Bowel Obstruction and Complications Quiz
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Questions and Answers

What happens to absorption and lymphatic drainage when intraluminal pressure exceeds capillary and venous pressure in the bowel wall?

  • They decrease (correct)
  • They fluctuate unpredictably
  • They are unaffected
  • They increase significantly

What is a potential consequence of bacteria entering the bloodstream due to bowel ischemia?

  • Enhanced lymphatic drainage
  • Increased peristaltic waves
  • Development of septicaemia (correct)
  • Rapid absorption of nutrients

Which type of obstruction allows for the most rapid sequence of complications?

  • Ileus
  • Partial obstruction
  • Non-mechanical obstruction
  • Closed-loop obstruction (correct)

Which clinical feature is most indicative of peritonitis in patients with bowel obstruction?

<p>Severe abdominal tenderness (A)</p> Signup and view all the answers

What type of bowel sounds are typically produced in cases of mechanical obstruction?

<p>Active, high-pitched sounds with rushes (C)</p> Signup and view all the answers

What is the risk associated with allowing bowel obstruction to progress significantly?

<p>Mortality approaching 70 percent (A)</p> Signup and view all the answers

What symptom is common in both elderly and younger patients with intestinal obstruction?

<p>Abdominal pain (A)</p> Signup and view all the answers

What indicates that a patient may be suffering from an adynamic ileus?

<p>Diminished or absent bowel sounds (D)</p> Signup and view all the answers

What type of bowel obstruction pain is often described as crampy and intermittent?

<p>Mechanical SBO (D)</p> Signup and view all the answers

Which condition is more likely to cause large bowel obstruction in elderly patients?

<p>Carcinomas (B)</p> Signup and view all the answers

What symptom is associated with adynamic ileus?

<p>Episodic pain lasting minutes (D)</p> Signup and view all the answers

What should be examined in patients with abdominal pain or distension?

<p>Signs of organomegaly or masses (A)</p> Signup and view all the answers

Which treatment measure is typically effective in managing adynamic ileus?

<p>Intravenous hydration and decompression (C)</p> Signup and view all the answers

What finding has been reported as a reliable sign of sigmoid volvulus?

<p>Emptiness of the left iliac fossa (D)</p> Signup and view all the answers

What should be discontinued in patients with bowel obstruction?

<p>Medications that inhibit bowel mobility (D)</p> Signup and view all the answers

Which of the following is commonly used to distinguish bowel obstruction from ileus?

<p>CT contrast radiography (C)</p> Signup and view all the answers

What is the most common cause of small bowel obstruction following abdominal surgery?

<p>Adhesions (A)</p> Signup and view all the answers

Which factor is a common cause of mechanical obstruction in the intestines?

<p>Intrinsic or extrinsic factors (A)</p> Signup and view all the answers

What is adynamic ileus primarily characterized by?

<p>Self-limiting disorder (A)</p> Signup and view all the answers

Which condition is most likely to present as small bowel obstruction due to intussusception?

<p>Lymphomas (A)</p> Signup and view all the answers

What are bezoars most commonly composed of?

<p>Vegetable matter or pulp from persimmons (D)</p> Signup and view all the answers

In patients who have undergone radiation therapy, which condition is a possible cause of small bowel obstruction?

<p>Radiation enteritis (D)</p> Signup and view all the answers

What is the second most common cause of small bowel obstruction?

<p>Incarceration of a groin hernia (A)</p> Signup and view all the answers

Colonic obstruction is almost never caused by which factor?

<p>Hernias (C)</p> Signup and view all the answers

What is the most common cause of large bowel obstruction (LBO)?

<p>Neoplasms (B)</p> Signup and view all the answers

Which of the following hernias are more readily apparent and can occur in any age group?

<p>Umbilical hernias (B)</p> Signup and view all the answers

Which patient demographic is particularly susceptible to femoral or medial thigh pain from hernias?

<p>Elderly females (C)</p> Signup and view all the answers

After cancer and diverticulitis, what is the next most frequent cause of large bowel obstruction?

<p>Sigmoid volvulus (B)</p> Signup and view all the answers

In which situation can gallstone ileus occur?

<p>When a gallstone erodes from the bowel (A)</p> Signup and view all the answers

Which type of obstruction is most often seen in elderly, bedridden, or psychiatric patients taking anticholinergic medication?

<p>Mechanical obstruction (A)</p> Signup and view all the answers

Which condition may precede the development of sigmoid volvulus?

<p>History of constipation (C)</p> Signup and view all the answers

Which type of primary small bowel lesion is considered unusual for causing intraluminal obstruction?

<p>Celiac disease (D)</p> Signup and view all the answers

What is the role of a pelvic examination in diagnosing bowel obstruction?

<p>To rule out gynecologic pathology (D)</p> Signup and view all the answers

What condition may mimic bowel obstruction and is often characterized by the presence of gas in the intestines?

<p>Intestinal pseudo-obstruction (A)</p> Signup and view all the answers

What indicates a need for surgical intervention in cases of bowel obstruction?

<p>Confirmed mechanical obstruction (D)</p> Signup and view all the answers

Why is the use of barium studies avoided in patients suspected of having bowel obstruction?

<p>Patients may be unable to evacuate the barium (A)</p> Signup and view all the answers

What treatment should be considered for decompression of intestinal pseudo-obstruction?

<p>Colonoscopy (D)</p> Signup and view all the answers

What preparation is recommended prior to surgical intervention for bowel obstruction?

<p>Insertion of a nasogastric tube (C)</p> Signup and view all the answers

What is a common characteristic of bowel obstruction seen on radiographs?

<p>Dilated colon with sepata and haustral markings (B)</p> Signup and view all the answers

Which medication type may decrease bowel motility and potentially contribute to obstructions?

<p>Anticholinergics and Tricyclic antidepressants (D)</p> Signup and view all the answers

What is typically the nature of vomitus in proximal bowel obstruction?

<p>Bilious (A)</p> Signup and view all the answers

Which symptom is associated with complete bowel obstruction?

<p>Vomiting (C)</p> Signup and view all the answers

In distal ileal obstruction, what is the characteristic nature of the vomitus?

<p>Feculent (A)</p> Signup and view all the answers

What leads to volume depletion in bowel obstruction cases?

<p>Decreased absorption and vomiting (B)</p> Signup and view all the answers

Which clinical finding is NOT characteristic of bowel obstruction?

<p>Regular bowel movements (A)</p> Signup and view all the answers

What is one consequence of untreated bowel obstruction?

<p>Renal failure (D)</p> Signup and view all the answers

Which of the following findings can increase in bowel obstruction?

<p>Intramural pressure (A)</p> Signup and view all the answers

How does partial bowel obstruction differ from complete obstruction regarding stool passage?

<p>Stool may be passed regularly in partial obstruction (B)</p> Signup and view all the answers

Flashcards

Intestinal Obstruction

A condition where the intestines are blocked, preventing the normal passage of food and waste. This can be caused by physical blockages or a lack of intestinal movement.

Adynamic Ileus

A common type of intestinal obstruction where the gut muscles stop working effectively, leading to a temporary standstill in food and waste transit.

Mechanical Obstruction

Intestinal obstruction caused by a physical barrier, such as adhesions, hernias, or tumors, blocking the passage of food or waste.

Adhesions

Scar tissue that forms after surgery or an injury, potentially causing intestinal obstruction.

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Intussusception

A common cause of small bowel obstruction where a section of the bowel telescopes into itself, creating a blockage.

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Bezoars

Hard, indigestible masses that can form in the stomach or intestines, often from consuming large amounts of certain foods.

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Inflammatory Bowel Disease (IBD)

Inflammation of the intestines that can cause narrowing and blockage.

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Radiation Enteritis

Damage to the intestines caused by exposure to radiation, possibly leading to obstruction.

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What is bowel distension?

The build-up of fluids, gas, and food in the intestines due to a blockage.

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What is intraluminal pressure?

Increased pressure inside the intestines caused by the buildup of fluids and gas.

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What is the role of peristalsis in bowel obstruction?

Intestinal muscles contract forcefully to try and move the blockage along, causing pain.

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What is bilious vomiting?

Vomiting that contains bile, indicative of a blockage in the upper part of the digestive system.

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What is feculent vomiting?

Vomiting that contains feces, indicating a blockage in the lower part of the digestive system.

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What is the relationship between bowel obstruction and flatus?

The inability to pass gas, often a key symptom of bowel obstruction.

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How can a partial bowel obstruction differ from a complete obstruction?

The passage of feces and flatus can occur in a partial bowel obstruction, while complete obstruction blocks all movement.

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What factors influence physical findings in bowel obstruction?

The site, duration, and cause of the obstruction contribute to the physical symptoms.

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Bowel Obstruction (SBO)

A blockage in the intestines that prevents the normal flow of food and waste.

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Intraluminal pressure exceeds capillary and venous pressure

When the pressure inside the bowel surpasses the pressure in the blood vessels surrounding it, hindering absorption and lymphatic drainage.

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Closed-loop obstruction

This occurs when there's no way for bowel contents to pass through the obstruction, leading to a buildup of pressure and potential complications.

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Hernia

A bulge or protrusion in the intestinal wall, often caused by a weakness in the abdominal muscles.

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High-pitched bowel sounds

The characteristic sound of bowel sounds, indicating active peristalsis, often heard with mechanical bowel obstruction.

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Abdominal distension

This condition is often accompanied by distension (swelling) of the abdomen, indicating a build-up of fluids and gas.

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Carcinomas (Cancer)

Most likely cause of Large Bowel Obstruction (LBO) in older adults due to increased risk of cancer with age.

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Pain of Mechanical SBO

Characterized by crampy, intermittent pain that usually lasts only a few minutes. It may be located around the belly button (periumbilical) or spread out (diffuse).

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Rebound tenderness

Pain that feels worse when pressure is released, often a sign of inflammation or peritonitis.

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Pain of Adynamic Ileus

Pain is typically more constant and dull, and often associated with nausea and vomiting.

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Peritonitis

Severe inflammation within the abdominal cavity, often a complication of bowel obstruction, requiring urgent medical attention.

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Absent Rectal Contents

The inability to pass stool or gas, even though the rectum is empty, could indicate a higher blockage in the bowels, but does not rule out a more proximal obstruction.

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Pessary and Bowel Obstruction

When a pelvic exam reveals a device in the vagina, such as a pessary, it can exert pressure on the colon, causing obstruction.

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Intestinal Pseudo-obstruction (Ogilvie Syndrome)

This syndrome mimics a bowel obstruction but is caused by a lack of normal gut movement, not a physical blockage. The colon becomes distended with gas, but little fluid, making it seem like a blockage.

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Surgical Intervention for Obstruction

If a mechanical obstruction is diagnosed, surgical intervention is often the course of action.

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Nasogastric Tube

Before surgery, a nasogastric tube is inserted to remove excess stomach contents and gas.

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Intravenous Fluids

Due to decreased absorption and fluid loss, intravenous fluids are essential to maintain hydration.

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Vital Signs Monitoring

Monitoring vital signs like blood pressure, heart rate and urine output can help assess the patient's condition before surgery.

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Colonoscopy for Pseudo-Obstruction

Colonoscopy is preferred over barium studies as an early intervention for pseudo-obstruction. It helps rule out true obstruction, identify lesions, and decompress the colon if needed.

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Study Notes

Intestinal Obstruction

  • Intestinal obstruction is the inability of the intestinal tract to allow normal food and bowel passage.
  • This can be mechanical (obstruction) or adynamic (paralytic).
  • Adynamic ileus is usually self-limiting and doesn't need surgery.
  • Mechanical obstruction requires intervention to identify and treat the cause, minimizing complications.

Small Bowel Obstruction (SBO)

  • Common causes: Adhesions (following surgery), incarcerated groin hernias (in infants and adults), hernias at umbilicus, femoral, or obturator foramens.
  • Umbilical hernias are more easily identifiable and can occur in any age group.
  • Less common causes: small bowel lesions (polyps, lymphoma, adenocarcinoma), gallstone ileus (gallstone in bowel), bezoars (vegetable matter or pulp), inflammatory bowel disease, infectious processes, and radiation enteritis.

Large Bowel Obstruction (LBO)

  • Common cause: Neoplasms (tumors).
  • Other causes: diverticulitis, stricture formation due to inflammation and scarring, fecal impaction (common in elderly), sigmoid volvulus (common in elderly, bedridden, or psychiatric patients taking anticholinergics), and cecal volvulus (higher incidence in pregnant patients).

Pathophysiology

  • Normal bowel contains gas, secretions, and food.
  • Obstruction leads to congestion, impaired absorption, vomiting, decreased oral intake, and fluid/electrolyte imbalance, possibly leading to renal failure or shock.
  • Distension occurs due to fluid and air build-up.
  • Severe obstruction causes ischemia (lack of blood flow) resulting in bowel necrosis and the possibility of sepsis.

Clinical Features

  • Pain: Crampy and intermittent in proximal SBO; often more intense and constant in distal SBO.
  • Vomiting: Bilious in proximal SBO, feculent (containing digested matter) in distal SBO or LBO.
  • Inability to pass stool or flatus: Indicates possible obstruction, but constipation could have other causes.
  • Physical findings: Usually abdominal tenderness (potentially severe or localized), distension. Distension is often more noticeable with LBO.
  • Elderly patients with obstruction may exhibit various symptoms

Treatment

  • Mechanical obstruction: Often requires surgery.
  • Nasogastric tube: To remove contents, improve symptoms, and reduce distention.
  • Intravenous fluids: To correct fluid and electrolyte imbalances
  • Broad-spectrum antibiotics: Reduce risk of infection.
  • Conservative measures (adynamic ileus): IV fluids, nasogastric suction, and observation.
  • Surgery is typically considered for patients with mechanical obstruction, potentially including endoscopic interventions or surgical procedures to remove the obstruction.

Pseudo-obstruction (Ogilvie syndrome)

  • Mimics bowel obstruction, but is functional, not mechanical
  • Characterized by significant colonic dilation, which is highlighted in radiographic images.

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Bowel Obstruction PDF

Description

Test your knowledge on the physiological effects and clinical features associated with bowel obstruction. This quiz covers topics such as absorption, lymphatic drainage, and complications arising from different types of obstructions. Assess your understanding of how bowel ischemia can lead to severe health issues.

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