Small bowel obstruction

Question 1

Mechanical obstruction to the passage of intraluminal contents

Answer 1

SBO

Question 2

What are the signs and symptoms of SBO

Answer 2

Abdominal discofort
Cramping
nausea
Abd distention
Emesis
HIGH-PITCHED bowel sounds

Question 3

What are classic electrolyte/acid base findings with proximal obstruction

Answer 3

HYPO:volemic, chloremic, kalemic

ALKALOSIS

Question 4

What must be ruled out on PE in patients with SBO

Answer 4

Incarcerated hernia (look for surgical scars)

Question 5

What major Abdominal Xray

Answer 5

AIR-Fluid levels

Question 6

Define complete SBO

Answer 6

Complete obstruction of the lumen

PAUCITY or NO colon gas

Question 7

Danger of Complete SBO

Answer 7

Closed loop STRANGULATION of the bowel leading to bowel NECROSIS

Question 8

Define partial SBO

Answer 8

some colon gas

Question 9

What is the initial management of all patients with SBO?

Answer 9

NPO, NGT, IVF, FC

Question 10

What TESTS can differentiate PARTIAL form COMPLETE SBO?

Answer 10

CT with oral contrast, small bowel follow-through

Question 11

Causes of SBO? (ABCs)

Answer 11

1. Adhesions
2. Bulge (hernias)
3. Cancer and tumors

Question 12

What are other causes of SBO?

Answer 12

GIVES BAD CRAMPS!
G allstone ileus
I intussusception
V olvulus
E xternal compression
S MA syndome

Bezoars, Bowel wall hematoma
A bscesses
D iverticulitis

C rohn's disease
Radiation enteritis
A Annular pancreas
M eckel's
P ertioneal adhesions
S tricture

Question 13

What is superior mesenteric artery (SMA) syndrome?

Answer 13

Seen with weight loss - SMA compresses duodenum, causing obstruction

Question 14

What is the treatment of complete SBO?

Answer 14

Laparotomy and lysis of adhestions (LOA)

Question 15

Treatment of incomplete SBO?

Answer 15

Initially, conservative treatment with close observation plus NGT decompression

Question 16

Intraoperatively, how can the level of obstruction be determined in patients with SBO?

Answer 16

DILATED proximal to DECOMPRESSED bowel distal to the obstruction

Question 17

What is the most common indication for abdominal surgery in patient’s with Crohn’ss disease?

Answer 17

SBO due to STRICTURES!

Question 18

Can a patient have complete SBO and bowel movements and flatus?

Answer 18

Yes, the bowel distal to the obstruction can clear out gas and stool

Question 19

After small bowel resection, why should the mesenteric defect always be closed?

Answer 19

To prevent internal hernia

Question 20

What may cause SBO if patient is on COUMADIN?

Answer 20

Bowel wall ischemia

Question 21

What is the #1 cause of SBO around the world?

Answer 21

Hernias

Question 22

What is the #1 cause of SBO in children?

Answer 22

Hernias

Question 23

What are the signs of strangulated bowel with SBO?

Answer 23

FEVER
PAIN -severe/continuous
SHOCK
hematemesis
gas in bowel wall or portal vain
abdominal free air
PERITONEAL SINGS
ACIDOSIS(inceased lactic acid)

Question 24

What are the clinical parameters that will lower the the threshold to operate on a partial SBO?

Answer 24

Increasing WBC
Fever
Tachycardia
Abdominal pain

Question 25

What is the absolute indication for operation with PARTIAL SBO

Answer 25

Peritoneal signs, free air on AXR

Question 26

What classic saying is associated with complete SBO?

Answer 26

“Never let the sun set or rise on complete SBO”

Question 27

What condition commonly MIMICS SBO?

Answer 27

Paralytic ileus (AXR reveals gas distention THROUGHOUT, including the colon)

Question 28

What is the differential diagnosis of paralytic (non obstructive) ileus?

Answer 28

Post operative ileus after abdominal surgery (usually resolves 3-5 days)
Electrolyte abnormalities (hypokalemia MC)
Medications (anticholinergics, narcotics)
Inflammatory intra-abdominal process
Sepis/shock
Spine injury

Question 29

What tumor classically causes SBO due to “mesenteric fibrosis”?

Answer 29

Carcinoid tumor