Intestinal Obstruction Overview

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Questions and Answers

Which of the following are MC causes of small bowel obstruction?

  • Adhesions (correct)
  • Cancer (correct)
  • Bulges (Hernia) (correct)
  • Diverticulitis

What is the MC cause of large bowel obstruction?

  • Sigmoid volvolus
  • Cancer (Colorectal CA) (correct)
  • Adhesions
  • Diverticulitis

What are the four cardinal symptoms of intestinal obstruction?

Colicky abdominal pain, vomiting, distention, and constipation.

The frequency of colicky abdominal pain in small bowel obstruction is generally shorter than in large bowel obstruction.

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

What is the MC cause of obstruction in neonates?

<p>Atresia (duodenal/jejunal/ilial) (A)</p> Signup and view all the answers

Which of the following is NOT a cause of functional obstruction?

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

What is the difference between complete and partial obstruction?

<p>Complete obstruction is characterized by the absence of air in the colon or rectum, while partial obstruction allows some air to pass through.</p> Signup and view all the answers

Which of the following is NOT a sign of intestinal obstruction on physical exam?

<p>Absent bowel sounds (D)</p> Signup and view all the answers

Which of the following is NOT a common electrolyte imbalance seen in intestinal obstruction?

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

A contrast enema is a helpful diagnostic tool for large bowel obstruction, especially for identifying colon cancer.

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

Surgery is always recommended for intestinal obstruction.

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

Which type of volvulus is more common in children?

<p>Mid-gut volvulus (B)</p> Signup and view all the answers

A 'whirlpool sign' on ultrasound is a characteristic finding in volvulus.

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

Explain the difference between primary and secondary volvulus.

<p>Primary volvulus is a congenital malformation, often involving a mid-gut rotation, while secondary volvulus is acquired and can be caused by adhesions, stoma, or a long mesentery.</p> Signup and view all the answers

What is the most common cause of intestinal obstruction overall?

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

Adhesions are always preventable.

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

Which of the following is NOT a common cause of adynamic (functional) obstruction?

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

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

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

Ogilvie syndrome is a form of acute megacolon.

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

The feared outcome of Ogilvie syndrome is ischemia or perforation of the colon.

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

Hirschsprung disease is a congenital cause of megacolon.

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

Which of the following is NOT a common complication of intestinal obstruction?

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

Which type of volvulus is acquired?

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

Botulism can cause intestinal obstruction.

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

A gallstone ileus can cause colon obstruction.

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

Flashcards

Intestinal obstruction

A blockage of the intestines, partial or complete, preventing food and waste from passing through.

Colicky abdominal pain

Recurring waves of pain in the abdomen, often due to the intestines contracting against an obstruction.

Small bowel obstruction

Blockage in the upper part of the intestines, often causing vomiting.

Large bowel obstruction

Blockage in the lower part of the intestines, often causing constipation, later vomiting.

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Strangulation

A serious complication of intestinal obstruction, where blood supply is cut off to a section of bowel.

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Paralytic ileus

A lack of intestinal movement, not caused by a blockage but by the bowel being unable to contract.

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Vomiting (in obstruction)

Ejection of stomach contents, with vomiting nature varying based on the location of the obstruction.

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Distention

Swelling of the abdomen, caused by gas buildup.

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Constipation

Difficulty passing stools.

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Mechanical obstruction

Obstruction caused by physical blockage of the intestine by solid objects or inflammation.

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Adhesions

Scar tissue that forms and binds together different parts of the intestines.

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Volvulus

Twisting of a portion of the intestine upon itself, causing obstruction.

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Intussusception

One part of the intestine slides into another, causing obstruction.

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Study Notes

Intestinal Obstruction

  • Mechanism: Partial or complete blockage of the intestines.
  • Common causes (Small Bowel): Adhesions, hernia, cancer.
  • Common causes (Large Bowel): Cancer, sigmoid volvulus, diverticulitis.
  • Cardinal Symptoms: Colicky abdominal pain (frequency varies based on bowel location), vomiting (nature of vomit depends on location), distension (lower obstruction = earlier distension), constipation (lower obstruction = earlier constipation).
  • 3-6-9 rule: Bowel diameter measurement. Small intestine <3 cm, Large intestine < 6cm, Cecum <9 cm. Above these values = obstruction.
  • IO Classification (Based on): Intraluminal (inside bowel lumen), Intramural (in the wall), Extramural (outside the wall).
  • Etiology: Fecal impaction, bezoars, gallstones, worms, strictures, intussusception, volvulus, hernia, adhesions, extra-luminal.
  • Clinical Presentation (Acute): Sudden onset, severe colicky abdominal pain; usually in the small intestine.
  • Clinical Presentation (Chronic): Gradual onset, less severe; usually in the large intestine.
  • Clinical Presentation (Acute on Chronic): Combination of acute and chronic symptoms.
  • Clinical Presentation (Subacute): Intermediate between acute and chronic.

IO Classification

  • Neonate: Atresia (duodenal, jejunal, ileal).
  • Infants: Incarcerated hernia, intussusception.
  • Elderly: Cancer, sigmoid volvulus, diverticulitis.

Investigations

  • Labs: Electrolytes (hypokalemia, hypercalcemia), Kidney Function Tests, Complete Blood Count, C-reactive protein/Erythrocyte sedimentation rate.
  • Imaging: Chest X-ray, Erect/Supine abdominal X-ray (for identification of air-fluid levels), CT scan, Ultrasound, Contrast enema.

Complete vs Partial Obstruction

  • Complete: Absence of air in the colon or rectum.
  • Partial: Presence of air in the colon or rectum.

Physical Exam

  • General: Signs of dehydration.
  • Inspection: Look for hernias, scars.
  • Palpation: Tenderness, distension.
  • Auscultation: Mechanical (tinkling bowel sounds), Non-mechanical (absent bowel sounds), Rectal examination (for fecal impaction).

Treatment

  • Conservative: NG tube (in acute vomiting cases), IV fluids, IV antibiotics, analgesia.
  • Surgical: Resection and anastomosis (small/large bowel).

Dynamic (Mechanical) Obstruction

  • Pathophysiology: Bowel tries to overcome obstruction, leading to increased gas/fluid accumulation proximal to the obstruction. Bowel distal to obstruction empties.
  • Bowel distal to obstruction starts emptying due to loss of peristalsis.
  • Bowel continues to collapse (paralytic ileus).

Adynamic (Functional) Obstruction

  • Paralytic Ileus: Neuromuscular failure.
  • Causes: Post-surgery, late stage of mechanical obstruction, infections.

Volvulus

  • Mechanism: Twisting (axial rotation) of a loop of bowel around its mesentery.
  • Types: Primary (congenital malrotation), Secondary (acquired).
  • Clinical presentation: Similar to mechanical intestinal obstruction

Pseudo-Obstruction (Ogilvie Syndrome)

  • Mechanism: Autonomic imbalance (↓ parasympathetic tone or ↑ sympathetic output).
  • Location: Colon.
  • Common in: Critically ill patients, patients with other medical issues.
  • Outcome (if untreated): Ischemia, perforation.

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