MCQ - Intestinal obstruction

Adhesions secondary to previous surgery

Metastatic or peritoneal carcinomatosis

• Colicky abdominal pain (1st symptom)Q, vomiting, abdominal distention, and a failure to pass flatus and feces (i.e., obstipation)Q
• Abdominal distention is more common in distal obstructionQ•

Typical crampy abdominal pain occurs in paroxysms at 4- to 5-minute intervals and occurs less frequently with distal obstructionQ

• Obstruction of the small intestineQ, with its rapid loss of gastric, biliary, pancreatic and intestinal secretions by antiperistalsis and ejection, whether by vomiting or aspiration.
• Duodenal, total biliary, pancreatic and high intestinal external fistulae are all notorious for bringing about early and profound hyponatremiaQ

In detecting the late stages of irreversible ischemia (e.g. pneumatosis intestinalis, portal venous gas)Q

• Gas - Swallowed airQ is the major source (NitrogenQ is not well absorbed by intestinal mucosa), Gases produced by bacterial fermentation (H2,, CO2, CH4)
• Fluid - Enormous quantities of fluid from the extracellular space are lost into gut (third space loss), Net GI secretion is enhanced in obstruction

• DuodenumQ
• MC cause of neonatal intestinal obstruction is Duodenal atresiaQ

• Conservative treatment should not be prolonged beyond 72 hoursQ
• During adhesionlysis, only one adhesion be causative. This should be divided and the remaining adhesions left in situQ unless severe angulation is present.
• When obstruction is caused by an area of multiple adhesions, the adhesions should be freed by sharp dissectionQ
• To prevent recurrence, the bare area should be covered with Omental graftsQ.

It is colicky in nature and is usually centred on the umbilicus (small bowel) or lower abdomen (large bowel)Q• The pain coincides with increased peristaltic activityQ

Apex

Highest incidence between 4 and 10 monthsQ of age

• Meckel’s diverticulumQ
• Approximately 5–10% of cases have a true pathologic lead point. The older the toddler, the more likely there will be a lead pointQ
• In Henoch-Schönlein purpura, Submucosal hemorrhage acts as a lead pointQ

feeling of emptiness in the right iliac fossaQ

Kidney-shaped mass in the longitudinal view or a target sign in the transverse view

Claw signQ: Rounded apex of intussusception protrudes into the contrast column•

• Failure of reduction
• Presence of peritonitis
• Third recurrenceQ – is an indication for operative intervention to look for a lead point

• Invariably associated with a lead point, usually a polyp, submucosal lipoma or other tumorQ
• In adults, colocolicQ intussusception is common

LeiomyomaQ >AdenomaQ

LymphomaQ

Carcinoid >AdenocarcinomaQ

IleumQ

• Hirschsprung’s diseaseQ,
• Maternal diabetesQ
• HypothyroidismQ,
• Cystic FibrosisQ

• • Earliest clinical manifestation of CF
• • Terminal ileum is dilated and filled with thick, tarlike, inspissated meconiumQ.
• • Relatively small colonQ

• • Dilated, gas-filled loops of small bowelQ
• • Absence of air-fluid levelsQ
• • Mass of meconium within the right side of the abdomen mixed with gas to give a ground-glass or soap bubble appearanceQ.

• Diagnostic and therapeutic procedure of choice is a water-soluble contrast enema (gastrograffin)Q.
• This often results in the passage of a plug of meconium and relief of the obstructionQ
• Operative management - Simple evacuation of the luminal meconium,
• Irrigate the proximal and distal bowel with either warmed saline solution or 4% N-acetylcysteineQ.

• Perforation of the intestine has taken place.
• May occur in uteroQ or the early neonatal periodQ
• Meconium peritonitis is an aseptic chemical peritonitisQ caused by spillage of meconium

Meconium within the peritoneal cavity results in severe peritonitis with a dense inflammatory response and calcification (Snow-storm sign on USGQ)

• The pilocarpine iontophoresis sweat test revealing a chloride concentration >60 mEq/L is the most reliable and definitive method to confirm the diagnosis of CFQ
• Detection of the mutated CFTR geneQ.