Scribd Logo
Upload

Welcome to Scribd!

  • 61 views

    Recognizing Bowel Obstruction and Ileus

    Uploaded by

    mustika
    CT is superior for determining the location, degree, and cause of bowel obstructions. There are four main abnormal gas patterns: localized ileus, generalized adynamic ileus, small bowel obstruction, and large bowel obstruction. CT is useful for identifying dilated bowel loops, transition points, ischemia, and other complications of obstructions. The key is looking for disproportionate dilation of either the small or large bowel depending on the type of obstruction. Pitfalls include differentiating partial from complete obstructions.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd

    Recognizing Bowel Obstruction and Ileus

    Uploaded by

    mustika
    61 views35 pages
    CT is superior for determining the location, degree, and cause of bowel obstructions. There are four main abnormal gas patterns: localized ileus, generalized adynamic ileus, small bowel obstruction, and large bowel obstruction. CT is useful for identifying dilated bowel loops, transition points, ischemia, and other complications of obstructions. The key is looking for disproportionate dilation of either the small or large bowel depending on the type of obstruction. Pitfalls include differentiating partial from complete obstructions.

    Original Description:

    bowel

    Copyright

    © © All Rights Reserved

    Available Formats

    PPTX, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    CT is superior for determining the location, degree, and cause of bowel obstructions. There are four main abnormal gas patterns: localized ileus, generalized adynamic ileus, small bowel obstruction, and large bowel obstruction. CT is useful for identifying dilated bowel loops, transition points, ischemia, and other complications of obstructions. The key is looking for disproportionate dilation of either the small or large bowel depending on the type of obstruction. Pitfalls include differentiating partial from complete obstructions.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    61 views35 pages

    Recognizing Bowel Obstruction and Ileus

    Uploaded by

    mustika
    CT is superior for determining the location, degree, and cause of bowel obstructions. There are four main abnormal gas patterns: localized ileus, generalized adynamic ileus, small bowel obstruction, and large bowel obstruction. CT is useful for identifying dilated bowel loops, transition points, ischemia, and other complications of obstructions. The key is looking for disproportionate dilation of either the small or large bowel depending on the type of obstruction. Pitfalls include differentiating partial from complete obstructions.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 35

    Recognizing bowel obstruction

    and ileus
    CT is superior in revealing the location,
    degree, and cause of an obstruction and in
    demonstrating any sign of reduced bowel
    viability
    Key questions
    Are there dilated loops of small and/or large
    bowel?
    On CT, is there a transition point?
    On plain films, is there air in the rectum or
    sigmoid?
    Abnormal gas pattern
    Functional Mechanical
    ileus obstruction

    Localized
    SBO
    ileus

    Generalized
    adynamic LBO
    ileus
    Functional ileus
    Localized ileus affect only one or two loops
    of (usually small) bowel sentinel loop
    Generalized adynamic ileus affect all loops
    of large and small bowel and frequently the
    stomach.
    Law of the gut
    Obstruction occurs

    Peristalsis continues
    This can occur with
    few hours of a comp
    SBO
    Loop proximal soon become
    dilated with air and/or fluid

    Loop distal become


    decompressed or airless

    The transition point !!


    Clinical manifestation
    Mechanical obstruction
    Abdominal pain
    Abdominal distention
    Constipation
    Vomiting
    Early in proximal SBO
    Late in distal SBO

    Prolonged obstruction elevated intraluminal pressure vascular compromise


    necrosis perforation.
    4 abnormal bowel gas pattern
    Pathophysiology
    Causes
    Key imaging features
    Diagnostic pitfalls
    Table 16-1 Abnormal gas patterns
    FUNCTIONAL ILEUS : LOCALIZED
    SENTINEL LOOPS
    Pathophysiology
    Focal irritation occurs most often from
    inflammation of an adjacent visceral organs
    Loops affected are almost always loops of
    small bowel
    Irritation lose normal function
    aperistaltic dilatation
    Air is visible in the rectum or sigmoid
    Causes
    Table 16-2 Causes of a localized ileus
    Key Imaging Small bowel loops > 2,

    Coventional radiographs
    There are one or two persistently dilated loops of
    small bowel
    There are frequently air fluid levels
    There is usually gas in the rectum or sigmoid

    these same loops remain


    dilated on multiple views of
    the abdomen
    Pitfalls
    Localized ileus vs early SBO
    Early means the patient has had symptoms for a
    day or two
    Solution : combination clinical and lab findings, ct
    scan abdomen
    GENERALIZED ADYNAMIC ILEUS
    Pathophysiology
    Entire bowel is aperistaltic or hypoperistaltic
    Swallowed air dilates and fluid fills most loops
    of both small and large bowel.
    Almost always the result of abdominal or
    pelvic surgery
    Causes
    Table 16-3
    Key Imaging
    The entire bowel is usually air containing and
    dilated, the stomach may be dilated as well.
    Many long air fluid levels in the bowel
    There should be gas in the rectum or sigmoid
    There is no transition point !
    BU are frequently absent or hypoactive
    Pitfalls
    SMALL BOWEL OBSTRUCTION (SBO)
    Pathophysiology
    Causes
    Table 16-4
    Key Imaging
    Conventional radiographs : there are multiple
    dilated loops of small bowel proximal to the
    point of the obstruction (> 2,5 cm)
    As they begin to dilate small bowel loops stacks up
    on one another forming a step ladder appearance
    usually beginning in the LUQ to RLQ
    The more proximal the obstruction, the fewer the
    dilated loops there will be
    The more distal the obstruction, the greater the
    number of dilated small bowel loops
    Key Imaging
    Upright or decubitus radiographs
    numerous air fluid levels in the small bowel
    proximal to the obstruction
    There will be little or no gas in the colon esp
    in the rectum if enough time to
    decompress and empty the bowel distal to the
    point of obs.
    In mechanical SBO there should always be a disproportionate dilatation of
    small bowel compared with the collapsed large bowel
    Pitfalls
    Partial SBO vs localized adynamic ileus
    CT scan without oral contrast
    Partial SBO occurs more often in patients in whom
    adhesions are the etiologic factors
    CT is the most sensitive study for diagnosing the
    site and cause of mechanical SBO
    With or without contrast
    Oral contrast (barium or iodinated contrast)
    identifying dilated loops of bowel and in finding
    the transition point
    IV contrast detecting complications of bowel
    obs such as ischemia and strangulation
    CT findings of SBO
    Fluid filled and dilated loops of small bowel (>
    2,5 cm in diameter)
    Transition point
    Collapsed small bowel and/or colon distal to
    the point of obstruction
    Small bowel feces sign
    Closed loop obstruction
    Strangulation
    LARGE BOWEL OBSTRUCTION
    Pathophysiology
    Causes
    Table 16-5
    Key Imaging
    The colon is dilated to the point of obstruction
    The site of obstruction sometimes as the last air containing
    segment of the colon
    The caecum is often the most dilated segment of the colon
    When the caecum reaches a diameter > 12 to 15 cm, there is
    danger of cecal rupture.
    The small bowel is not dilated unless the ileocecal valves
    is incompetent
    The rectum contains little or no air
    There are usually no or very few air fluid levels in the
    large bowel
    Pitfalls : LBO can mimic an SBO
    Incompetent ileocecal valve
    Disproportionate dilatation of the small bowel
    compared with the decompressed large bowel
    Solution CT scan of the abdomen. Barium is
    not administered by mouth.
    LBO in CT
    Volvulus of the colon
    Intestinal pseudoobstruction
    (Ogilvie syndrome)
    = acute intestinal pseudoobstruction

    You might also like