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12 Cards in this Set
- Front
- Back
What is paralytic ileus? |
–Lackof normal peristaltic activity that propulses the bowel contents0, "expiry": |
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What can cause paralytic ileus? |
•Followinglaparotomy –smallbowel- 24h, stomach- 48h, colon- 3-5d •Inflammatione.g. pancreatitis •Thoracicconditions e.g. pneumonia, # ribs•Systemicdisorders e.g. sepsisintrabadmonal, hypokalemia •Drugse.gopiates, Ca-channel blockers •X-ray:–Gasdiffusely through intestine, incl. colon–Noobvious transition point on contrast study. |
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What is the management of paralytic ileus? |
•Management: –Ruleout mechanical causes, –Dripand Suck •Fluidsand correct electrolytes imbalances •NGtube–Usuallyresolves spontaneously in 2-4 days |
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What is pseudoobstruction? |
like mechanical obstruction but no cause found acute: •Ogilvie’ssyndrome •Commonin the elderly and the ‘verysick’patients •Presentwith symptoms and signs of bowel obstruction •Riskfactors –Chestinfection –Myocardialinfarction –Cerebrovascularevent –Renalfailure –Electrolytedisturbances treatment: neostigmimine or colonoscopic decompression useful |
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What is a problem in chronic pseudoobstruction? |
malabsorption |
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What are the signs and symptoms of LBO? |
pain more constant, vomitting later, much more distension •Presentation: Colicky abdominal pain,constipation/obstipation –Vomiting - late( faeculent) abdominal distension –Fever, sepsis and shock, peritonism •Leftsided tumours: Change in bowel habit, Absolute constipation •Highindex of suspicion for malignancy –Askabout “Redflag” symptoms – night sweats, weight loss, change in bowel habit, tenesmus, blood in stool,lethargy, loss of appetite (caecal tumour - SBO) |
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What are the main causes of LBO? |
•Causes: –Colorectalcancer 65% -elderly •15%of colorectal cancers present with obstruction •Riskof obstruction greatest with left sided lesions •Usuallypresent at a more advanced stage •25%have distant metastases at presentation •Perforationcan occur at site of tumour or in a dilated caecum –Strictures:(diverticular 10%post infective, IBD, ischaemic) –Volvulus5% -elderly, intermittent •UnlikeSBO, adhesions very unlikely to produce LBO |
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What are the complications that can result from LBO? |
ischaemia, perforation and biochemical derangement |
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What are all the causes of LBO? |
malignancy Adhesions – less common diverticular disease volvulus UC/Crohns hernia constipation/impaction pseudo-obstruction |
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How can you interpret an xray of LBO? |
peripheal gas shadows proximal to blockage (e.g. in caecum) but not in rectum peripheral dilated loops haustra which do not cross whole width |
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what are the conservative managment of LBO? |
•Dripand suck –NGtube – relieve pressure, nbm, urinarycatheter– accuayemeasurement and cant move, –IVfluids: deficit+ maintenance + ongoing losses. |
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consequence of LB resection? |
more loss of fluid from end ileostomy |