Intestinal obstruction

Question 1

What are some causes of IO in extramural, intramural, and mural

Answer 1

1) Extramural: adhesions from surgery or crohn, hernias, volvulus
2) Intramural: Foreign body
3) Mural: cancers or strictures (eg previous radiation)

Question 2

What are the 4 cardinal symptoms of IO

Answer 2

1) Vomiting
2) Abdominal distension
3) Obstipation
4) Colicky abdominal pain

Question 3

What is the first investigation you would do when you suspect IO

Answer 3

AXR. Followed by CTAP

Question 4

What are some differential diagnosis for IO

Answer 4

• mesenteric ischemia
• perforated or intra-abdominal sepsis
• Post-operative paralytic ileus

Question 5

When should you have a trial of non-operative treatment

Answer 5

when there is no vascular compromise, no perforation or closed loop obstruction

Question 6

What should you do in non-operative management

Answer 6

1) NBM
2) KIV NG decompression
3) IV fluid and electrolyte
4) Urinary catheter
5) Analgesia
6) Serial abdomen xray and investigations

Question 7

When should you decide on operative management instead of non-operative

Answer 7

When there is persistent obstruction for >3 days. When drainage volume >500ml on third day. when there are signs of peritonitis or ischemia