Large bowel obstruction power point (3)
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Large bowel obstruction power point (3)

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Large bowel obstruction power point (3) Large bowel obstruction power point (3) Presentation Transcript

  •  78 year old white female T: 99.0 P 115 R 16 BP 110/75 presents from nursing Gen: Elderly white female with chronic debilitation, actively home with increasing vomiting in room. abdominal HEENT: PERRL, NC/AT, distention, vomiting, cra Oropharynx clear, mping abdominal CV: mildly tachycardic, no m/r/g pain, and 3 days of Pulm: CTAB constipation. Pt has a Abd: abdominal distention, decreased bowel sounds, history of chronic diffuse TTP, hyperressonance to constipation. percussion Ext: 2+ pulses, no c/c/e
  • What is Diagnosis?(1) Dilated Colon >6cm(2) Effacement of Haustrae Peripherally located(3) Multiple Air Fluid LevelsLarge Bowel Obstruction
  •  IV & IVFs Analgesics & Antiemetics NG decompression Antibiotics for Gram (-) Aerobes & Anaerobes (ie. Flagyl, Cipro, Zosyn, Clindamycin) Surgery Consult Admission for all LBO Emergency Laparotomy if:  (1) Peritonitis (2) Peritoneal Free Air (3) Sepsis (4) Cecal Distention >12cm
  •  How to Differentiate Large from Small Bowel Obstruction: Gas in the Large Bowel is usually situated peripherally.  Gas in the small bowel is usually centrally located. Large intestine has haustrae, which are blunter, thicker, and do not completely transverse intestine.  Small Intestine has valvulae conniventes that transverse width of intestine, giving it a ribbed appearance. Feces are only found in Large Intestine.
  •  Rule of 3,6,9:  suspect obstruction if small bowel dilated >3cm; large bowel >6cm, cecum >9cm. Causes of LBO:  Carcinoma (60%), Diverticulitis (20%), Volvulus (10%)
  •  String of Pearls Sign = obstruction  Small Bowel: air pockets trapped in valvulae of small intestine, smaller, rounder  Large Bowel: air pockets trapped in haustra, larger, and have flat underside Large Small Bowel Bowel
  •  Greenberg, Michael. Greenberg’s Atlas of Emergency Medicine. Ginzberg, Leon. “X-Ray Diagnosis of Acute Intestinal Instruction Without the Use of Contrast Media” Annals of Surgery Lifeinthefastlane.com “Abdominal X-Ray Interpretation” Schwartz, David. Emergency Radiology. 2000. pg 527- 529. Tintanelli’s Emergency Medicine: A Comprehensive Study Guide. Chapter 79 Intestinal Obstruction