[Surgery] Small Bowel Obstruction Flashcards
what are the 2 categories of small bowel obstruction (SBO)?
- mechanical
2. functional
what is meant by mechanical SBO?
physical compression of the bowel
what is meant by functional SBO?
dysmotility of the bowel
what are the most common causes of mechanical obstruction?
post-op adhesions
what do pts with SBO present with?
1 or a combination of:
- abdo distension
- colicky abdo pain
- vomiting
- absolute constipation (no faeces or flatus)
what is the mx of SBO based on?
CT and clinical findings
how should a simple adhesional SBO or pts not suitable for surgery be managed?
conservative mx with NG tube and IV fluids (drip and suck)
SBO highly suspected / seen on AXR and pt is acutely unstable with imminent risk of death. what is your next mx?
emergency laparotomy
SBO highly suspected / seen on AXR and pt is stable. what is your next mx?
CT abdo pelvis with IV contrast
if eGFR <30, CT without contrast
CT abdo pelvis with IV contrast shows bowel ischaemia, obstructive lesion / closed loop obstruction. next mx?
emergency laparotomy
CT abdo pelvis with IV contrast does not show bowel ischaemia, obstructive lesion / closed loop obstruction. next mx?
= adhesional SBO → conservative mx
what are clinical evidences of ischaemia?
- peritonism
- high lactate
- irreducible and discoloured hernia
what is the pathophysiology behind an extrinsic obstruction?
external compression e.g. hernias, adhesions, volvulus
what is the pathophysiology behind an intrinsic “disease” causing an obstruction?
disease of the small bowel wall causing internal blockages e.g. inflammatory strictures, tumours
what is the pathophysiology behind an intrinsic obstruction?
normal bowel wall, but a foreign body or abnormal bowel lie causes a block e.g. intusussception, bezoars (undigested material e.g. hair)
