Intestinal Obstruction

Question 1

What factors are likely to cause a small bowel obstruction?

Answer 1

• Adhesions (post-surgery!)
• Hernias
• Crohn’s strictures

Question 2

What factors are most likely to cause a large bowel obstruction?

Answer 2

• Colon cancer
• Constipation
• Diverticulitis and subsequent stricture
• Volvulus

Question 3

What are the cardinal features of bowel obstruction? How can you distinguish SBO from LBO?

Answer 3

• Vomiting (begins earlier in SBO)
• Colicky pain (higher in abdomen for SBO, more constant in LBO)
• Abdominal distension (LBO > SBO)
• Constipation

Question 4

What is the most important sign that could be found on examination in a patient with a bowel obstruction (i.e. indicator for emergency surgery)?

Answer 4

Peritonism

Question 5

What investigative tests might be warranted in a patient suspected of having a bowel obstruction?

Answer 5

• AXR
• Abdo CT
• ?Lipase - exclude pancreatitis and subsequent ileus

Question 6

What are the principles of management of bowel obstruction?

Answer 6

• Fluid resuscitation and bowel rest
  
  • NG tube, IV fluids and nil-by-mouth. Catheterise to monitor fluid output
• Correction of underlying cause
  
  • Sometime conservative (above) treatment will lead to resolution
  • Laparotomy, hernia repair, tumour resection
• Symptomatic management
  
  • Analgesics, antiemetics