FN: Bowel obstruction : Generla Management

Question 1

Medical management

Answer 1

1. Resuscitate: “drip and suck”
2. Therapy
3. Monitoring

Question 2

Resuscitate

Answer 2

NBM
IV fluids: aggressive as pt. may be v. dehydrated
NGT: decompress upper GIT, stops comiting, prevents aspiration
Cathertise: monitor UO

Question 3

Therapy

Answer 3

1. Analgesia: may required strong opiod
2. Antibiotics cef + metronidazole if strangulation on perforation
3. Gastrogaffin study: oral or via NGT
4. Consider need for parentreral nutrition

Question 4

Surgical management indications

Answer 4

closed loop obstruction
obstructing neoplasm
Stranglation/perforation - sepsis peritonitis
Failure of conservative MX (up to 72h)

Question 5

Surgical principals

Answer 5

aim to treat the cause
Involves resection
Can use stents
Often with no bowel prep can create a hartmanns

Question 6

Procedures

Answer 6

Must consent pt. for possible resection ± stoma
SBO: ahdesiolysis
LBO:
1. Hartmanns
2. Colectomy + primary anastomosis + on table lavage
3. Palliative bypass procedure
4. Transverse loop colostomy or loop ileostomy
5. Caecostomy