Small Bowel Obstruction

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Small Bowel Obstruction

Examination

  • central abdominal distension
  • visible peristalsis
  • tenderness / guarding
    • implies ischaemic bowel
  • tinkling bowel sounds

Investigation

  • AXR
    • dilated loops
    • fluid levels
    • valvulae conniventes

Treatment

  • lots of fluid
    • e.g. 5l Dextrose saline over 24 hours
  • NBM
  • nasogastric tube
    • aspirated 4 hourly
  • analgesia
  • DVT prophylaxis
    • TEDS
    • Heparin / Clexane
  • Monitor fluid balance
    • pulse
    • BP
    • Urine
    • CVP
  • Bloods
    • FBC
    • U&E
    • Amylase
    • Group and Save
  • Surgery
    • only when rescucitated
    • indicated
      • if non obvious cause
      • strangulated hernia
      • evidence of peritonitis
      • after 48 hours if not settled
 

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