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Questions and Answers
Which of the following are MC causes of small bowel obstruction?
Which of the following are MC causes of small bowel obstruction?
What is the MC cause of large bowel obstruction?
What is the MC cause of large bowel obstruction?
What are the four cardinal symptoms of intestinal obstruction?
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.
The frequency of colicky abdominal pain in small bowel obstruction is generally shorter than in large bowel obstruction.
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What is the MC cause of obstruction in neonates?
What is the MC cause of obstruction in neonates?
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Which of the following is NOT a cause of functional obstruction?
Which of the following is NOT a cause of functional obstruction?
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What is the difference between complete and partial obstruction?
What is the difference between complete and partial obstruction?
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Which of the following is NOT a sign of intestinal obstruction on physical exam?
Which of the following is NOT a sign of intestinal obstruction on physical exam?
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Which of the following is NOT a common electrolyte imbalance seen in intestinal obstruction?
Which of the following is NOT a common electrolyte imbalance seen in intestinal obstruction?
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A contrast enema is a helpful diagnostic tool for large bowel obstruction, especially for identifying colon cancer.
A contrast enema is a helpful diagnostic tool for large bowel obstruction, especially for identifying colon cancer.
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Surgery is always recommended for intestinal obstruction.
Surgery is always recommended for intestinal obstruction.
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Which type of volvulus is more common in children?
Which type of volvulus is more common in children?
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A 'whirlpool sign' on ultrasound is a characteristic finding in volvulus.
A 'whirlpool sign' on ultrasound is a characteristic finding in volvulus.
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Explain the difference between primary and secondary volvulus.
Explain the difference between primary and secondary volvulus.
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What is the most common cause of intestinal obstruction overall?
What is the most common cause of intestinal obstruction overall?
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Adhesions are always preventable.
Adhesions are always preventable.
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Which of the following is NOT a common cause of adynamic (functional) obstruction?
Which of the following is NOT a common cause of adynamic (functional) obstruction?
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Which of the following is NOT a common cause of paralytic ileus?
Which of the following is NOT a common cause of paralytic ileus?
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Ogilvie syndrome is a form of acute megacolon.
Ogilvie syndrome is a form of acute megacolon.
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The feared outcome of Ogilvie syndrome is ischemia or perforation of the colon.
The feared outcome of Ogilvie syndrome is ischemia or perforation of the colon.
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Hirschsprung disease is a congenital cause of megacolon.
Hirschsprung disease is a congenital cause of megacolon.
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Which of the following is NOT a common complication of intestinal obstruction?
Which of the following is NOT a common complication of intestinal obstruction?
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Which type of volvulus is acquired?
Which type of volvulus is acquired?
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Botulism can cause intestinal obstruction.
Botulism can cause intestinal obstruction.
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A gallstone ileus can cause colon obstruction.
A gallstone ileus can cause colon 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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Description
This quiz covers the mechanisms, causes, symptoms, and clinical presentations of intestinal obstruction. Learn about the different types, including small and large bowel obstructions, and understand the 3-6-9 rule for bowel diameter. Test your knowledge on etiology and classification of obstructions.
