Bowel Obstruction

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Bowel Obstruction

• Tintinallis Ch 86

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Definition

• The inability of the intestinal tract to allow
  for regular passage of food and bowel contents
  secondary to mechanical obstruction or adynamic
  ileus

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Causes

• SBO
• Most common cause is adhesions after abdominal
  surgery
• 2 MCC is incarceration of groin hernia
• Then inflammatory bowel disease, bariatric
  surgery, blunt trauma
• LBO
• Neoplasm MCC

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Pathophysiology

• Intraluminal accumulation of gastric contents ?
  vomiting/decreased PO intake ?volume depletion
  ?electrolyte imbalance ? renal failure/shock
• Mortality approached 70 if bowel obstruction
  progresses to shock

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Clinical Features

• Diffuse, crampy, intermittent abdominal pain
• Abdominal distention
• N/V
• Constipation
• High pitched bowel sounds in obstruction
• Hypoactive BS in adynamic ileus

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Work Up

• CBC, BMP
• WBC gt20K ?bowel gangrene/peritonitis
• Lactic Acid
• Plain films
• CXR for free air
• Flat, upright, decub view
• CT with IV and ORal

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(No Transcript)
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Treatment

• If true mechanical obstuction ? Surgery
• NG tube often unnecessary, but consider if severe
  distention and vomiting
• IVF
• Broad-spectrum Abx
• If adynamic ileus ? conservative measures
• IVF, observation
• Dc any meds that inhibit bowel motility