Small Bowel Obstruction (1)

Question 1

What is the most common cause?
→ What are some other causes?

How does it present?

Answer 1

➊ Adhesions
→ • Hernia
• Intussusception
• Gallstone

➋ • Abdominal pain – Initially colicky, then becomes continuous
• Abdominal distension
• Absolute constipation (no faeces or flatus)
• Bilious vomiting
• O/E - Tympanic, high-pitched BS

Question 2

Investigations:
Which bloods should be done?
→ Which is lactate done?
→ Why is a VBG done?

What is the 1st line imaging to do?
→ What will be seen?

What else could be done?

Answer 2

➊ FBC, U&Es, Lactate, VBG
• U&Es for any electrolyte imbalances
→ Raised in bowel ischaemia
→ Shows metabolic alkalosis due to vomiting

➋ AXR
→ Dilated bowel loops, Valvulae conniventes

➌ Erect CXR – Look for pneumoperitoneum if suspected perforation

Question 3

How is it managed conservatively?
→ What should be avoided here?

What should be done if conservative options don’t work?

Answer 3

➊ • NBM
• Drip and Suck – IVF, NG (Aspirate for decompression)
• Anti-emetics
→ Metoclopramide as it’s a prokinetic, which may worsen the obstruction and increase the risk of perforation

➋ Surgery