Large Bowel Obstruction

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Examination

  • general abdominal distension
  • tinkling bowel sounds
  • RIF tenderness
    • implies risk of caecal perforation

Diagnosis

  • AXR
    • distended large bowel +/- small bowel

Treatment

  • fluids
    • 4l Normal saline / 24 hours
  • Bloods
    • FBC
    • U&E
    • LFTs
    • Blood sugar
    • cross-match 2 units
  • DVT prophylaxis
    • TEDS
    • Heparin / clexane
  • Antibiotics
  • CXR
  • ECG
  • Analgesia
  • consider nasogastric tube
  • Surgery
    • urgent - within 12-24 hours
    • emergency if caecal tenderness
    • (??) consider PR/sigmoidoscopy/barium enema
 

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