Bowel Obstruction Overview
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Questions and Answers

A patient presents with symptoms of a bowel obstruction, but imaging reveals no physical blockage. Which of the following conditions might be the cause?

  • Intussusception
  • Strangulated hernia
  • Pseudo-obstruction (correct)
  • Surgical adhesions

    • What is the primary difference between a simple bowel obstruction and a strangulated bowel obstruction?

  • Simple obstructions have an intact blood supply, while strangulated obstructions do not. (correct)
  • Simple obstructions resolve with conservative treatment; strangulated require immediate surgery.
  • Simple obstructions are always partial, while strangulated are always complete.
  • Simple obstructions occur in the small intestine, while strangulated occur in the large intestine.

    • Which of the following is the most common cause of a small bowel obstruction?

  • Diverticular disease
  • Malignant tumor
  • Volvulus
  • Surgical adhesions (correct)

    • A patient develops a paralytic ileus post-operatively. What is the underlying mechanism of this nonmechanical obstruction?

    <p>Reduced or absent peristalsis due to altered neuromuscular transmission (A)</p> Signup and view all the answers

    A patient with a history of Crohn's disease is admitted with signs of a bowel obstruction. Where is the most likely location of this obstruction because of this condition?

    <p>Either the small or large intestine (A)</p> Signup and view all the answers

    What is the primary cause of a vascular bowel obstruction?

    <p>Interference with the blood supply to the intestines (B)</p> Signup and view all the answers

    Which electrolyte imbalance is most commonly associated with the development of a paralytic ileus?

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

    Following bariatric surgery, a patient develops a bowel obstruction. What type of mechanical obstruction is most likely?

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

    A complete bowel obstruction is different from a partial bowel obstruction in that...

    <p>A complete obstruction totally occludes the lumen and partial does not (C)</p> Signup and view all the answers

    What is the most common cause of a large bowel obstruction?

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

    Which condition is NOT typically associated with the formation of emboli?

    <p>Normal sinus rhythm (C)</p> Signup and view all the answers

    What is the primary initial consequence of intestinal distention in the context of a bowel obstruction?

    <p>Stimulation of intestinal secretions (B)</p> Signup and view all the answers

    If bowel obstruction leads to impaired blood flow, what is the most dangerous potential outcome, before complete necrosis?

    <p>Intestinal strangulation or infarction (D)</p> Signup and view all the answers

    Which is characteristics is unique of small bowel obstruction (SBO)?

    <p>Sudden onset of abdominal pain (B)</p> Signup and view all the answers

    In a high obstruction, such as in the upper duodenum, what acid-base imbalance is most likely to occur?

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

    Which diagnostic finding is most indicative of bowel strangulation or perforation?

    <p>Elevated white blood cell count (C)</p> Signup and view all the answers

    Which treatment method is NOT typically employed for resolving a bowel obstruction?

    <p>Administration of pro-motility agents (B)</p> Signup and view all the answers

    What physical assessment finding is most indicative of dehydration and sepsis in a patient with a bowel obstruction?

    <p>Tachycardia, dry mucous membranes, and hypotension (B)</p> Signup and view all the answers

    What is the correct order of events of SBO, from initial symptoms to the development of necrosis?

    <p>Distention, increased capillary permeability, decreased blood flow, muscle fatigue, necrosis. (A)</p> Signup and view all the answers

    In the context of a bowel obstruction, what is the primary concern that guides nursing care for a patient?

    <p>Preventing fluid imbalances and early recognition of deterioration (C)</p> Signup and view all the answers

    When assessing a patient with a suspected bowel obstruction, which of these findings would necessitate immediate notification of the healthcare provider?

    <p>Decreased urine output and changes in bowel sounds (D)</p> Signup and view all the answers

    A patient with a suspected high bowel obstruction is likely to exhibit which acid-base imbalance?

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

    Which parameter is most crucial for hourly monitoring in a patient with a bowel obstruction to detect inadequate vascular volume and potential kidney injury?

    <p>Hourly urine output (B)</p> Signup and view all the answers

    When documenting a patient's vomitus, which of the following elements should be included?

    <p>Color, odor, and amount (A)</p> Signup and view all the answers

    In patients with suspected bowel obstruction, what is the primary focus of nursing care?

    <p>Promoting comfort, fluid balance, and electrolyte balance (D)</p> Signup and view all the answers

    Besides decreased urine output, which laboratory findings would indicate acute kidney injury in a patient with a bowel obstruction?

    <p>Rising serum creatinine and BUN levels (D)</p> Signup and view all the answers

    What is indicated by the presence of muscle guarding and rebound pain upon abdominal assessment?

    <p>Signs of peritoneal irritation (B)</p> Signup and view all the answers

    What is the primary goal for a patient with a bowel obstruction?

    <p>Relief of the obstruction with minimal discomfort (C)</p> Signup and view all the answers

    What is the patient with a low bowel obstruction more likely to develop?

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

    What should be recorded in a patient with an obstruction and an inserted urinary catheter?

    <p>Urine output hourly (C)</p> Signup and view all the answers

    Flashcards

    Emboli

    Emboli are obstructions in blood vessels that may originate from thrombi due to conditions like atrial fibrillation.

    Thrombi

    Thrombi are blood clots that form in a blood vessel and can lead to emboli if dislodged.

    Intestinal obstruction

    A blockage in the small or large intestine preventing normal passage of contents.

    Hallmark symptoms of obstruction

    The four hallmark symptoms of intestinal obstruction are abdominal pain, nausea, vomiting, and distension.

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    Colicky abdominal pain

    Sharp, intermittent pain often seen in small bowel obstructions, indicating obstruction severity.

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    Proximal obstruction vomiting

    In proximal obstructions, vomiting is rapid, may be projectile, and often contains bile.

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    Metabolic alkalosis

    A condition that can occur from high obstructions due to loss of HCl from vomiting.

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    Diagnostic imaging studies

    Tests like x-rays and CT scans used to locate and assess the severity of an obstruction.

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    Surgical management of obstruction

    Intervention may include resection of obstructed segments, stenting, or non-surgical methods like colonoscopy.

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    Fluid and electrolyte management

    Critical care focus in bowel obstruction to prevent imbalances and shock during assessment.

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    Bowel Obstruction

    A blockage preventing intestinal contents from passing through the GI tract.

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    Partial Obstruction

    An obstruction that allows some fluid and gas to pass through.

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    Complete Obstruction

    An obstruction that totally occludes the intestinal lumen.

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    Mechanical Obstruction

    Obstruction caused by a physical blockage in the intestinal lumen.

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    Nonmechanical Obstruction

    Obstruction due to reduced or absent peristalsis.

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    Paralytic Ileus

    Lack of intestinal peristalsis and bowel sounds.

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    Pseudo-obstruction

    Symptoms of obstruction with no visible cause on imaging.

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    Strangulated Obstruction

    An obstruction with a compromised blood supply.

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    Common Cause of SBO

    Surgical adhesions are the leading cause of small bowel obstruction.

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    Vascular Obstruction

    Obstruction resulting from compromised blood supply to intestines.

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    Abdominal Assessment

    A process of evaluating the abdomen's condition by inspecting, auscultating, and palpating.

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    Bowel Sounds

    The noises produced by the movement of the intestines, indicating gastrointestinal activity.

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    Peritoneal Irritation

    Indications of inflammation of the peritoneum, such as muscle guarding or rebound tenderness.

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    Fluid Imbalance

    A condition where the body's fluids are not at normal levels, leading to complications.

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    Urine Output Monitoring

    Tracking the volume of urine produced to assess kidney function and hydration status.

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    Metabolic Acidosis

    A condition characterized by a decrease in blood pH, often seen in low obstructions.

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    Intake and Output Record

    A documentation of all fluids taken in and excreted by the patient.

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    Vital Signs Changes

    Observations of the patient's heart rate, blood pressure, temperature, and respiratory rate.

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    Abdominal Girth Measurement

    The measurement around the abdomen to assess swelling or distention.

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    Study Notes

    Bowel Obstruction

    • Bowel obstruction (intestinal obstruction) is a condition where intestinal contents cannot pass through the gastrointestinal tract. It can be partial or complete, and affect the small intestine (SBO) or large intestine (LBO).
    • Partial obstructions allow some fluid and gas to pass, usually resolving with non-surgical treatment.
    • Complete obstructions totally block the lumen, generally requiring surgery.
    • Simple obstructions have an intact blood supply, whereas strangulated obstructions do not.

    Types of Bowel Obstruction

    • Mechanical obstruction results from a physical blockage in the intestinal lumen.
      • Surgical adhesions are the most common cause of small bowel obstruction (SBO).
      • Other causes of SBO include hernias, cancers, strictures (e.g., Crohn's disease), and intussusception (following bariatric surgery).
      • Colorectal cancer (CRC) is the most common cause of Large Bowel Obstructions (LBO), followed by diverticular disease.
      • Other causes include adhesions, ischemia, volvulus, and Crohn's disease.
    • Nonmechanical obstruction results from decreased or absent peristalsis due to altered neuromuscular transmission.
      • Paralytic ileus (lack of intestinal peristalsis and bowel sounds) is the most common type, often occurring after abdominal surgery.
      • Other causes include peritonitis, inflammatory responses (e.g., pancreatitis, appendicitis), electrolyte imbalances (e.g., hypokalemia), and spinal fractures.
      • Pseudo-obstruction mimics a mechanical obstruction, but no cause is identified through imaging. It can be associated with various conditions (neurologic, medication related, endocrine/metabolic, lung, trauma or burn).
    • Vascular obstruction is rare, caused by impaired blood flow to the intestines, most often from emboli or atherosclerosis of the mesenteric arteries.

    Etiology and Pathophysiology

    • Fluid (about 6-8 liters daily) and gas (mostly swallowed air) accumulate proximal to the obstruction.
    • This distention reduces fluid absorption and stimulates secretions, leading to fluid and electrolyte imbalances (extravasation into peritoneal cavity).
    • Bowel muscle fatigue and cessation of peristalsis happen.
    • Reduced circulating blood volume leads to hypotension and hypovolemic shock; ischia, necrosis, perforation, edema, cyanosis, and gangrene can occur if blood flow is insufficient.

    Clinical Manifestations

    • Four hallmark manifestations: abdominal pain, nausea and vomiting, distension, and constipation. Symptoms vary by cause, location, and type.
    • Small bowel obstruction (SBO) pain is often sudden, colicky (4-5 minutes apart for proximal, less frequent for distal), and accompanied by rapid/projectile bile-containing vomiting which can provide temporary relief from pain, progressing to increasingly fecal and foul-smelling.
    • Bowel sounds above the obstruction may be high-pitched.
    • Large bowel obstruction (LBO) pain is persistent and cramping, with abdominal distension, obstipation (or significant change in bowel habits), and lack of flatus; bowel sounds are usually present and progressively decrease.
    • Strangulation causes severe, constant, rapidly onset pain. Signs of both include abdominal tenderness, rigidity and the patient may appear acutely ill, with signs of dehydration, tachycardia, dry mucous membranes, and hypotension; fever may occur.

    Diagnostic Studies

    • Thorough history & physical examination.
    • Imaging (abdominal x-rays, CT scan, contrast enema, sigmoidoscopy/colonoscopy) to identify and guide surgical decisions.
    • Blood tests (CBC, blood chemistries) to assess for dehydration, strangulation, perforation (high WBC), bleeding, hemoconcentration (increased hematocrit), serum electrolyte levels (BUN, creatinine) and acid-base imbalances.

    Interprofessional Care

    • Treatment aims to restore intestinal patency.
    • Emergency surgery may be needed for strangulation or perforation.
    • Possible conservative approaches depending on the cause, such as NG tube for decompression, nutritional support if needed (parenteral nutrition – PN)
    • Stents (via endoscopic/fluoroscopic procedures) can be used for palliative treatment or a "bridge to surgery".
    • Corticosteroids may be used for decreasing edema and inflammation.
    • Surgery options include resection and anastomosis, or colectomy/colostomy/ileostomy for extensive obstruction or necrosis.

    Nursing Management: Bowel Obstruction

    • Assessment:

      • Detailed history and physical exam focusing on pain (location, duration, intensity, frequency, restlessness, position changes), vomiting (onset, frequency, color, odor), bowel sounds, abdominal distension/tenderness/rigidity, and patient's vital signs.

    • Monitoring: strict intake and output, hourly urine output (less than 0.5 mL/kg/hour is significant), laboratory and arterial blood gas values (metabolic acidosis/alkalosis, electrolytes as relevant), signs of deterioration (hypovolemic shock, sepsis).

    • Planning: Patient goals include relief of obstruction, minimal pain, and normalized fluid/electrolyte/acid-base balance.

    • Implementation: comfort measures and fluid/electrolyte balance management postoperatively (per general laparotomy care principles).

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    Description

    Explore the key concepts of bowel obstructions, including types, causes, and treatments. Understand the differences between partial and complete obstructions, as well as mechanical and strangulated conditions. This quiz covers important aspects of gastrointestinal health.

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