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OBSTRUCTION

OBSTRUCTION. Chris Harmston Consultant 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

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OBSTRUCTION

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  1. OBSTRUCTION Chris Harmston Consultant Colorectal Surgeon UHCW

  2. Learning objectives • Recognise the types of bowel obstruction • Understand their symptoms and signs • Initiate basic management

  3. The GI tract ! • Foregut • Stomach and duodenum • Midgut • Small bowel • Hindgut • Colon (well most of it)

  4. Obstruction • Gastric outlet obstruction • Small bowel obstruction • Large bowel obstruction

  5. Symptoms • Signs • Management • Causes

  6. Gastric outlet obstruction • What is it? • Mechanical obstruction to the gastric outflow • How does it present? • Elective • Emergency

  7. Symptoms • Vomiting • Nature • Solids, then liquids • Type • Bile stained or not • Timing • Usually within an hour of a meal

  8. Symptoms • Weight loss • Insidious • Can lead to malnutrition • More significant in those with malignant disease • Early satiety • Epigastric fullnes • Pain?

  9. Signs • Look at the patient! • Dehydrated • Cachectic • Basic observations • Tachycardia • Examination • Often unremarkable • Succusion splash

  10. Investigations • Biochemical CO2 + H20 <= H2CO3 => HCO3- + H+ • Loss of • H+, Cl-, Na+ • Hypokalaemic hypochloraemic alkalosis

  11. Imaging

  12. Imaging

  13. Imaging

  14. Initial Management • Decompress the stomach • Correct biochemical abnormalities • Address the nutrition

  15. Definitive management • Conservative • Surgical • Resect • Bypass • Stent

  16. Causes • Benign • PUD • Caustic stricture • Malignant • Gastric Ca • Pancreatic CA

  17. Small bowel obstruction • What is it? • Mechanical obstruction of the small bowel • How does it present? • Usually as an emergency

  18. Symptoms • Vomiting • Nature • Usually to solids and liquids • Continuous • Type • Bile stained • Abdominal pain • Midgut • Colicky • Absolute constipation

  19. 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

  20. Investigations

  21. Initial management • Decompression • Correct the biochemical abnormalities • Rule out ischaemia

  22. Definitive management • Conservative – drip and suck • Operative

  23. Causes • Benign • Adhesions • Hernias • Inflammatory bowel disease • Malignant • Caecal tumour • Disseminated peritoneal disease • Primary small bowel tumour

  24. Large bowel obstruction • What is it? • Mechanical outflow obstruction of the colon • How does it present? • Usually emergency

  25. Symptoms • Distention • Abdominal pain • Colicky • Hindgut • Vomiting • Constipation

  26. Signs • Look at the patient • Distended • Baseline observations • Be afraid if tachycardia,Fever,Hypotension • Examination • Distention • Be afraid of peritonism

  27. Investigations

  28. Investigations • Confirm large bowel obstruction with, • Contrast enema • CT

  29. Initial management • Decompression (if possible) • Correct the biochemical disturbance • Rule out ischaemia or perforation

  30. Definitive management • Conservative? • Endoscopically • Scope • Stent • Surgically • Stoma • Resection

  31. Causes • Malignant • Colorectal cancer • Benign • Stricture • Volvulus

  32. 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?

  33. Questions?

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