Adult Small Bowel Obstruction

Question 1

Case study:

Answer 1

32 year old man presents with intermittent colicky abdominal pain and vomiting
- Crescendo with free intervals
- He is constipated and has abdominal distention.
Past history:
- Laparotom; perforated appendix about 5 years ago.
Clinical exam:
- Dehydrated, visible peristalsis, distended abdomen, tingling bowel sounds
Rectal exam:
- Empty, no blood

Question 2

What is the case study diagnosis?

Answer 2

Small bowel obstruction.

Question 3

What is the cause of the case study diagnosis?

Answer 3

Adhesions

Question 4

What is the management process for the diagnosis of the case study?

Answer 4

Nasogastric suction tube
Intravenous fluids
Surgery

Question 5

Keeping the diagnosis of the case study in mind, what should be monitored?

Answer 5

Clinical response 
Blood gas
Metabolic changes 
Myoglobin 
Electrolyte abnormalities

Question 6

What is the surgical management of small bowel obstructions?

Answer 6

• Resection of necrotic and ischemic bowel.

- Discharge within a week

Question 7

What is small bowel obstruction? Name 2 classifications of this disease.

Answer 7

Two Classifications of small bowel obstructions are:

1. Mechanical/dynamic obstructions
2. Non-chemical/Adynamic (ileus) obstructions.

Question 8

How is normal motility achieved in the small bowel?

Answer 8

Through electrical activity
- Contractile potentials are created by spike discharges
- Small bowel contractions are achieved
> Ring contractions
> Peristaltic contractions

Question 9

Give an example of mechanical obstructions of the small bowel:

Answer 9

• Simple Lumen

- Complicated (strangulated);: compromised blood supply.

Question 10

Explain the concept of Non-mechanical obstructions of the small bowel:

Answer 10

In this case there is no barrier to progress of content

• It is a Neurological failure.
• There is poor peristalsis.
• Gas is found throughout the bowel.
• A Non-operative approach is required.

Question 11

Give 5 causes of adynamic obstruction of the small bowel:

Answer 11

Peritonitis. 
Mesenteric occlusion. 
Pelvic fracture. 
Retro-peritoneal hematoma.
Metabolic disorders 
  - CKD 
  - Hyponatraemia 
  - Hypokalaemia
  - Uraemia

Question 12

Name 4 causes of mechanical small bowel obstructions:

Answer 12

1. Adhesions
2. Hernia’s
3. Inturesusseption
4. Carcinomas

Question 13

Explain adhesion formation and how they are related to small bowel obstructions:

Answer 13

Adhesions can be formed in the following ways:

• Congenital or acquired (previous surgery, inflammation, infection)
• Tough fibrous bands connective tissue (scaring)

Question 14

What pathophysiological reactions can one expect in the bowel due to small bowel obstructions:

Answer 14

Reactive hyperperistalsis 
Luminal distention 
  - Gas 
  - Fluid 
Bacterial fermentation 
Edema and mural transudation

Question 15

What clinical features are seen in patients with small bowel obstructions ?

Answer 15

Pain
Tenderness 
Temperature 
Distention 
Vomiting 
Constipatin 
Increased bowel sounds

Question 16

What procedures are used in the management of the treatment of a small bowel obstruction?

Answer 16

• Nasogastric suction
  
  • Surgery
  • IV fluid
  • Correction of electrolytes
  • Monitoring
  • Removal of cause

Question 17

Monitoring is an Important part of the management of small bowel obstruction treatment.
What are some red flags to look out for?

Answer 17

Dehydration. 
Pain and tenderness. 
Electrolyte derangement. 
Blood gas fluctuation. 
Elevated WBC. 
Free intra-peritoneal gas.

Question 18

What are some in Indications for surgery?

Answer 18

Peritonitis 
Hernia 
Evidence of ischaemia 
Metabolic derangement lion-resolution 
Cancer