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Small bowel obstruction
Small bowel obstruction can occur due to various intraluminal, extramural, or intramural causes that obstruct the lumen. The clinical manifestations include abdominal pain, vomiting, distension, and constipation. Diagnosis involves history, physical exam, abdominal x-rays showing dilated small bowel loops and air-fluid levels. Management depends on the severity and includes supportive care, surgery for complete or strangulated obstructions, or potentially conservative management for some inflammatory causes.
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Small bowel obstruction
- 1. SMALL BOWEL OBSTRUCTION Topic discussion: Acute Abdomen นศพ.ณัฐริกา กานาค ชั้นปีที่ 4
- 2. Small Bowel Obstruction • Clinicalmanifestation • Epidemiology • Pathophysiology • Type • Complication • Diagnosis • Management
- 3. Clinical manifestation • The4 cardinals signs • Abdominal colicky pain • Vomiting • Abdominal distension • Absolute constipation (Obstipation)
- 4. Epidemiology • Intraluminal • Foreignbodies • Bezoars • Gallstones • Parasites • Extramural • Bands/adhesions • Hernia • Intramural • Stricture • Crohn’s disease • Malignancy • Intussusception • Volvulus
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- 6. Pathophysiology • The distensionproximal to an obstruction is caused by two factors: • Gas: there is a significant overgrowth of both aerobic and anaerobic organisms, resulting in considerable gas production. Following the reabsorption of oxygen and carbon dioxide, the majority is made up of nitrogen (90 per cent) and hydrogen sulphide. • Fluid: this is made up of the various digestive juices (saliva 500 mL, bile 500 mL, pancreatic secretions 500 mL, gastric secretions 1 litre – all per 24 hours). This accumulates in the gut lumen as absorption by the obstucted gut is retarded.
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- 9. Pathophysiology • Dehydration andelectrolyte loss are therefore due to: • reduced oral intake • defective intestinal absorption • losses as a result of vomiting • sequestration in the bowel lumen • transudation of fluid into the peritoneal cavity
- 10. Type • Proximal orDistal • Partial (incomplete) or Complete • Simple or Strangulation • Mechanical or Functional
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- 12. SBO : Strangulation •Localized abdominal tenderness • Constant pain, severe pain • Fever • Tachycardia • Leukocytosis • Acidosis
- 13. Diagnosis • History • Physical examination •Acute abdomen series • Dilated small bowel loop • Air-Fluid Level • Absent or decrease large bowel gas
- 14. Diagnosis • History • Physical examination •Acute abdomen series • Dilated small bowel loop • Air-Fluid Level • Absent or decrease large bowel gas
- 15. Diagnosis • History • Physical examination •Acute abdomen series • Ultrasound • CT scan • Small bowel series or Enteroclysis
- 16. Management Supportive Tx • NPO •Fluid Resuscitation & urine output monitoring • Pass NG tube( diagnostic/therapeutic purpose) • I.V antibiotics if indicated : Enteric Gram-negative bacilli, anaerobes, enterococci Symptomatic Tx • Analgesia after confirming diagnosis Specific Tx • Surgery
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- 18. Management Immediate operation • CompleteSBO • SBO with • Peritoneal sign • Suspected or confirm Strangulation • Incarcerated strangulated hernia • Closed loop obstruction
- 19. Management More conservative (Nonoperativemanagement) • Early postoperative bowel obstruction • Inflammatory bowel • Infectious small bowel disease – Patients who present with a partial small bowel obstruction due to tuberculosis may improve with medical management, although, similar to Crohn’s disease, delayed diagnosis is more likely to require surgery. • Colonic diverticular disease causing small bowel obstruction – Antibiotic therapy reduces peridiverticular inflammation and may relieve obstructive symptoms.