Small bowel obstruction

common problem in acute abdomen
which have 4 cardinal sign

1. Small Bowel Obstruction Topic discussion : Acute Abdomen นศพ.ณัฐ ริกา กานาค ชั้นปีที่ 4

2. Small Bowel Obstruction Clinical manifestation Epidemiology Pathophysiology Type Complication Diagnosis Management

3. Clinical manifestation The 4 cardinals signs Abdominal colicky pain Vomiting Abdominal distension Absolute constipation (Obstipation)

4. Epidemiology Intraluminal Foreign bodies Bezoars Gallstones Parasites Extramural Bands/adhesions Hernia Intramural Stricture Crohn’s disease Malignancy Intussusception Volvulus

5. Epidemiology

6. Pathophysiology The distension proximal 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.

7. Pathophysiology

8. Pathophysiology

9. Pathophysiology Dehydration and electrolyte 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 or Distal Partial (incomplete) or Complete Simple or Strangulation Mechanical or Functional

11. SBO : Strangulation

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

17. Management

18. Management Immediate operation Complete SBO SBO with Peritoneal sign Suspected or confirm Strangulation Incarcerated strangulated hernia Closed loop obstruction

19. Management More conservative ( Nonoperative management) 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.