Intestinal obstruction and ileus Flashcards
What is small bowel obstruction and some causes
passage of food,fluids and gas through small intestines become blocked
Adhesions are most common
hernias
cancer
What is seen on presentation in someone with SBO
diffuse central abdominal pain
nausea and bilious vomiting
constipation with obstruction and lack of flatulence
abdominal distension may be apparent
What may be heard on physical examination in someone with SBO
tinkling bowel sounds – more common in early stage of SBO
What investigations are required for SBO
Abdominal x-ray - first line in suspected SBO
– distended small bowel loops with fluid levels - if bowel >3cm consider dilation
CT is definitive investigation and more sensitive
What are the initial conservative steps of management in someone with SBO
NBM
IV fluids
NG tube with free drainage
What are some surgical treatments for someone with SBO
bowel resection, bypass, gastrostomy or tube jejunostomy
What are causes of large bowel obstruction
tumour- accounts fro 60% of cases
usually initial presentation of colonic malignancy
volvulus
diverticular disease
What may someone with LBO present with
absence of passing flatus/stool
abdominal pain
abdominal distension
nausea and vomiting are late symptoms
peritonism may be present if there is also bowel perforation
What investigations should be considered for LBO
Abdominal X-ray is usually first line
3,6,9 rule if diameters are greater than this it is diagnostic of obstruction
presence of free intraperitoneal gas indicates colonic perforation
CT scan is highly sensitive and specific for identifying obstruction and identifying the aetiology of obstruction
What is the management for someone with LBO
Initial steps
NBM
IV fluids
NG tube with free drainage
urgency depends on if bowel has perforated
if cause of obstruction does not require surgery, conservative management for up to 3 days can be trialled
majority will need surgery
IV antibiotics given if perforation suspected
When is surgery carried out for LBO
if there is any overt peritonitis/evidence of bowel perforation emergency surgery is required
irrigation of abdominal cavity
resection of perforated segment and ischaemic bowel
address underlying cause of obstruction
What is paralytic ileus
common complication after bowel surgery
reduced bowel peristalsis resulting in pseudo-obstruction
What are some symptoms of paralytic ileus
abdominal distension/bloating
abdominal pain
nausea/vomiting
inability to pass flatus
inability to tolerate an oral diet
constipation
What investigations are required for paralytic ileus
Abdominal ultrasound
chest x ray
DRE
check potassium , magnesium and phosphate because deranged electrolytes can contribute to development of paralytic ileus
What is the management of paralytic ileus
Bowel rest -NBM initially , the sips of clear fluids
NG tube if vomiting
IV fluids maintain normovolaemic
total parenteral nutrition - required for prolonged/severe cases
prokinetics - promote peristalsis
