Gastroenterology Bowel Obstruction Quiz
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Questions and Answers

Which of the following is NOT a cause of a mechanical bowel obstruction?

  • Hernia
  • Cancer
  • Peritonitis (correct)
  • Surgical adhesions

    • What is the most common cause of a small bowel obstruction (SBO)?

  • Hernia
  • Surgical adhesions (correct)
  • Crohn's disease
  • Intussusception

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

  • Crohn's disease
  • Volvulus
  • Diverticular disease
  • Colorectal cancer (CRC) (correct)

    • A bowel obstruction that completely blocks the intestinal lumen is known as?

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

    A patient presents with symptoms of bowel obstruction but imaging reveals no physical obstruction. This scenario is likely due to?

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

    Which of the following is NOT a common cause of paralytic ileus?

    <p>Atherosclerosis of the mesenteric arteries (D)</p> Signup and view all the answers

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

    <p>Presence or absence of blood supply (D)</p> Signup and view all the answers

    Which of the following conditions can contribute to non-mechanical bowel obstruction?

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

    What is the usual first symptom of a bowel obstruction?

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

    Which of the following is NOT a condition that can lead to venous thrombosis?

    <p>Diseased heart valves (A)</p> Signup and view all the answers

    What is the primary reason for bowel distention in a bowel obstruction?

    <p>Accumulation of fluid, gas, and intestinal contents (A)</p> Signup and view all the answers

    How does vomiting typically affect abdominal pain in a patient with a high bowel obstruction?

    <p>Provides temporary relief (B)</p> Signup and view all the answers

    What is the main concern regarding a bowel obstruction in terms of potential complications?

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

    Which of the following is a potential sign of bowel strangulation?

    <p>Severe, constant pain (B)</p> Signup and view all the answers

    What is the primary goal of treatment in a patient with a bowel obstruction?

    <p>Restore intestinal patency (B)</p> Signup and view all the answers

    What imaging technique is commonly used to identify a bowel obstruction and guide surgical decisions?

    <p>Abdominal x-ray (B)</p> Signup and view all the answers

    Which of the following is NOT a potential treatment strategy for a bowel obstruction?

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

    A patient with a high small bowel obstruction is most likely to experience which type of acid-base imbalance?

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

    In a patient with a bowel obstruction, monitoring serum electrolytes, BUN, and creatinine is primarily done to assess?

    <p>The extent of fluid and electrolyte imbalances (A)</p> Signup and view all the answers

    In cases of a strangulated bowel obstruction, surgical intervention is typically required for?

    <p>Relief of the obstruction and removal of the necrotic bowel segment (B)</p> Signup and view all the answers

    Which of the following is NOT a potential complication of a bowel obstruction?

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

    What is the primary role of a nurse in managing a patient with a bowel obstruction?

    <p>Assessing the patient's condition and monitoring vital signs (C)</p> Signup and view all the answers

    Which of these is a characteristic of vomiting in a patient with a proximal bowel obstruction?

    <p>Projectile and containing bile (A)</p> Signup and view all the answers

    Which of these is MOST LIKELY to cause bowel obstruction?

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

    What is the primary focus of care for a patient with an intestinal obstruction?

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

    Which of the following is NOT a clinical problem associated with intestinal obstruction?

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

    What is the significance of monitoring urine output in a patient with an intestinal obstruction?

    <p>To detect potential for acute kidney injury (A)</p> Signup and view all the answers

    Which of the following laboratory values would indicate potential acute kidney injury in a patient with an intestinal obstruction?

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

    What is the expected acid-base status of a patient with a high intestinal obstruction?

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

    Which of the following is NOT a nursing intervention to promote comfort in a patient with intestinal obstruction?

    <p>Restricting fluid intake (D)</p> Signup and view all the answers

    What is the primary goal of nursing care for a patient after surgery for an intestinal obstruction?

    <p>Facilitating return to normal bowel function (D)</p> Signup and view all the answers

    Which of the following is NOT a sign that a patient with an intestinal obstruction is improving?

    <p>Increased abdominal distention (B)</p> Signup and view all the answers

    Flashcards

    Bowel Obstruction

    A condition where intestinal contents can't pass through the GI tract.

    Partial Obstruction

    A type of bowel obstruction allowing some fluid/gas to pass.

    Complete Obstruction

    Total blockage of the intestinal lumen requiring surgery.

    Simple Obstruction

    An obstruction with an intact blood supply.

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    Strangulated Obstruction

    An obstruction where blood supply is compromised.

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    Mechanical Obstruction

    Physical blockage of the intestinal lumen, common in SBO.

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    Nonmechanical Obstruction

    Reduced peristalsis without physical blockage; often due to neuromuscular issues.

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    Paralytic Ileus

    A common nonmechanical obstruction with lack of peristalsis and bowel sounds.

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    Abdominal Pain Assessment

    Determine location, duration, intensity, and frequency of pain.

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    Vomitus Characteristics

    Record onset, frequency, color, odor, and amount of vomitus.

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    Bowel Function Assessment

    Assess bowel function including passage of flatus and bowel sounds.

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    Peritoneal Irritation Signs

    Check for muscle guarding and rebound pain to indicate irritation.

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    Urine Output Monitoring

    Report urine output less than 0.5 mL/kg/hour as inadequate.

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    Acute Kidney Injury Indicators

    Rising serum creatinine and BUN levels indicate potential kidney injury.

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    Metabolic Alkalosis vs. Acidosis

    High obstruction leads to alkalosis, low obstruction leads to acidosis.

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    Overall Goals for Obstruction Patient

    Goals include relief of obstruction, minimal discomfort, and normal fluid status.

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    Emboli sources

    Emboli may come from thrombi due to heart issues.

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    Venous thrombosis

    Formation of a blood clot in veins, often due to low blood flow.

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    Intestinal obstruction causes

    Obstruction leads to fluid, gas, and contents buildup in bowel.

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    Emergency from obstruction

    Complications include ischemia, necrosis, and possible perforation.

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    Clinical manifestations of obstruction

    Symptoms include abdominal pain, nausea, vomiting, and distention.

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    Colicky abdominal pain

    Sharp, intermittent abdominal pain often indicates obstruction.

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    Proximal obstruction vomiting

    Vomiting is sudden and can contain bile.

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    Fecal vomiting

    Gradual onset vomiting with foul smell indicates distal obstruction.

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    Signs of large bowel obstruction

    Include abdominal distention and lack of flatus.

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    Strangulation pain

    Severe, constant pain indicating cut-off blood supply.

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    Diagnostic studies for obstruction

    Includes imaging like X-rays and CT scans to identify blockages.

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    Treatment goal for bowel obstruction

    To regain intestinal patency and resolve the blockage.

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    Non-surgical obstruction resolution

    Some obstructions may resolve without surgery, like adhesions.

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    Nursing management concerns

    Focus on fluid balance and early recognition of complications.

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    Emergency surgical intervention

    Needed for strangulated obstructions or perforations.

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    Study Notes

    Bowel Obstruction Overview

    • Bowel obstruction (intestinal obstruction) is a condition where intestinal contents cannot pass through the gastrointestinal (GI) tract. It can be partial (some passage possible) or complete (no passage), simple (intact blood supply) or strangulated (compromised blood supply).
    • Location of obstruction (small intestine or large intestine) affects symptoms and treatment.

    Types of Bowel Obstruction

    • Mechanical Obstruction: A physical blockage of the intestinal lumen.
      • Small Bowel Obstruction (SBO): Most commonly caused by surgical adhesions (scar tissue), but also hernias, cancers, Crohn's disease strictures, and intussusception after bariatric surgery.
      • Large Bowel Obstruction (LBO): Most commonly caused by colorectal cancer (CRC), followed by diverticular disease. Other causes include adhesions, ischemia, volvulus, and Crohn's disease.
    • Nonmechanical Obstruction: Reduction/absence of intestinal peristalsis (muscle contractions) due to nervous system issues.
      • Paralytic ileus: Lack of intestinal peristalsis and bowel sounds; common after abdominal surgery, also caused by peritonitis, inflammatory responses (like pancreatitis or appendicitis), electrolyte imbalances (especially hypokalemia), and spinal fractures.
      • Pseudo-obstruction: GI motility disorder mimicking a mechanical obstruction; patient has symptoms but no apparent cause.
    • Vascular Obstruction: Rare; interference with blood supply to intestines.
      • Primarily caused by emboli and atherosclerosis (hardening and narrowing) of mesenteric arteries.
        • Emboli can originate from blood clots (thrombi) in individuals with chronic atrial fibrillation, diseased heart valves, or prosthetic valves.

    Etiology and Pathophysiology

    • Daily fluid intake in small intestine ~6-8 liters. Most is absorbed, leaving 75% of gas swallowed air.
    • Obstruction causes fluid, gas, and contents to accumulate proximal to blockage.
    • Initial distention stimulates secretions, reduces absorption, and empties & collapses distal bowel.
    • Increased intraluminal pressure leads to fluid leakage, eventually causing fatigue and stopping peristalsis.
    • Fluid retention in intestines and peritoneal cavity reduces blood volume & can cause hypotension/shock.
    • Inadequate blood flow causes ischemia (reduced blood supply), necrosis (tissue death), eventual bowel perforation, and potential for dangerous conditions like strangulation, leading to infection and death.

    Clinical Manifestations

    • Hallmarks: Abdominal pain, nausea/vomiting, distention, constipation.
    • Order and severity vary based on cause, location, and obstruction type.
    • SBO: Sudden, colicky pain (4-5 min intervals), projectile, bile-containing vomiting (often temporary relief); high-pitched bowel sounds above obstruction, more gradual onset/foul-smelling vomit with distal obstruction.
    • LBO: Persistent, cramping pain, obstipation (severe constipation) or change in bowel habits, lack of flatus; bowel sounds initially present but progressively decrease in activity; vomiting is rare.
    • Strangulation: Severe, constant, rapid-onset pain.
    • General Signs: Abdominal tenderness/rigidity, acute illness appearance, dehydration, sepsis (tachycardia, dry mucous membranes, hypotension, temperature >100°F).

    Diagnostic Studies

    • Thorough history and physical assessment are crucial.
    • Imaging (abdominal X-rays, CT scans, contrast enemas) to identify obstruction and guide surgical decisions.
      • Endoscopic visualization (sigmoidoscopy/colonoscopy) helpful for LBO.
    • Blood tests (CBC, blood chemistries) assess dehydration, infection potential/strangulation, and bleeding.
      • Monitor electrolytes, BUN, creatinine, etc.

    Interprofessional Care

    • Treatment goal: restore intestinal patency.
    • Treatment depends on cause. Strangulated/perforated obstructions require emergency surgery.
    • Non-surgical options:
      • NG tube decompression
      • Parenteral nutrition (PN) for bowel rest
      • Stents to allow time for fluid/electrolyte correction before surgery.
    • Surgical options: resection (remove and reattach segments), partial/total colectomy, colostomy/ileostomy, colonoscopy to remove polyps/dilate strictures.

    Nursing Management: Bowel Obstruction

    • Assessment: Focused on patient's history (pain location, duration, intensity), changes in vomiting (onset, frequency, color), bowel function (flatus), bowel sounds, abdominal distention/tenderness.
    • Monitoring Vital signs: Assess/record respiratory rate, heart rate, blood pressure, temperature. Report significant deviations.
    • Intake and Output/Urinary Output: Monitor urine output (less than 0.5 mL/kg per hour may indicate decreased fluid volume/AKI) and record all relevant intake and outputs meticulously, including emesis and tube drainage.
    • Lab Values: Monitor electrolytes, CBC, blood chemistries, and ABGs for acid-base imbalances and other complications.
    • Collaboration: Work closely with healthcare providers, reporting changes in patient condition.

    Clinical Problems

    • Pain
    • Impaired GI function
    • Fluid imbalance

    Planning

    • Goals: relief of obstruction, return to normal bowel function, minimal discomfort, and normalization of fluid/electrolyte/acid-base balance.

    Implementation

    • Care prioritizes patient comfort and fluid/electrolyte balance. Post-op care similar to laparotomy patient care.

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    Description

    Test your knowledge on bowel obstructions with this quiz. It covers causes, types, and distinctions between mechanical and non-mechanical obstructions. Perfect for students in medical fields or anyone interested in gastroenterology.

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