bowel obstruction

Question 1

What are the four main features of bowel obstruction?

Answer 1

C o nstipation (m ay n o t be absolute), vomiting, colicky abdominal
pain, distension.

Question 2

What features in a patient’s history would make you think of
small-bowel obstruction over large-bowel obstruction?

Answer 2

Small-bowel obstruction (any two of the following): pain is higher
in the abdomen as it is a midgut structure, vomiting occurs earlier
and abdominal distension is less.

Question 3

Give four common causes of bowel obstruction.

Answer 3

Constipation, adhesions, hernias, tum our, diverticulitis.

Question 4

What clinical sign would distinguish between an ileus and a
mechanical obstruction?

Answer 4

Absence o f bow el sounds indicates an ileus. Tinkling bowel
sounds supports a mechanical obstruction.

Question 5

What investigation would help you to distinguish between a
small- and large-bowel obstruction?

Answer 5

Abdominal X-ray.

Question 6

What immediate management would you start?

Answer 6

Bowel rest - ‘drip and suck’. T h e p atien t should be m ade nil by
m o u th and a nasogastric tube should be passed to rest th e bow el
from the gastric con ten ts produced each day. Intravenous fluids
should be started to adequately rehydrate the patient.