Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
14 Cards in this Set
- Front
- Back
When you come upon a case of bowel obstruction, what are the things YOU must assess for?
|
Level of obstruction
Cause of obstruction Presence of enhancement of all small bowel loops (can always see enhancement in normal small bowel), and in large bowel if possible. |
|
What are the three most common causes of small bowel obstruction in adult?
|
1) Adhesions (65%)
2) External hernia (15%) 3) Neoplasm (15%) |
|
What are they in the colon?
|
1) Colon CA (65%)
2) Diverticulitis (20%) 3) Volvulus (10%) |
|
What is the point then?
|
Colonic obstruction and SBO have totally different etiologies, with SBO being benign causes usually, and colonic obstr malignant usually.
|
|
What is a common cause of bowel obstruction in younger patients (i.e. 20s)?
|
Inflammatory pseudotumor (inflammatory myofibroblastic tumor)
|
|
What do you do when encountered with SBO in a "virgin" abdomen?
|
Pretty much rules out adhesions. Must search hard for a cause, because there is always a good reason.
Hernia, mass, midgut volvulus with congenital Ladd bands, patient with cystic fibrosis with inspissated feces. |
|
What additional abdominal finding do CF patients get?
|
FATTY replacement of pancreas
|
|
What is the cause of small bowel feces sign?
|
Stasis of material in the small bowel
|
|
What are the bowel obstruction situations most likely to result in strangulation?
|
1) Closed loop obstructons
2) Volvulus 3) High grade obstructions (due to increased perfusion pressure) -- high grade obs happens with CA |
|
What is sufficient to make dx of closed loop obstruction?
|
1) Small bowel obstruction
2) U-shaped loop of distended bowel 3) Clouding of the adjacent mesentery OR See distended loop of bowel with two limbs in close contiguity and obstruction proximal to this region. |
|
What is a sign of bowel ischemia that predates absence of enhancement?
|
Target sign: See mural stratification or just see thickening and prominent enhancement of the mucosal surface.
|
|
When the ischemia progresses to infarction, what occurs?
|
The wall goes from thickened and enhancing to non-enhancing and almost paper thin. Next comes pneumatosis.
|
|
Post-op patient with dilated ascending colon and SBO with collapsed descending colon. You want to r/o an obstructing lesion. CT is indeterminate. What do you do?
|
Put patient on fluoro table, do single contrast BE just to demonstrate normal transverse colon. If normal, you know patient just has a variant pattern of adynamic ileus.
|
|
When is enteroclysis preferred over CT?
|
Chronic recurrent obstruction. Enteroclysis is good for challenging the small bowel to look for areas of poor dilation, which may reflect adhesions that can be removed laparoscopically.
|