Surgery Cf Ch 6 (Sbo) 1

Front 1

1. What is the next step in management of small bowel obstruction?

Back 1

a. Place a nasogastric (NG) tube to decompress the stomach, begin fluid resuscitation, and place of Foley catheter to monitor urine output and assess response to fluid resuscitation.

Front 2

2. Complications associated with small bowel obstruction?

Back 2

a. Strangulation
b. bowel necrosis
c. sepsis
d. vomiting may result in aspiration pneumonitis.
e. When unrecognized or untreated, intravascular fluid loss (from third space fluid loss and vomiting) can lead to prerenal azotemia and acute renal insufficiency.

Front 3

3. Probable therapy for small bowel obstruction?

Back 3

a. Exploratory laparotomy after fluid resuscitation.

Front 4

4. With small bowel obstruction, why is the changing pain pattern from intermittent to persist a concern?

Back 4

a. Persistent pain in this setting can be produced by severe bowel distention (which may produce venous congestion, decreased perfusion, and necrosis)
b. Or
c. Bowel ischaemia secondary to strangulation!!!

Front 5

5. What other features suggest small bowel-obstruction?

Back 5

a. Fever
b. Tachycardia
c. Leukocytosis
d. Elevated serum amylase level.
e. Radiographic signs of a high-grade small bowel obstruction.

Front 6

6. What does mechanical obstruction of the bowel result in?

Back 6

a. Accumulation of fluid in the bowel lumen and bowel wall, in addition to extravasation of fluid into the peritoneal cavity.
b. The net result of these fluid shifts the depletion of intravascular volume and decreased perfusion of all organs.
c. Therefore, one of the most vital aspects of treatment is early recognition of the problem and restoration of intravascular volume to reestablish organ perfusion.

Front 7

7. Closed loop obstruction?

Back 7

a. This can develop when intestinal blockage occurs at both proximal and distal ends of the bowel segment.
b. I.e. include small bowel incarceration in a tight hernia defect or in intestinal volvulus.
c. The situation is associated with more rapid progression to strangulation, and it is unlikely to resolve without operative therapy.

Front 8

8. Ileus?

Back 8

a. Ileus is distention of the small bowel and/or colon from non-obstructive causes.

Front 9

9. Common causes of Ileus?

Back 9

a. Local or systemic inflammatory or infectious processes
b. A variety of metabolic derangements
c. recent abdominal surgery
d. adverse effects of medications.

Front 10

10. Internal hernia?

Back 10

a. A congenital or acquired defect within the peritoneal cavity that can lead to small bowel structured

Front 11

11. Gallstone ileus?

Back 11

a. Mechanical structure of the small bowel to two large gallstones in the bowel lumen.
b. This condition generally occurs when a stone or stones enter the gallbladder.

Front 12

12. What is the typical clinical presentation of gallstone Ileus?

Back 12

a. Intermittent bowel obstruction for several days until the stone lodges in the distal small bowel and causes complete obstruction.

Front 13

13. What is a small bowel obstruction in a neonate, infant, or a young child, most likely the result of?

Back 13

a. Hernia
b. Malrotation
c. meconium ileus
d. Meckel diverticulum
e. Intussusception
f. intestinal atresia

Front 14

14. what a small bowel obstruction in adults most likely caused by?

Back 14

a. Adhesions
b. Hernia
c. Crohn disease
d. gallstone ileus
e. tumor.

Front 15

15. Symptoms of small bowel obstruction?

Back 15

a. Because a mechanical small bowel obstruction prevents the passage of intestinal luminal contents, the patient develops cramp-like abdominal pain, nausea, and bilious vomiting.
b. It is not uncommon for patients describe the occurrence of a bowel movement. At the onset of acute attraction, which generally is because of the stimulation of peristalsis, leading to evacuation of the distal gastrointestinal tract contents.

Front 16

16. Note: the presence of a bowel movement does NOT rule out Bowel obstruction!!!!!!!

Back 16

16. Note: the presence of a bowel movement does NOT rule out Bowel obstruction!!!!!!!

Front 17

17. What is commonly observed following successful decompression by the placement of NG tube in patients with uncomplicated small bowel obstruction?

Back 17

a. Improvement of nonspecific tenderness.

Front 18

18. What does localized tenderness directly over distended bowel loops suggest?

Back 18

a. The presence of severe distention or bowel ischemia.

Front 19

19. What does a DRE of patients with small bowel obstruction often reveal?

Back 19

a. Little or no stool in the rectal vault, which is because of continued peristalsis and evacuation of stool from the distal bowel.

Front 20

20. What may the signing of a large amount storm the rectum suggest?

Back 20

a. This would be unusual for SBO and may suggest ileus, rather than mechanical obstruction as the cause of distention.

Front 21

21. Pathophysiology of SBO?

Back 21

a. Mechanical obstruction of the small bowel reduces bowel absorptive function in causes luminal fluid accumulation.
b. Additionally, there is a fluid shift into the extravascular space because of local inflammatory stimulation and venous congestion
c. these losses, along with vomiting, generally produce tremendous intravascular volume depletion and place untreated patients at the risk of development of remote organ dysfunction caused by hypoperfusion.

Front 22

22. How does the presentation of patients with small bowel obstruction generally compared to those with more distal obstruction?

Back 22

a. Generally, patients with proximal small bowel obstruction have more frequent vomiting, and those more distal obstruction have more distention and less vomiting.

Front 23

23. What is a risk with long standing distal small bowel obstruction?

Back 23

a. Bacterial overgrowth can develop and lead to feculent vomitus.
b. Prolonged distal small bowel obstruction could lead to further intra-abdominal and pulmonary (aspiration) infectious complications.

Front 24

24. Laboratory evaluation of SBO?

Back 24

a. CBC with diff
b. serum electrolyte and amylase determinations
c. UA
d. ABG for selected patients
e. with dehydration and a physiologic response to bowel obstruction, patients with uncomplicated small bowel obstruction may initially presented with mild leukocytosis and a left shift.
f. Generally, the leukocytosis resolves with therapy.

Front 25

25. What should persistent leukocytosis after hydration raised suspicion of?

Back 25

a. Complications and may mandate early surgical intervention or additional diagnostic evaluation.

Front 26

26. Note: elevation serum amylase level is most commonly associated with pancreatitis but may also develop with complicated small bowel obstruction.

Back 26

26. Note: elevation serum amylase level is most commonly associated with pancreatitis but may also develop with complicated small bowel obstruction.

Front 27

27. What is the value of CT for small bowel obstruction?

Back 27

a. A CT scan provides additional information for patients in whom the etiology is unclear, such as those with a functional attraction (ileus), IBD, a tumor, or gallstone ileus.
b. CT scans can reliably identify the transition from dilated to decompressed bowel, which is diagnostic for mechanical obstruction.

Front 28

28. What test can be used to differentiate between mechanical obstruction and ileus?

Back 28

a. Upper G.I. and small bowel follow-through (UGI/SBFT).
b. It can also be used in terminal location and severity of a bowel obstruction.

Front 29

29. What is the goal inpatient evaluation of possible SPO?

Back 29

a. To diagnose the bowel obstruction and ID patients with complicated SBO, who may benefit from early operative interventions.

Front 30

30. Treatment of uncomplicated partial small bowel obstruction from adhesions?

Back 30

a. Can by initially treated with the trial of non-operative therapy consisting of NPO, placement of an NG tube, close monitoring of fluid status, serial clinical exams, and laboratory and radiographic follow-up.
b. Most patients who are successfully treated nonoperatively demonstrate improvement within 6 to 24 hours after initiation of treatment.
c. These improvements include decreased abdominal discomfort, distention, and a decrease in the volume of Nasogastric aspirate, and radiographic resolution of bowel distension.