Bowel Obstruction Flashcards
What is the weakest point of a suture?
The knot is the weakest point
What are some host risk factors for wound infection?
- Diabetes
- Hypoxemia
- Hypothermia
- Leukopenia
- Smoking
- Long term steroid use
- Malnutrition
What is a bowel obstruction?
Partial or complete blockage of the bowel resulting in failure of intestinal contents to pass through the lumen
What happens (pathogenesis) when someone has a bowel obstruction
- disruption of normal flow leading to proximal dilation, and distal decompression
- Bowel ischemia may occur
- Bowel wall edema
What are some risk factors for bowel obstruction?
- Prior abdominal or pelvic surgery
- Abdominal wall or groin hernia
- Hx malignancy
- Prior radiation
Causes of SBO (SHAVING) and the Top 3 causes (ABC)
S- stricture H- Hernia A- Adhesion V- Volvulus I- Intussusception N- Neoplasm G- Gallstones
Top 3 causes (In order)
A- Adhesion
B - Bulge (hernia)
C - Cancer
Small Bowel Obstruction clinical Presentation
- N/V: Early and may be bilious
- Colicky abdominal pain
- Constipated
- Normal to increased bowel sounds
Large Bowel Obstruction clinical presentation
N/V: Late and may be feculent
- Colicky abdominal pain
- Normal to increased bowel sounds
Abdominal XR findings with SBO
1) Air fluid levels
2) Ladder pattern from plicae circularis let you know its small bowel
3) Proximal dilation (>3cm)
4) Collapsed distal to obstruction (No colonic gas)
Abdominal XR findings LBO
1) Air fluid levels
2) Picture frame appearance
3) Proximal distention (>6cm), distal decompression
4) If ileocecal valve is competent then there is no small bowel air
Which imaging studies would you order with suspected bowel obstruction?
1) Abdominal X-ray (3 views) to differentiate SBO, LBO, and ileus
2) Upright chest XR or left lateral decubitus to rule out free air (Perforation)
3) CT scan to provide info on the level of obstruction, severity and cause
Which laboratory investigations would you order?
1) BUN, Cr, Hematocrit to assess degree of dehydration
2) Electrolytes
3) Amylase (elevated) due to ^ resorption due to SB inflammation
4) Metabolic alkylosis (if emesis)
5) WBC (if stragulation you get increased with L shift, lactic acidosis and elevated LDH)
Tx of Small bowel obstruction (conservative management)
- NG tube decompression
- GI rest
- Serial abdo exams
- Surgery if no resolution in 2-3 days or complication occur
Tx Small bowel obstruction (Strangulation)
- Urgent surgery after stabilizing patient with fluid resuscitation
Mortality for SBO?
- Non-strangulating:
