky but then diffuse, pain is higher in the abdo than LBO
-Profuse vomitting following pain 🤮
-tenderness
-constipations
-increased bowel sounds

Question 23

what would make you think SBO rather than LBO

Answer 23

-PAIN is higher in the abdomen
- vomiting occurs earlier
- constipation with no passage of gas occurs late

Question 24

diagnosis for SBO

Answer 24

HISTORY
assesment
investigations

Question 25

what is a colic pain

Answer 25

cant get comfortable comes and goes in severance

Question 26

what would you ask in a SBO history

Answer 26

* Colic * Bilious vomiting * Bloating/distension * Sudden vs gradual onset * Previous surgery * Last eat and drink * Medical comorbidities

Question 27

1st line examination of SBO

Answer 27

Abdominal x ray shows central gas shadows no gas seen in large bowel

Question 28

what investigations would you do for SBO

Answer 28

Full blood count * Urea and electrolytes * Lactate * C-reactive Protein * CT scan

Question 29

why would you do a CT scan for SBO

Answer 29

3D representation of problem * Localises site of obstruction * Indicates cause * Tells you if bowel is ischaemic

Question 30

treatment foR SBO

Answer 30

* Manage pain: Analgesia * Assess fluid balance: Nasogastric tube, urinary catheter * Resuscitate: IV Fluids * Alleviate nausea: Nasogastric tube, select antiemetics * Nutrition: If >5 days without intake, may need parenteral feed

Question 31

WHAT is part of the early management of SBO

Answer 31

IV fluids nasogastric tube urinary catheter analgesia

Question 32

what is the most common complication of SBO

Answer 32

Renal failure

Question 33

when would you advise surgery in adhesive SBO

Answer 33

signs of ischaemia on a CT scan

Question 34

causes of LBO

Answer 34

Malignancy - 90% volvulus diverticulitis crohns

Question 35

clinical presentation of LBO

Answer 35

Abdo pain increased abdo distension normal bowel sounds initially then increased palpable mass vomiting

Question 36

1st line investigation for LBO

Answer 36

aBDO X RAY

Question 37

INVESTIGATIONS for LBO

Answer 37

digitall rectal exam FBC CT- abdo x ray

Question 38

maangement of LBO

Answer 38

-Aggressive fluid resuscitation - Decompression of bowel - analgesia and anti - emetics for symptoms -antibiotics - surgery to remove obstruction

Question 39

are pseudo bowel obstructions more common in LBO or SBO

Answer 39

Present identically to both

Question 40

aetiology of pseudo bowel obstruction

Answer 40

- intra abdo trauma - intro abdo sepsis - drugs - electrolyte imbalances UNDERLYING CAUSE TREATED

Question 41

Would haematamesis indicate upper or lower gi bleed

Answer 41

Upper

Question 42

Would haemotochezia indicate upper or lower gi bleed

Answer 42

Lower

Question 43

Contraindicative medication for SBO and LBO

Answer 43

metoclopramide - gets it moving