Recognizing bowel obstruction and ileus. Flashcards
Why are bowel sounds high pitched and hyperactive in SBO?
Because peristalsis continues and increases in an effort to overcome the obstruction.
What is wrong with this pt?
Sentineal loops aka localized ileus. Probably 2/2 acute pancreatitis based on location.
What is wrong with this pt?
Generalized adynamic ileus. Dilated loops of small and large bowel with gas seen down to an including rectum. Pt underwent colon surgery previous day.
ID what is wrong with the pt.
Generalized adynamic ileus
What is indicated by the arrows?
Stepladder appearance of obstructed small bowel. As they begin to dilate, small bowel loops stack up, forming a step ladder appearance usually beginning in LUQ and proceeding to right lower quadrant. More proximal the SBO, the fewer the dilated loops there will be.
What is wrong with the patient?
Generalized ileus 2/2 ischemic bowel. Note the thickened bowel wall (this is how you know the pt has ischemia).
What is wrong with the pt?
Partial SBO. Small bowel is disproportionately dilated compared to large bowel – finding suggestive of SBO. ADhesions are most likely etiology.
ID what is wrong.
Partial SBO because there is gas in large bowel.
What are the arrows pointing to?
small bowel feces sign. there is air mixed with debris and old oral contrast in a dilated loop of small bowel. The pt had a CT with oral contrast several days earlier and returned for this non contrast scan when sx persisted. Intestinal debris and fluid may accumualte in the loop proximal to SBO and produce this finding which resembles fecal matter in colon.
ID what is wrong.
Closed loop obstruction in terminal ileum. A loop of small bowel obstructed twice at same point produce the closed loop. No oral contrast enters this loop but is present at more proximal loop. These obstructions have higher incidence of necrosis 2/2 strangulation of bowel.
What is wrong
Large bowel obstruction– look for air in cecum/dilatation of cecum.
What is the dx
Large bowel obstruction – look for air in cecum
Dx?
Caecal volvulus
Dx?
Sigmoid volvulus. Classic coffee bean shape. The wall between the two volvulated loops of sigmoid (black arrow) always points to the RUQ. Considerable amt of stool in colon 2/2 chronic constipation.
