Intestinal Obstruction AAFP
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Questions and Answers

What is the primary non-surgical treatment approach for clinically stable patients with intestinal obstruction?

  • Bowel rest (correct)
  • Nasogastric intubation
  • Intravenous antibiotic therapy
  • Surgical intervention

    • Which radiographic technique involves naso-enteric intubation for delivering contrast media to the small bowel?

  • Magnetic resonance imaging
  • Computed tomography with oral contrast
  • Enteroclysis (correct)
  • Ultrasound imaging

    • In cases of low-grade obstruction, which diagnostic technique may provide useful information?

  • Enteroclysis (correct)
  • CT with oral contrast
  • Colonoscopy
  • Traditional x-ray

    • Which of the following is NOT a medical management measure performed in acute intestinal obstruction?

    <p>Oral intake encouragement</p> Signup and view all the answers

    What is the difference in treatment between bowel rest and surgical intervention in intestinal obstruction?

    <p>Bowel rest is a temporary measure while surgery is a definitive solution</p> Signup and view all the answers

    What is the primary mechanism that leads to an acute intestinal obstruction?

    <p>Forward flow of intestinal contents is interrupted by a mechanical cause</p> Signup and view all the answers

    What is the most common cause of acute intestinal obstruction?

    <p>Adhesions</p> Signup and view all the answers

    What type of bowel obstruction is primarily associated with adhesions?

    <p>Small bowel obstruction</p> Signup and view all the answers

    Which type of obstruction is commonly seen with neoplasms?

    <p>Large bowel obstruction</p> Signup and view all the answers

    What is a significant acid-base disturbance associated with intestinal obstruction due to emesis?

    <p>Metabolic alkalosis</p> Signup and view all the answers

    What imaging modality is recommended for the initial evaluation of intestinal obstruction in high suspicion cases?

    <p>CT scan</p> Signup and view all the answers

    How does dehydration from intestinal obstruction relate to metabolic alkalosis?

    <p>It causes increased chloride loss and bicarbonate retention</p> Signup and view all the answers

    What are the hallmark symptoms of intestinal obstruction?

    <p>Colicky abdominal pain, nausea, vomiting, abdominal distension, and cessation of flatus</p> Signup and view all the answers

    What mechanism primarily leads to dehydration in cases of acute intestinal obstruction?

    <p>Fluid loss from emesis</p> Signup and view all the answers

    Which pattern of obstruction is characterized by gas and/or fluid passing beyond the obstruction point?

    <p>Low grade (incomplete) intestinal obstruction</p> Signup and view all the answers

    What is the underlying reason for significant dehydration leading to metabolic alkalosis in intestinal obstruction?

    <p>Stimulation of renal proximal tubule reabsorption of bicarbonate</p> Signup and view all the answers

    What complication is associated with closed-loop intestinal obstruction?

    <p>Surgical emergency</p> Signup and view all the answers

    Which symptom is NOT typically identified as a hallmark of intestinal obstruction?

    <p>Persistent diarrhea</p> Signup and view all the answers

    Where does dehydration secondary to bowel wall edema primarily affect absorption?

    <p>Small intestine</p> Signup and view all the answers

    What is the common pathologic effect of acute intestinal obstruction related to electrolyte balance?

    <p>Fluid and electrolyte imbalances</p> Signup and view all the answers

    Which imaging method is preferred for assessing patients suspected of intestinal obstruction?

    <p>CT scan</p> Signup and view all the answers

    Which of the following statements best describes bowel rest in the context of treating intestinal obstruction?

    <p>Bowel rest involves complete avoidance of all oral intake.</p> Signup and view all the answers

    What role does intravenous fluid resuscitation play in managing intestinal obstruction in clinically stable patients?

    <p>It helps in maintaining hydration and electrolyte balance.</p> Signup and view all the answers

    Enteroclysis is indicated for which of the following conditions?

    <p>Assessing low-grade obstruction that is difficult to diagnose.</p> Signup and view all the answers

    Which treatment is considered the hallmark for managing intestinal obstruction?

    <p>Bowel rest followed by tube decompression.</p> Signup and view all the answers

    What is the primary effect of nasogastric intubation in the management of acute intestinal obstruction?

    <p>It relieves pressure and decompresses the obstructed bowel.</p> Signup and view all the answers

    Study Notes

    Acute Intestinal Obstruction

    • Occurs when forward flow of intestinal contents is interrupted or impaired by a mechanical cause.

    Common Causes

    • Adhesions: Most prevalent cause leading to small bowel obstructions.
    • Neoplasms: Typically causes obstruction in the large bowel.
    • Herniation: Another significant cause of obstruction.

    Pathological Effects

    • Results in fluid and electrolyte imbalances.
    • Can lead to dehydration due to:
      • Fluid loss from vomiting (emesis).
      • Edema of the bowel wall.
      • Reduced absorptive capacity.

    Acid-Base Disturbance

    • Metabolic alkalosis is often caused by vomiting associated with intestinal obstruction.
    • Dehydration stimulates proximal renal tubule to reabsorb bicarbonate while losing chloride, perpetuating metabolic alkalosis.

    Types of Obstruction

    • Low-grade or incomplete intestinal obstruction allows some gas and/or fluid to pass beyond the obstruction.

    Clinical Manifestations

    • Hallmarks include colicky abdominal pain, nausea, vomiting, abdominal distension, and cessation of flatus and bowel movements.

    Diagnostic Procedures

    • Initial Imaging Modality: CT scan recommended for high suspicion of intestinal obstruction.
    • Enterography: Uses larger volumes of contrast media before conducting CT or MRI.
    • Abdominal Radiography: Appropriate initial examination for suspected obstruction.
    • CT with Contrast: Diagnostic choice for confirming intestinal obstruction.
    • Enteroclysis: Technique requiring naso-enteric intubation to rapidly distend the entire small bowel, useful for low-grade obstruction diagnostic challenges.

    Treatment Approach

    • Surgical Emergency: Closed-loop obstructions must be treated as surgical emergencies.
    • Clinically Stable Patients: Managed with bowel rest, tube decompression, and intravenous fluid resuscitation.
    • Medical Management: Involves IV isotonic fluids (restrict oral intake) and nasogastric intubation for decompression.
    • Hallmark Treatment: Focus on bowel rest and decompression to alleviate obstruction effects.

    Acute Intestinal Obstruction

    • Occurs when forward flow of intestinal contents is interrupted or impaired by a mechanical cause.

    Common Causes

    • Adhesions: Most prevalent cause leading to small bowel obstructions.
    • Neoplasms: Typically causes obstruction in the large bowel.
    • Herniation: Another significant cause of obstruction.

    Pathological Effects

    • Results in fluid and electrolyte imbalances.
    • Can lead to dehydration due to:
      • Fluid loss from vomiting (emesis).
      • Edema of the bowel wall.
      • Reduced absorptive capacity.

    Acid-Base Disturbance

    • Metabolic alkalosis is often caused by vomiting associated with intestinal obstruction.
    • Dehydration stimulates proximal renal tubule to reabsorb bicarbonate while losing chloride, perpetuating metabolic alkalosis.

    Types of Obstruction

    • Low-grade or incomplete intestinal obstruction allows some gas and/or fluid to pass beyond the obstruction.

    Clinical Manifestations

    • Hallmarks include colicky abdominal pain, nausea, vomiting, abdominal distension, and cessation of flatus and bowel movements.

    Diagnostic Procedures

    • Initial Imaging Modality: CT scan recommended for high suspicion of intestinal obstruction.
    • Enterography: Uses larger volumes of contrast media before conducting CT or MRI.
    • Abdominal Radiography: Appropriate initial examination for suspected obstruction.
    • CT with Contrast: Diagnostic choice for confirming intestinal obstruction.
    • Enteroclysis: Technique requiring naso-enteric intubation to rapidly distend the entire small bowel, useful for low-grade obstruction diagnostic challenges.

    Treatment Approach

    • Surgical Emergency: Closed-loop obstructions must be treated as surgical emergencies.
    • Clinically Stable Patients: Managed with bowel rest, tube decompression, and intravenous fluid resuscitation.
    • Medical Management: Involves IV isotonic fluids (restrict oral intake) and nasogastric intubation for decompression.
    • Hallmark Treatment: Focus on bowel rest and decompression to alleviate obstruction effects.

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    Description

    This quiz covers the key concepts surrounding acute intestinal obstruction, including its causes, types, and pathologic effects. It addresses common causes such as adhesions, neoplasms, and herniation, and their impact on both small and large bowel obstructions. Test your knowledge and understanding of this critical medical condition.

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