Obstruction Popcorn

Question 1

Blood supply to small bowel?

Answer 1

SMA

Question 2

Blood supply to large bowel?

Answer 2

SMA & IMA

Question 3

Innervation to small and large bowel?

Answer 3

Autonomic nervous system (ANS)

Question 4

Digestion/Absorption of water, electrolytes, & nutrients

Answer 4

Small Bowel

Question 5

Absorbs water & electrolytes from liquid stool –> right colon

Answer 5

Large Bowel

Question 6

FAST transit time

Answer 6

Small Bowel

Question 7

SLOW transit time

Answer 7

Large Bowel

Question 8

Which study?

• used to see air fluid levels

Answer 8

Upright x-ray

Question 9

Which study?

• used to see free air

Answer 9

PA chest x-ray

Question 10

MC cause of SBO WORLDWIDE??

Answer 10

Hernias

Question 11

MC cause of SBO in the UNITED STATES??

Answer 11

Post-operative surgical adhesions

Question 12

SBO

• Small intestine dilates PROXIMAL or DISTAL to obstruction??

Answer 12

Proximal

Question 13

MC finding in a patient’s Hx of has SBO??**

Answer 13

Prior abdominal surgery**

Question 14

Which condition?

• Periumbilical pain (colicky, then steady)
• Crampy pain
• Gas in small intestine

Answer 14

SBO

Question 15

SBO

• Which symptom is more pronounced is obstruction is DISTAL?

Answer 15

Distention

Question 16

SBO

• Which symptom is more pronounced is obstruction is PROXIMAL?

Answer 16

Vomiting

Question 17

Normal or Increased Bowel Sounds

Answer 17

SBO

Question 18

Gastrografin if perforation is suspected

Answer 18

SBO

Question 19

Rebound tenderness / pt laying still

Answer 19

Strangulation (advanced/late SBO)

Question 20

Tachycardia

Hypotension

Dry membranes

Early obstruction: high pitched BS

Late obstruction: silent BS

Answer 20

SBO

Question 21

Causes of what condition?

• narcotics
• bedrest
• trauma
• hypothryoid
• electrolyte abnormalities
• anesthesia
• sepsis

Answer 21

Paralytic Ileus

Question 22

• Minimal abd pain*
• Decreased or Absent BS
• Gas in BOTH small & large intestine on x-ray**

Answer 22

Paralytic Ileus

Question 23

Decreased bowel motility

Bowel distended WITHOUT mechanical obstruction

Answer 23

Paralytic Ileus

Question 24

No transition zone appreciated***

Tx conservatively (NPO, NG tube, IV fluids)

Answer 24

Paralytic Ileus

Question 25

Sigmoid colon MC site! Adhesions are RARE!!

Answer 25

LBO

Question 26

3 top causes of LBO

Answer 26

1. Adenocarcinoma 2. Scarring 3. Volvulus

Question 27

* Proximal colon distended * Absence of air in rectum * Competent ileocecal valve: closed loop & MASSIVE dilation of cecum

Answer 27

LBO plain film findings

Question 28

Localized, tender, palpable mass

Answer 28

**LBO** (consistent w/ strangulated closed loop)

Question 29

Tx for Partial / Complete / Perforated LBO??

Answer 29

**Partial:** conservative (NG tube) **Complete:** OR for laparotomy **Perforated:** IMMEDIATE laparotomy w/ resection & colostomy

Question 30

Abnormal twisting of intestine --\> obstruction

Answer 30

Volvulus (LBO)

Question 31

MASSIVE abd distention MASSIVELY dilated sigmoid/cecum

Answer 31

LBO due to Volvulus

Question 32

Loss of haustral markings\*\*\* Bird's Beak on Barium Enema

Answer 32

LBO due to Volvulus

Question 33

Tx for LBO due to Volvulus?

Answer 33

Reduced w/ sigmoidoscopy