2 CaseA 50 year old man presents with abdominal pain, distension and absolute constipation. With repeated episodes of vomiting.Vital sign were stable, abdomen distended with diffuse tenderness but minimal peritonism. Bowel Sounds are hyperactive.The plain abdominal xray was taken on admission.
3 DefinitionLack of transit of intestinal contents is called intestinal obstructionIntestinal obstruction is a very common problem encountered in the ED, accounting for up to 15% of all emergency admissions for abdominal pain.
7 Differentiating SBO from Paralytic Ileus SBOIleusEtiologyPatient with prior surgery weeks to years priorRecent (hours) post- operative patientPainColickyNot a prominent featureAbdominal distensionFrequently prominentSometimes not apparentBowel soundsUsually increasedUsually absentSmall bowel dilatationPresentLarge bowel dilatationAbsent
11 Clinical Findings 1. History Colicky abdominal pain, vomiting, constipation (absolute), abdominal distension.ColonicPre-existing change in bowel habitColicky in the lower abdomenVomiting is lateDistension prominentDistal small bowelPain: central and colickyVomitus is feculuntDistension is severeVisible peristalsisMay continue to pass flatus and feacus before absolute constipationProximal small bowelPain is rapidVomiting copious and contains bile jejunal contentAbdominal distension is limited or localizedRapid dehydration
12 Clinical Findings 2. Examination OthersSystemic examinationIf deemed necessary.CNSVascularGynaecologicalmuscuoloskeltalAbdominalAbdominal distensionPrevious surgical scarHerniaVisible peristalsisCecal distensionTenderness, guarding and reboundOrganomegalyBowel soundsHigh pitchedAbsentRectal examinationGeneralVital signs:P, BP, RR, T, SatdehydrationAnaemia, jaundice, LNAssessment of vomitus if possibleFull lung and heart examination
14 DiagnosticPlain radiographs can diagnose SBO in 50 to 60% of cases but usually cannot identify the cause of the obstruction. CT scanning is much better for determining the cause and is also very useful in identifying strangulation complicating SBO.
24 Ogilvie’s SyndromeOgilvie’s syndrome, or acute colonic pseudo-obstruction, is a rare clinical entity that usually accompanies other medical or surgical conditions. It usually responds to non-operative therapy, but occasionally requires surgical intervention.Sir Heneage Ogilvie, first described Ogilvie’s syndrome, or isolated colonic pseudo-obstruction, in 1948 in the British Medical Journal. He postulated that the colonic ileus was secondary to an imbalance between parasympathetic and sympathetic innervation caused by metastatic disease to the celiac plexus.
25 Treatment Resuscitation. Conservative treatment Previous surgery.Incomplete obstruction.Advanced malignancy.Uncertain diagnosis.C. Indications for surgeryGeneralized or localized peritonitis.Perforation.Irreducible hernia.Palpable mass.Closed loopFailure to improve.
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