Small Bowel Obstruction Flashcards
A 60-year-old male patient with history of old laparotomy, presented with central abdominal pain , vomiting & abdominal distension. You have been called by nursing staff because he became confused.
A 60-year-old male patient with history of old laparotomy, presented with central abdominal pain , vomiting & abdominal distension. You have been called by nursing staff because he became confused.
Given the following radiograph:
Q1: What’re the findings?
Abd x-ray showing dilated small bowel due to ints. Obstruction
Q2: How to scan him?
US , CT WITH CONTRAST
XRAY – VEIWS Erect and spine
Q3: How to manage him?
According CCRISP
Q4: How to assess circulation?
Vital signs , mental status and UOP, capillary refill time
Q6: How to diagnose hypoxia?
Pulse oximeter or ABG, central venous O2 Pressure
Q5: If capillary refill is 4 seconds, what does that indicate?
Delayed refill
Due to dehydration or hypoxia
Q7: What to expect in ABG?
Met. Acidosis due to dehydration and sepsis and accumulation of lactate
Either companseted or not
Q8: Hb dropped from 13gm to 9?What does that indicate?
Due to ongoing bleeding or over hydration leading to dilutional
Q9: What are the factors affecting tissue oxygenation? Mention the equation.
COP, Hb concentration, arterial O2 Content
DO2 = COPxHbxSO2x1.34
Q10: How O2 is carried in blood?
Large part binding to Hb
Small part is dissolved
Q11: What’re the factors affecting affinity of Hb to O2?
Partial pressure of Co2 / temp / conc. of 2.3-DPG / presence of unusual Hb
Q12: Now he regained his consciousness, what’s next?
Full assesment of the pt
Hx and examination
Chart review (News Chart)
Manage according to the chart
Stable – > daily management plan
Unstable – > dx , invx and definitive care
NEWS Chart –> vital signs + mental status+ UOP
Q13: In FBC, MCV & MCHC are low. What does this mean?
Pt has microcytic hypochromic anemia
invx for TIBC , ferritin and FIT Test, Bidirectional endoscopy.
