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Flashcards in Intestinal obstruction Deck (33):
1

Volvus

twist/rotation of segment of bowel

always at part of bowel with mesentery

narrow base + wide lumen

2

adhesions

sticking together

3

intesussuption

telescoping of one hollow structure into its distal hollow structure

4

atresia

absence of opening or failure of development of hollow structure

5

which is more common, SBO or LBO?

SBO: 70% of cases

6

RFs for SBO in adults

adhesions - previous surgery
hernia
Caron's
malignancy

7

RFs for SBO in children

appendicitis
interruption
volvulus
atresia
hypertrophic pyloric stenosis

8

RFs LBO

age + race dependent

9

what makes up the majority of LBOs?

colorectal malignancies, distal to the transverse colon

10

Classification of BO

site
extent of luminal obstruction
mechanism
pathology e.g. simple, closed loop, strangulation

11

SBO pathology of obstruction

proximal dilatation
increased secretions + distension

untreated obstruction --> ischamia --> necrosis --> perforation

12

LBO pathology of obstruction

colon prox to obstruction dilates
increase in colonic pressure
decreased mesenteric BF
mucosal oedema

atrial supply compromised
mucosal ulceration
full thickness necrosis
perforation

13

Presentation

vomiting
nausea
anorexia

colic occurs early
active 'tinkling' bowel sounds

14

Why faceulent vomiting?

fermentation of intestinal contents in established obstruction

15

What would a digital rectal exam of LBO show?

empty rectum
hard stools
blood

16

what would sudden onset, pain, localised tenderness and distension in large bowel be?

volvulus

17

does vomiting follow or precede pain in SBO?

follows

18

resonance if theres gas and resonance if theres fluid?

tympanic - gas
dull - fluid

19

Plain X-ray partial SBO

gas throughout abd

20

in LBO what does contrast enema provide info on?

level, degree & type of obstruction

21

Mx

fluid resuscitation
bowel decompression
analgesia + antiemetic

22

non-mechanical obstruction

a dynamic obstruction
**failure of peristalsis**
no mechanical cause

23

differences in presentation of SBO and LBO

SBO: vom occurs earlier, distention is less and pain higher in the abdomen

24

AXR SBO

central gas shadows and no gas in large bowel

25

AXR LBO

pain is more constant, peripheral gas shadows proximal to blockage, but not in rectum

(unless you've done a PR examination!)

26

ileus obstruction

functional obstruction from reduced bowel motility
no pain + bowel sounds are absent

27

simple obstruction

1 obstructing point
no vascular compromise

28

closed loop obstruction

obstruction at 2 points
loop of grossly distended bowel at risk of perforation

29

strangulated obstruction

blood supply is compromised

peritonism is the cardinal sign
other signs of mesenteric ischamia

30

which types require surgery?

strangulation
closed loop

LBO

31

which types can be managed conservatively? (initially)

incomplete SBO

ileus

32

AXR with 'inverted U' loop of bowel that looks like a coffee bean

sigmoid volvulus

severe, rapid, strangulated obstruction

elderly, constipated + morbid pt

33

laparotomy

surgical procedure involving a large incision through the abdominal wall to gain access into the abdominal cavity. It is also known as a celiotomy.