GENERAL SURGERY
GENERAL SURGERY
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LARGE BOWEL OBSTRUCTION
LARGE BOWEL OBSTRUCTION
ABOUT THIS SESSION
ABOUT THIS SESSION
This is a self-directed learning resource designed to be worked through in the clinical environment.
Learning objectives:
Learning objectives:
- Demonstrate focused history taking from a patient presenting with likely large bowel obstruction (LBO)
- Perform an abdominal/GI examination and describe relevant clinical findings
- Suggest appropriate investigations and be able to interpret results to the level of an FY1 doctor
- Suggest a management plan for a patient with LBO in the acute setting and understand the basic principles behind ongoing management
Total time:
60 minNumber of students:
2-6Grade of students:
3rd to 5th year medical studentsCreated by:
Dr Emma SewartUploaded:
15th October 2019Last updated:
15th October 2019Resources needed for this session:
Resources needed for this session:
Patient, pen, paper
Resources linked to this session:
Resources linked to this session:
Activity 1: History Taking and Examination
20 minActivity 1: History Taking and Examination
Take a focused history from a patient presenting with large bowel obstruction, to include past medical and surgical history, drug history, family history and social history. Following this, perform a focused abdominal examination.
Activity 2: Diagnostic Reasoning
10 minActivity 2: Diagnostic Reasoning
Consider:
- What is the most likely diagnosis and why?
- What are the important differentials for the patient's presentation and why are these less likely?
- What investigations would be useful acutely and why?
- What are the commonest causes of this presentation?
Activity 3: Blood Gas Interpretation
5 minActivity 3: Blood Gas Interpretation
Review blood gas results from the patient if possible. If none are available, use the example opposite.
Consider
- Is there a pH disturbance?
- Is this likely a metabolic or respiratory disturbance?
- What is the likely pathological process underlying this?
- How would this result influence your management?
Arterial Blood Gas Results Example
pH 7.31 (7.35 – 7.45)
PaO2 12.2kPa (10.0 – 13.1)
PaCO2 3.5kPa (4.9 – 6.1)
HCO3 31mM (22 – 28)
Lac 4.7mM (<2.0)
Activity 4: Investigations
5 minActivity 4: Investigations
Review the patients abdominal x-ray. If none are available, use the image opposite. Consider:
- What are the common AXR findings in large bowel obstruction?
- How would you differentiate large vs. small bowel on AXR?
Activity 5: Advanced Imaging
minActivity 5: Advanced Imaging
Discuss the role of CT scans in diagnosing large bowel obstruction - what are the pros and cons?
If possible review the patients abdominal CT to identify key anatomy below. If none is available use the example opposite.
- Liver
- Stomach
- Pancreas
- Spleen
- Kidneys
- Small bowel
- Large bowel
- Any key pathology!
Work through an interactive CT image via this link.
Activity 7: Further Management
10 minActivity 7: Further Management
What is the key immediate/acute management for patients presenting with large bowel obstruction?
What definitive management options are available for large bowel obstruction secondary to colorectal cancer.
Consider the following points:
- What are the different operative and non-operative management options?
- What factors might influence the choice of management in the acute setting?
- What will be the next steps for this patient (staging, MDT, further surgery (or not) etc.)
Summary and Feedback
Summary and Feedback
Highlight three key things you have learned today. Summarise them on a post-it note and keep it somewhere you will find in a week or two.
Found this useful? Please leave some feedback.
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