Small Bowel obstruction, large bowel obstruction Flashcards
acute colonic pseudoobstruction (Ogilvie syndrome)
dilated colon without mechanical observation; unclear etiology from it but likely from combination of autonomic nervous systems or electrolyte abnormalities
causes of acute colonic pseudoobstruction (Ogilvie’s)
major surgery, traumatic injury, severe infection
electrolyte derangement (low K, low Mg, low Ca)
medications (opiates, anticholingerics)
neurological disorders (stroke, dementia)
clinical findings of acute colonic pseudoobstruction
abdominal distention, pain, obstipation, vomiting
tympanic to percussion, decreased bowel sounds
if perforation, guarding, rigidity rebound tenderness
Imaging findings of acute colonic pseudoobstruction
Xray: colonic dilation, normal haustra, non dilated small bowel
CT scan with colonic dilation without anatomical obstruction
Management of acute colonic pseudoobstruction
NPO, nasogastric or rectal tube decompression
supportive care
neostigmine if no improvement 48 hrs or if cecal diameter is >12 cm.
who gets acute colonic pseudoobstruction (Ogilvie syndrome)?
institutionalized men age>60 or hospitalized.
who should not get neostigme?
those with recent MI, bradycardia and beta blocker therapy or active bronchospasm or PUD.
It can lead to bradycardia, bronchospasm, hypotension.
if pt fails neostigme for acute colonic pseudoobstruction what to do next
may need colonscopic or surgical decompression including a percutaneous tube cecostomy
do we ever use methylnatrexone for acute colonic pseudoobstruction treatment?
no because it can increase risk for bowel perforation.
crampy periumbilical abd pain with nausea and vomiting without radiatio nto the back and history of abdominal surgery
likely proximal small bowel obstruction.
complete bowel obstruction characteristics:
obstipation and can’t pass flatus
generally starts 12 to 24 hrs after onset of obstruction.
what is the next step to do after suspected bowel obstruction?
get CXR upright and supine abdominal films to diagnose SBO
do not need further imaging.
what is seen on XR for SBO?
see multiple air-fluid levels with distended small bowel loops. air in colorectal area rules out complete obstruction
when to order CT abd with oral and IV contrast?
when CXR and AB XR are non diagnostic for SBO
CT scans are better at looking at SBO etiology, evidence of ischemia or closed loop obstructions.
But if CT abd is non diagnostic then order a small bowel series (as they are as great as CT scans).
non operative management of SBO is:
NPO, fluid resuscitation and electrolyte repletion and serial abdominal examinations and strict monitoring of UOP and NG output.
