HTHSCI 1DT3 Lecture Notes - Lecture 20: Ileocecal Valve, Hypovolemia, Volvulus

• School: McMaster University
• Department: Health Sciences
• Course: HTHSCI 1DT3
• Professor: Carl Richards

Document Summary

1 obstructing point + no vascular compromise. Central but level depends on gut region. Constant / localised pain suggests strangulation or impending perforation. Axr: erect film for fluid levels. Look for mechanical obstruction: no free flow. Follow through may relieve mild mechanical obstruction: usually adhesional. Both small and large bowel may be visible. Ngt: decompress upper git, stops vomiting, prevents. Iv fluids: aggressive as pt. may be v. dehydrated aspiration. Regular clinical examination is necessary to ensure that the pt. is not deteriorating. Non-operative mx successful in ~80% of pts. c sbo w/o peritonitis. Pts. c lbo are more likely to need surgery. Failure of conservative mx (up to 72h) Typically involves resection of the obstructing lesion. Colon has not been cleansed therefore most surgeons utilise a proximal ostomy post-resection. Pts. c substantial comorbidity or unresectable tumours may be offered bypass procedures. Endoscopically placed expanding metal stents offer palliation or a bridge to surgery allowing optimisation.