SMALL BOWEL OBSTRUCTION

Question 1

D/Dx

Answer 1

Adhesions
Hernias
Cancers
Intussusception, Volvulus (cecal, sigmoid), Strictures
Crohn’s disease Radiation Enteritis
Abscesses
Gallstone ileus Bezoars.

Question 2

Risk Factors

Answer 2

Previous surgeries
(especially appendectomy or hysterectomy).

Question 3

Labs / Imaging

Answer 3

CBC
Electrolytes
BUN
Cr
VBG
AXR
CT Abdo Pelvis with IV and oral contrast

Question 4

Acute Management

Answer 4

NG tube (use a salem sump
tube to low continuous suction)
IV fluids
NG replacements with 1:1 with NS+20meq KCL/l
Foley in
Analgesia
Anti Emetic

Question 5

AXR Features

Answer 5

should illustrate multiple air-fluid levels (upright film), distended loops of small bowel or colon (supine film), absence of free air on upright CXR.

Question 6

Imaging to distinguish complete vs incomplete SBO, ileus

Answer 6

CT Abdo Pelvis with IV and oral contrast

Question 7

DDx for paralytic ileus

Answer 7

Post operative ileus (normally resolves in 3-5 days)
Electrolyte abnormalities (hypokalemia, hypocalcemia)
Meds (anticholinergic, narcotics)
Inflammatory intra abdominal process
Sepsis
Spinal cord injury
Retro peritoneal hemorrhage