3 Bowel Obstruction

Question 1

intestinal pseudo-obastruction

Answer 1

Ogilvie’s syndrome

Question 2

examples of closed-loop obstruction

Answer 2

incarcerated hernia
complete colon obstruction in the presence of a closed ileocecal valve

Question 3

accounts for most bowel obstruction

Answer 3

SMALL bowel obstruction
1. adhesion after abdominal surgery
2. incarceration of a hernia

blunt abdominal trauma may cause a duodenal hematoma

Question 4

remarks on bezoars

Answer 4

most commonly composed of
- vegetable matter
- pul from persimmons

patients who have undergone GI pyroloplasty or pyloric resection are most susceptible to intraluminal obstruction by bezoars

Question 4

causes of large bowel obstruction

Answer 4

1. NEOPLASMS, especially in the eldrely
2. diverticulitis
3. sigmoid volvolus

Question 5

remarks on sigmoid volvolus

Answer 5

most at risk for volvolus:
elderly, bedriddne, or psychiatric patients who are taking anticholinergic medicaitons

Question 6

ileus vs bowel obstruction

Answer 6

ILEUS
decreased bowel sounds
labs: possible dehydration
tx: observation, hydration

BOWEL OBSTRUCTION
high-pitched bowel sounds
if obstruction has been present for several hours, peristaltic waves and bowel sounds may be diminished
labs: leukocytosis
tx: NGT, surgery

Question 7

remarks on bowel obstruction

Answer 7

abdominal pain is nearly universal

SBO
distention is the most reliable sign

SIGMOID VOLVOLUS
emptiness of the left iliac fossa is a reliable sign

‼️ presence of stool or air in the rectal vault does NOT eliminate a more proximal obstruction ‼️

Question 8

WBC in bowel obstrruction

Answer 8

> 20,000/mm3
- bowel gangrene
- intra-abdominal abscess
- peritonitis

> 40,000/mm3
- mesenteric vascular occlusion

Question 9

remarks on imaging in relation to bowel obstruction

Answer 9

in the ED, flat and upright abdominal radiographs with an upright chest radiograph or a lateral decubitus view are of LITTLE UTILITY ‼️

CT SCAN WITH ORAL AND IV CONTRAST
- the imaging of choice in the ED
- provides information on location, severity, and cause of obstruction

Question 10

management of bowel obstruction

Answer 10

many patients with SBO may be successfully managed nonoperatively
whereas most patients with LBO will requuire surgery

**vigorous IVF replacement8* is needed bec of loss of absorptive capacity, dec oral intake, and vomiting

pre-op broad-spectrum antibiotics
- piptaz, 3.375 g IV q6
- ticarcillin-clavulanate 3.1 g IV q6
- carbapenem

Question 11

remarks on NGT

Answer 11

use of NGT is often unnecessary

but should be considered in the presence of severe distention and vomiting

local surgeon preference continues to dictate local practice with regard to NGT use

Question 12

mgt of adynamic ileus

Answer 12

IVF and observation
discontinue meds that inhibit bowel mobility
should also be admitted for the traetment of the underlying cause and until resolution of ileus

Question 13

the most reliable sign in SBO

Answer 13

abdominal distention

Question 14

a reliable sign in sigmoid volvolus

Answer 14

emptiness of the left iliac fossa is a reliable sign