Upload
others
View
4
Download
0
Embed Size (px)
Citation preview
Small bowel
Obstruction
Outline
• Definition
• Types
• Presentation
• Deferential Diagnosis
• Management
• Blockage of the flow of GI contents through the small
intestine
Classification
• Functional VS mechanical
• Partial VS complete
• Simple VS complicated
• Proximal VS distal
• Functional ( ileus )
✴Retroperitoneal hematoma
✴Post operative
✴Medications ( Narcotics )
✴Peritonitis
• Mechanical
✴Intraluminal ( Foreign body , Gallstone ileus)
✴Intramural ( intramural hematoma , malignancy,
strictures , Crohns disease )
✴External compression ( Adhesions, hernia,
carcinomatosis)
• Partial VS complete ;
✴Pathophysiology :
✴blockage of passage ==> increased intraluminal fluid
and gas
✴ ==> increased intraluminal pressure ==> decreased
venous return==> venous congestion and decrease
blood supply ==> ischemia and death of involved
intestine
• Simple VS complicated ( strangulation and ischemia ,
perforation ).
• Proximal VS distal .
Clinical presentation
• Abdominal pain ( characters ? )
• Constipation or Obstipation.
• Nausea and vomiting.
• ? fever ? BPR
• O/E ;
✴V/S ( signs of dehydration or sepsis ) .
✴Abdominal examination ( scars , HERNIA , peritonitis,
distention , hyperactive bowel sounds or silent
abdomen)
Laboratory Workup
• CBC.
• BMP and electrolytes.
• Lactate.
• Blood gas analysis.
Alarming findings
• Localized pain.
• Fever.
• Tachycardia.
• Peritonitis
• Elevated lactate after resuscitation
• Leukocytosis.
Imaging
• Plain films ( Abdominal X-rays supine and erect )
• Which one is more important ?
• Dilated small bowel loops ( > 3 cm )
• Paucity of air in the colon and rectum.
• Gas in the small intestine.
• Multiple air fluid levels on upright films
CT scan
• More sensitive and specific. ( 70-90%)
• Helps identify transition point.
• Can detect areas of compromised blood supply or
strangulation ( thickened wall, pneumatosis
intestinalis or perforation).
• Helps identify closed loop obstruction.
Enterolysis ( Small bowel
contrast study )
Treatment
• NPO.
• IVF ( maintenance and deficit ).
• NGT drainage.
• Serial abdominal examination
• Serial laboratory work up
Surgery
• Indications ;
• Non adhesive mechanical small bowel obstruction.
• Bowel ischemia or perforation.
• Closed loop obstruction ( emergency )
• Failure of adhesive SBO to resolve ( 48-72 hrs ?).