Bowel Obstruction
Features
- Anorexia
- Nausea
- Vomiting with relief
- Colicky abdominal pain with distension
- Constipation
- absolute is diagnostic of obstruction but need not be present if
obstruction is high
- 'Tinkling' bowel sounds
Investigations
- AXR - abnormal gas patterns
Large Vs Small bowel
- Small bowel obstruction
- vomiting earlier
- distension less
- pain higher in abdomen
- AXR show central gas shadows, no gas in large bowel
- Large Bowel Onstruction
- pain more constant
- pain often over distended caecum
- AXR - gas proximal to block, not in rectum
Ileus vs Mechanical
- No pain
- bowel sounds absent
Strangulated
- More ill than expected
- sharper, more constant pain - localised
- Cardinal sign is peritonism
- May be fever raised WCC
Management
- Conservative
- paralytic ileus, incomplete small bowel obstruction
- NG tube
- IV fluids & electrolytes
- Surgical
- Strangulation, large bowel obstruction (>8cm) = URGENT
- Sigmoid volvulus - flatus tube initially if not strangulated
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