Un (consciousness) Dr Antony Thomas Consultant Neurologist UHCW UHCW Alexandra Hospital Redditch.
OBSTRUCTION Chris Harmston Consultant Colorectal Surgeon UHCW.
-
Upload
melinda-gardner -
Category
Documents
-
view
271 -
download
4
Transcript of OBSTRUCTION Chris Harmston Consultant Colorectal Surgeon UHCW.
OBSTRUCTION
Chris HarmstonConsultant Colorectal Surgeon
UHCW
Learning objectives
• Recognise the types of bowel obstruction
• Understand their symptoms and signs
• Initiate basic management
The GI tract !
• Foregut• Stomach and duodenum
• Midgut • Small bowel
• Hindgut• Colon (well most of it)
Obstruction
• Gastric outlet obstruction
• Small bowel obstruction
• Large bowel obstruction
• Symptoms
• Signs
• Management
• Causes
Gastric outlet obstruction
• What is it?– Mechanical obstruction to the gastric outflow
• How does it present?
– Elective – Emergency
Symptoms
• Vomiting– Nature• Solids, then liquids
– Type• Bile stained or not
– Timing• Usually within an hour of a meal
Symptoms
• Weight loss– Insidious– Can lead to malnutrition– More significant in those with malignant disease
• Early satiety• Epigastric fullnes• Pain?
Signs
• Look at the patient!• Dehydrated• Cachectic
• Basic observations• Tachycardia
• Examination• Often unremarkable • Succusion splash
Investigations
• Biochemical
CO2 + H20 <= H2CO3 => HCO3- + H+
• Loss of– H+, Cl-, Na+
• Hypokalaemic hypochloraemic alkalosis
Imaging
Imaging
Imaging
Initial Management
• Decompress the stomach
• Correct biochemical abnormalities
• Address the nutrition
Definitive management
• Conservative
• Surgical
– Resect
– Bypass
– Stent
Causes
• Benign• PUD• Caustic stricture
• Malignant• Gastric Ca• Pancreatic CA
Small bowel obstruction
• What is it?– Mechanical obstruction of the small bowel
• How does it present?– Usually as an emergency
Symptoms
• Vomiting• Nature
– Usually to solids and liquids– Continuous
• Type– Bile stained
• Abdominal pain– Midgut– Colicky
• Absolute constipation
Signs
• Look at the patient• Abdominal distention• Check for hernias – twice!
• Baseline observations• Be afraid of
– Tachycardia, fever, hypotension
• Examination• Should have a soft abdomen
– Be afraid of peritonism
Investigations
Initial management
• Decompression
• Correct the biochemical abnormalities
• Rule out ischaemia
Definitive management
• Conservative – drip and suck
• Operative
Causes
• Benign– Adhesions– Hernias– Inflammatory bowel disease
• Malignant– Caecal tumour– Disseminated peritoneal disease– Primary small bowel tumour
Large bowel obstruction
• What is it?– Mechanical outflow obstruction of the colon
• How does it present?
– Usually emergency
Symptoms
• Distention
• Abdominal pain– Colicky– Hindgut
• Vomiting• Constipation
Signs
• Look at the patient• Distended
• Baseline observations• Be afraid if tachycardia,Fever,Hypotension
• Examination• Distention• Be afraid of peritonism
Investigations
Investigations
• Confirm large bowel obstruction with,– Contrast enema– CT
Initial management
• Decompression (if possible)
• Correct the biochemical disturbance
• Rule out ischaemia or perforation
Definitive management
– Conservative?– Endoscopically• Scope• Stent
– Surgically• Stoma• Resection
Causes
• Malignant– Colorectal cancer
• Benign– Stricture– Volvulus
Have we met our objectives?
• Do we know the different types of obstuction?
• Do understand the symptomatology?
• Do we know the concepts of initial management?
Questions?