Chris Harmston Consultant Colorectal Surgeon UHCW 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 Midgut Hindgut Stomach and duodenum Small bowel 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 Type Timing Solids, then liquids Bile stained or not Timing Usually within an hour of a meal

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

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

CO2 + H20 <= H2CO3 => HCO3- + H+ 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 Abdominal pain Absolute constipation Nature Type Usually to solids and liquids Continuous Type Bile stained Abdominal pain Midgut Colicky Absolute constipation

Signs Look at the patient Baseline observations Examination 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 Malignant Adhesions Hernias Inflammatory bowel disease 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 Vomiting Constipation Colicky Hindgut Vomiting Constipation

Signs Look at the patient Baseline observations Examination Distended 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?