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12 Cards in this Set

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What is paralytic ileus?

–Lackof normal peristaltic activity that propulses the bowel contents0, "expiry":

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.

What is the management of paralytic ileus?

•Management:


–Ruleout mechanical causes,


–Dripand Suck




•Fluidsand correct electrolytes imbalances


•NGtube–Usuallyresolves spontaneously in 2-4 days

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





What is a problem in chronic pseudoobstruction?

malabsorption



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)

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

What are the complications that can result from LBO?

ischaemia, perforation and biochemical derangement

What are all the causes of LBO?

malignancy


Adhesions – less common


diverticular disease


volvulus


UC/Crohns


hernia


constipation/impaction


pseudo-obstruction

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

what are the conservative managment of LBO?

•Dripand suck


–NGtube


– relieve pressure, nbm,


urinarycatheter– accuayemeasurement and cant move,


–IVfluids: deficit+ maintenance + ongoing losses.

consequence of LB resection?

more loss of fluid from end ileostomy