Term
| What are the 3 most common causes of SBO in order from most to least common? |
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Definition
| 1)Post-op adhesions 2)Malignant tumors or strictures 3)Hernias |
|
|
Term
| what is the hallmark sign of SBO? |
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Definition
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Term
| What is strangulation obstruction? |
|
Definition
| obstruction w/ compromised blood flow |
|
|
Term
| What etiologies of SBO more often result in strangulation? |
|
Definition
| Hernia, volvulus, and intussusceptions |
|
|
Term
| What can stragulation of the bowel lead to? |
|
Definition
| Infarction and gangrene in as little as 6hrs |
|
|
Term
| Is strangulation a common complication of LBO? |
|
Definition
| No rare except w/ volvulus |
|
|
Term
| When is perforation of the bowel a high risk? |
|
Definition
| If the cecum is dilated > or = 13cm |
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Term
| Name 4 risk factors for bowel obstruction. |
|
Definition
| 1)Prev. abd surgery 2)Crohn's 3)Intra-abd malignancy 4)Gallstones |
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|
Term
| Name 4 sx of bowel obstruction. |
|
Definition
| Abd distension, cramping, vomiting, and later obstipation |
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Term
| Differentiate b/t the onset of abd cramps in SBO vs. LBO. |
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Definition
| SBO - sx soon /p onset centered around umbilicus or epigastrium. LBO - milder cramps dev. gradually in hypogastrium |
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|
Term
| Does vomiting more often occur in SBO or LBO? |
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Definition
|
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Term
| What types of BMs are seen in pts w/ PSBO vs. complete SBO? |
|
Definition
| PSBO - diarrhea. Complete SBO - obstipation. |
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|
Term
| What does severe, steady pain in a pt w/ SBO suggest? |
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Definition
|
|
Term
| Describe abd pain in a pt w/ volvulus. |
|
Definition
| Continuous pain w/ an abrupt onset, sometimes w/ superimposed waves of colicky pain |
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Term
| Which is a more serious finding during physical exam of a pt w/ SBO, hyperactive/high-pitched BS or absent BS? |
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Definition
| Absent - may indicate strangulation/infarction |
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|
Term
| Is the abd tender in a pt w/ SBO but no strangulation? |
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Definition
|
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Term
| What are expected findings on PE of a pt w/ LBO? |
|
Definition
| Distended abd, loud borborygmous, non-tenderrectum usu. empty |
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|
Term
| Would you expect dehydration and lyte abnormalities in a pt w/ LBO? |
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Definition
|
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Term
| what dx tests are typ. done to dx bowel obstruction? |
|
Definition
| supine and upright abd X-rays |
|
|
Term
| What findings are typ. on abd x-ray in a pt w/ SBO but may also occur w/ obstruction of (R) colon? |
|
Definition
| ladder-like series of distended bowel loops |
|
|
Term
| What are expected findings on abd x-ray in a pt w/ LBO? |
|
Definition
| distension of the colon proximal to the obstruction |
|
|
Term
| What does gas in the bowel wall indicate? What is another name for this finding? |
|
Definition
| Gangrene. Pneumatosis intestinalis |
|
|
Term
| What diameters of the SB, LB, and cecum suggest a complete obstruction and possibility of bowel necrosis? |
|
Definition
| SB - 6cm, LB - 12cm, cecum - 15cm |
|
|
Term
| What dx tests shoulb be done for suspected volvulus? |
|
Definition
|
|
Term
| What finding on barium enema is dx of a volvulus? A volvulus in what section of bowel can be resolved by barium enema? |
|
Definition
| Bird-beak deformity. Sigmoid (rarely works on cecal) |
|
|
Term
| What lab results may indicate that strangulation has already occurred? |
|
Definition
|
|
Term
| what labs may be elev. d/t extreme dehydration from vomiting and fluid sequestration in the bowel? |
|
Definition
|
|
Term
| What complications can result from bowel perforation/infarction? From severe dehydration? |
|
Definition
| abscess, gangrene, or peritonitis. Shock. |
|
|
Term
| How likely is a LB volvulus to reoccur if tx w/ barium enema /s resection? |
|
Definition
| Almost inevitable recurrence |
|
|
Term
| What % of PSBO resolve w/ nonoperative tx? What % of complete SBO req. operation? |
|
Definition
|
|
Term
| If you are unsure if a pt has a partial obstruction or a paralytic ileus, what tx is rec.? |
|
Definition
| NG decompression, IV fluid, observation |
|
|
Term
| What is the tx for a pt w/ mechanical obstruction? |
|
Definition
| immediate surgerical consult and broad spectrum IV abx |
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