Intestinal Obstruction & Ileus

Answer Explanation:

• Barrett’s oesophagus is the correct answer because it is not a cause of small-bowel obstruction. Barrett’s oesophagus is a condition where the cells of the oesophagus (gullet) grow abnormally. It is often seen in patients with long term gastroesophageal reflux disease (GERD). It does not cause obstruction of the small bowel.
• Lymphoma, Crohn’s disease, gallstone ileus, and adhesions, on the other hand, can all cause small-bowel obstruction. Lymphoma and Crohn’s disease can cause obstruction due to inflammation and swelling or the formation of tumours. Gallstone ileus can cause obstruction when a gallstone enters the small bowel and blocks it. Adhesions can cause obstruction by creating bands of scar tissue that can trap the small bowel.

Overview of Small-Bowel Obstruction:

• Small-bowel obstruction is a blockage of the small intestine that prevents the flow of contents through the digestive tract. This can lead to severe abdominal pain, vomiting, and other symptoms.
• Causes: Common causes include adhesions (bands of scar tissue), hernias, Crohn’s disease, cancer (such as lymphoma), and gallstones.
• Symptoms: Symptoms can include abdominal pain, bloating, vomiting, constipation, and inability to pass gas.
• Diagnosis: Diagnosis is usually made based on symptoms, physical examination, and imaging studies such as X-rays, CT scans, or ultrasound.
• Treatment: Treatment depends on the cause and severity of the obstruction. It may include hospitalization for fluid and electrolyte replacement, nasogastric tube for decompression, and possibly surgery to remove the obstruction.

Answer Explanation:

• The correct answer is “It can be treated by laparoscopic surgery”. Small-bowel obstruction can indeed be managed surgically, and laparoscopic surgery is one of the methods used. This is a minimally invasive procedure that can help to remove the obstruction and restore normal bowel function.

Incorrect Options Explanation:

• “Strangulated obstruction can usually be managed conservatively” – This is incorrect. Strangulated obstruction is a surgical emergency and requires immediate intervention to prevent bowel necrosis.
• “Patients with acute obstruction should be resuscitated with oral fluids” – This is not accurate. Patients with acute obstruction are typically managed with intravenous fluids due to the risk of aspiration.
• “A nasogastric tube should not be placed in a vomiting patient” – This is incorrect. A nasogastric tube can be used to decompress the stomach and relieve symptoms in a patient with small bowel obstruction who is vomiting.
• “Intravenous fluids should only be administered if renal failure is present” – This is incorrect. Intravenous fluids are a key part of the management of small bowel obstruction, regardless of the presence of renal failure.

Overview of Small-Bowel Obstruction:

Definition:

• Small-bowel obstruction is a blockage of the small intestine that prevents the normal passage of food and fluids through the digestive tract.

Causes:

• Common causes include adhesions from previous surgeries, hernias, Crohn’s disease, and tumors.

Symptoms:

• Patients may present with abdominal pain, vomiting, constipation, and inability to pass gas.

Management:

• Initial management includes resuscitation with intravenous fluids, pain control, and nasogastric tube placement for decompression.
• Surgical intervention, including laparoscopic surgery, may be required to remove the obstruction.

Answer Explanation:

• The correct answer is “Vomiting may be a feature”. This is because paralytic ileus often presents with symptoms such as nausea and vomiting due to the build-up of gas and fluids in the intestines.
• “It is treated operatively” is incorrect. Paralytic ileus is typically managed conservatively with bowel rest, intravenous fluids, and correction of electrolyte imbalances. Surgery is reserved for cases where there is a mechanical obstruction or ischemia.
• “It is usually extremely painful” is also incorrect. While abdominal discomfort or bloating can occur, severe pain is not a typical feature of paralytic ileus. Severe pain is more indicative of a mechanical obstruction or ischemia.
• “Bowel sounds are hyperactive and tinkling” is incorrect. In paralytic ileus, bowel sounds are typically absent or reduced due to the lack of intestinal motility.
• “‘Nil by mouth’ is not necessary” is incorrect. ‘Nil by mouth’ or NPO (nothing by mouth) is often necessary in the management of paralytic ileus to allow the bowel to rest.

Overview of Paralytic Ileus:

• Definition: Paralytic ileus is a condition characterized by cessation of intestinal peristalsis without any mechanical obstruction.
• Causes: It can be caused by various conditions such as surgery (especially abdominal surgery), certain medications (e.g., opioids), electrolyte imbalances, and severe illnesses or infections.
• Symptoms: Common symptoms include abdominal distension, nausea, vomiting, and inability to pass gas or stool.
• Diagnosis: It is typically diagnosed based on clinical presentation and confirmed with imaging studies (e.g., abdominal X-ray or CT scan) showing dilated bowel loops with gas and fluid levels.
• Management: The mainstay of treatment is conservative management, including bowel rest (NPO), intravenous fluids, correction of electrolyte imbalances, and discontinuation of causative medications. In some cases, nasogastric suction may be used to decompress the bowel. Surgery is reserved for cases where there is a mechanical obstruction or ischemia.