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Case 6: Small Bowel Obstruction
Terms in this set (24)
If a patient presents with a small bowel obstruction what is the first step in management?
Placement of a nasogastric tube to decompress the stomach and initiation of fluid resuscitation, in addition a Foley catheter should be placed to monitor urination
What are some of the complications or small bowel obstruction?
Strangulation, bowel necrosis, and sepsis
What is the typical treatment for small bowel obstruction?
What is the pain of a bowel obstruction due to?
Distention of the bowel or bowel ischemia
What is a closed loop obstruction?
When obstruction occurs at both the proximal and distal ends. This can be due to an incarcerated hernia. It rapidly progresses to strangulation
What is the definition of ileus?
Distention of the small bowel or colon from non-obstructive causes
What is an internal hernia?
A defect within the peritoneal cavity that can lead to small bowel obstruction
What is gallstone ileus?
Bowel obstruction due to a large gallstone, typically it occurs at the ileocecal junction
What are some of the common causes of small bowel obstruction in an infant or young child?
Hernia, malrotation, meconium ileus, intussusception, or intestinal atresia
What are some of the common causes of small bowel obstruction in an adult?
Adhesions, hernia, Crohn's disease, gallstone ileus, or a tumor
What is the common clinical presentation in a patient with a small bowel obstruction?
Cramp-like abdominal pain, nausea, and bilious vomiting
Is it possible for a person to have a small bowel obstruction and to have passed stool since the onset of the associated pain?
What are some of the findings that can be found on physical examination?
Low grade fever, mild diffuse abdominal tenderness, improvement with NG tube placement, and little or no stool in the rectal vault with DRE
Generally patients with a bowel obstruction that is located proximally will have more of what?
Generally patients with a bowel obstruction that is located distally will have more what?
What laboratory studies should be ordered in a patient who is suspected of having a small bowel obstruction?
A CBC, amylase, and UA.
What does the CBC typically show in a patient with small bowel obstruction?
A mild leukocytosis
What should be the initial imaging test to order in a patient suspected of a small bowel obstruction?
Abdominal x-ray. This will typically reveal a dilated small bowel with or without colonic air
What additional imaging is commonly done in patients whose SBO does not resolve with medical therapy?
What are some common findings of severe small bowel obstruction as seen on CT?
Intraperitoneal free air in the case of perforation, small bowel feces, mesenteric feces, whirl sign with volvulus, and decreased bowel wall enhancement
What is the treatment for uncomplicated partial small bowel obstruction?
Non-operative therapy that includes NPO, NG tube placement, IV fluid hydration, and follow up labs and x-rays
What is the operative treatment for adhesive small bowel obstruction?
Surgery with removal of adhesions and resection of any ischemic or necrotic bowel
If a person has an SBO within 30 days of a surgery what is the typical treatment?
Non operative treatment
In a patient with a high grade bowel obstruction, or in a patient suspected of having strangulated bowel what should the therapy be?
Early resuscitation and immediate surgery
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