Small bowel obstruction Flashcards

1
Q

How common is it?

A

.

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2
Q

What causes it?

A

The most common cause of small-bowel obstruction (SBO) in developed countries is intra-abdominal adhesions, accounting for approximately 65% to 75% of cases.
Postoperative adhesions can be the cause of acute obstruction within 4 weeks of surgery or of chronic obstruction decades later.

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3
Q

What risk factors are there (and how can they be reduced)?

A
  • previous abdominal or pelvic surgery
  • previous radiation therapy
  • history of malignancy: particularly ovarian and colonic malignancy
  • inflammatory bowel disease.
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4
Q

What signs may the patient have on examination?

A
Abdominal distension
Hyperactive bowel sounds
Gross/occult faecal blood on PR
Abdominal masses
Fever 
Tachycardia
Peritonism (guarding, rigid abdomen, rebound tenderness, pain out of proportion to the examination)
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5
Q

Which other conditions might present similarly?

A
Acute Cholangitis
Acute Cholecystitis and Biliary Colic
Alcoholic Ketoacidosis
Constipation
Diverticulitis
Dysmenorrhea
Early Pregnancy Loss
Endometriosis
Gallstones (Cholelithiasis)
Inflammatory Bowel Disease
Mesenteric Ischemia Imaging
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6
Q

How would you investigate this patient?

A
FBC
Urinalysis
U&Es
Abdo X-ray
Abdo CT
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7
Q

what treatment/s (surgical, pharmacological and non-pharmacological) would you discuss with
them? What risks and benefits of treatment are there?

A
  • In the absence of signs of strangulation and a history of persistent vomiting or combined computed tomography (CT) scan signs, patients with partial ASBO can be safely managed with nonoperative management; tube decompression should be attempted
  • Nonoperative management can be prolonged for up to 72 hours in the absence of signs of strangulation or peritonitis; surgery is recommended after 72 hours of nonoperative management without resolution
  • Open surgery is frequently used for patients with strangulating ASBO and after failed conservative management; in appropriate patients, a laparoscopic approach using an open access technique is recommended
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8
Q

what treatment/s (surgical, pharmacological and non-pharmacological) would you discuss with
them? What risks and benefits of treatment are there?

A

.

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