small bowel obstruction€¦ · •partial vs complete ; pathophysiology : blockage of passage...
TRANSCRIPT
![Page 1: Small bowel Obstruction€¦ · •Partial VS complete ; Pathophysiology : blockage of passage ==> increased intraluminal fluid and gas ==> increased intraluminal pressure ==> decreased](https://reader034.vdocuments.us/reader034/viewer/2022042200/5e9fad1197a00f0ad40991de/html5/thumbnails/1.jpg)
Small bowel
Obstruction
![Page 2: Small bowel Obstruction€¦ · •Partial VS complete ; Pathophysiology : blockage of passage ==> increased intraluminal fluid and gas ==> increased intraluminal pressure ==> decreased](https://reader034.vdocuments.us/reader034/viewer/2022042200/5e9fad1197a00f0ad40991de/html5/thumbnails/2.jpg)
Outline
• Definition
• Types
• Presentation
• Deferential Diagnosis
• Management
![Page 3: Small bowel Obstruction€¦ · •Partial VS complete ; Pathophysiology : blockage of passage ==> increased intraluminal fluid and gas ==> increased intraluminal pressure ==> decreased](https://reader034.vdocuments.us/reader034/viewer/2022042200/5e9fad1197a00f0ad40991de/html5/thumbnails/3.jpg)
• Blockage of the flow of GI contents through the small
intestine
![Page 4: Small bowel Obstruction€¦ · •Partial VS complete ; Pathophysiology : blockage of passage ==> increased intraluminal fluid and gas ==> increased intraluminal pressure ==> decreased](https://reader034.vdocuments.us/reader034/viewer/2022042200/5e9fad1197a00f0ad40991de/html5/thumbnails/4.jpg)
Classification
• Functional VS mechanical
• Partial VS complete
• Simple VS complicated
• Proximal VS distal
![Page 5: Small bowel Obstruction€¦ · •Partial VS complete ; Pathophysiology : blockage of passage ==> increased intraluminal fluid and gas ==> increased intraluminal pressure ==> decreased](https://reader034.vdocuments.us/reader034/viewer/2022042200/5e9fad1197a00f0ad40991de/html5/thumbnails/5.jpg)
• Functional ( ileus )
✴Retroperitoneal hematoma
✴Post operative
✴Medications ( Narcotics )
✴Peritonitis
![Page 6: Small bowel Obstruction€¦ · •Partial VS complete ; Pathophysiology : blockage of passage ==> increased intraluminal fluid and gas ==> increased intraluminal pressure ==> decreased](https://reader034.vdocuments.us/reader034/viewer/2022042200/5e9fad1197a00f0ad40991de/html5/thumbnails/6.jpg)
• Mechanical
✴Intraluminal ( Foreign body , Gallstone ileus)
✴Intramural ( intramural hematoma , malignancy,
strictures , Crohns disease )
✴External compression ( Adhesions, hernia,
carcinomatosis)
![Page 7: Small bowel Obstruction€¦ · •Partial VS complete ; Pathophysiology : blockage of passage ==> increased intraluminal fluid and gas ==> increased intraluminal pressure ==> decreased](https://reader034.vdocuments.us/reader034/viewer/2022042200/5e9fad1197a00f0ad40991de/html5/thumbnails/7.jpg)
• Partial VS complete ;
✴Pathophysiology :
✴blockage of passage ==> increased intraluminal fluid
and gas
✴ ==> increased intraluminal pressure ==> decreased
venous return==> venous congestion and decrease
blood supply ==> ischemia and death of involved
intestine
![Page 8: Small bowel Obstruction€¦ · •Partial VS complete ; Pathophysiology : blockage of passage ==> increased intraluminal fluid and gas ==> increased intraluminal pressure ==> decreased](https://reader034.vdocuments.us/reader034/viewer/2022042200/5e9fad1197a00f0ad40991de/html5/thumbnails/8.jpg)
• Simple VS complicated ( strangulation and ischemia ,
perforation ).
• Proximal VS distal .
![Page 9: Small bowel Obstruction€¦ · •Partial VS complete ; Pathophysiology : blockage of passage ==> increased intraluminal fluid and gas ==> increased intraluminal pressure ==> decreased](https://reader034.vdocuments.us/reader034/viewer/2022042200/5e9fad1197a00f0ad40991de/html5/thumbnails/9.jpg)
Clinical presentation
• Abdominal pain ( characters ? )
• Constipation or Obstipation.
• Nausea and vomiting.
• ? fever ? BPR
![Page 10: Small bowel Obstruction€¦ · •Partial VS complete ; Pathophysiology : blockage of passage ==> increased intraluminal fluid and gas ==> increased intraluminal pressure ==> decreased](https://reader034.vdocuments.us/reader034/viewer/2022042200/5e9fad1197a00f0ad40991de/html5/thumbnails/10.jpg)
• O/E ;
✴V/S ( signs of dehydration or sepsis ) .
✴Abdominal examination ( scars , HERNIA , peritonitis,
distention , hyperactive bowel sounds or silent
abdomen)
![Page 11: Small bowel Obstruction€¦ · •Partial VS complete ; Pathophysiology : blockage of passage ==> increased intraluminal fluid and gas ==> increased intraluminal pressure ==> decreased](https://reader034.vdocuments.us/reader034/viewer/2022042200/5e9fad1197a00f0ad40991de/html5/thumbnails/11.jpg)
Laboratory Workup
• CBC.
• BMP and electrolytes.
• Lactate.
• Blood gas analysis.
![Page 12: Small bowel Obstruction€¦ · •Partial VS complete ; Pathophysiology : blockage of passage ==> increased intraluminal fluid and gas ==> increased intraluminal pressure ==> decreased](https://reader034.vdocuments.us/reader034/viewer/2022042200/5e9fad1197a00f0ad40991de/html5/thumbnails/12.jpg)
Alarming findings
• Localized pain.
• Fever.
• Tachycardia.
• Peritonitis
• Elevated lactate after resuscitation
• Leukocytosis.
![Page 13: Small bowel Obstruction€¦ · •Partial VS complete ; Pathophysiology : blockage of passage ==> increased intraluminal fluid and gas ==> increased intraluminal pressure ==> decreased](https://reader034.vdocuments.us/reader034/viewer/2022042200/5e9fad1197a00f0ad40991de/html5/thumbnails/13.jpg)
Imaging
• Plain films ( Abdominal X-rays supine and erect )
• Which one is more important ?
![Page 14: Small bowel Obstruction€¦ · •Partial VS complete ; Pathophysiology : blockage of passage ==> increased intraluminal fluid and gas ==> increased intraluminal pressure ==> decreased](https://reader034.vdocuments.us/reader034/viewer/2022042200/5e9fad1197a00f0ad40991de/html5/thumbnails/14.jpg)
• Dilated small bowel loops ( > 3 cm )
• Paucity of air in the colon and rectum.
• Gas in the small intestine.
• Multiple air fluid levels on upright films
![Page 15: Small bowel Obstruction€¦ · •Partial VS complete ; Pathophysiology : blockage of passage ==> increased intraluminal fluid and gas ==> increased intraluminal pressure ==> decreased](https://reader034.vdocuments.us/reader034/viewer/2022042200/5e9fad1197a00f0ad40991de/html5/thumbnails/15.jpg)
![Page 16: Small bowel Obstruction€¦ · •Partial VS complete ; Pathophysiology : blockage of passage ==> increased intraluminal fluid and gas ==> increased intraluminal pressure ==> decreased](https://reader034.vdocuments.us/reader034/viewer/2022042200/5e9fad1197a00f0ad40991de/html5/thumbnails/16.jpg)
![Page 17: Small bowel Obstruction€¦ · •Partial VS complete ; Pathophysiology : blockage of passage ==> increased intraluminal fluid and gas ==> increased intraluminal pressure ==> decreased](https://reader034.vdocuments.us/reader034/viewer/2022042200/5e9fad1197a00f0ad40991de/html5/thumbnails/17.jpg)
![Page 18: Small bowel Obstruction€¦ · •Partial VS complete ; Pathophysiology : blockage of passage ==> increased intraluminal fluid and gas ==> increased intraluminal pressure ==> decreased](https://reader034.vdocuments.us/reader034/viewer/2022042200/5e9fad1197a00f0ad40991de/html5/thumbnails/18.jpg)
![Page 19: Small bowel Obstruction€¦ · •Partial VS complete ; Pathophysiology : blockage of passage ==> increased intraluminal fluid and gas ==> increased intraluminal pressure ==> decreased](https://reader034.vdocuments.us/reader034/viewer/2022042200/5e9fad1197a00f0ad40991de/html5/thumbnails/19.jpg)
![Page 20: Small bowel Obstruction€¦ · •Partial VS complete ; Pathophysiology : blockage of passage ==> increased intraluminal fluid and gas ==> increased intraluminal pressure ==> decreased](https://reader034.vdocuments.us/reader034/viewer/2022042200/5e9fad1197a00f0ad40991de/html5/thumbnails/20.jpg)
CT scan
• More sensitive and specific. ( 70-90%)
• Helps identify transition point.
• Can detect areas of compromised blood supply or
strangulation ( thickened wall, pneumatosis
intestinalis or perforation).
• Helps identify closed loop obstruction.
![Page 21: Small bowel Obstruction€¦ · •Partial VS complete ; Pathophysiology : blockage of passage ==> increased intraluminal fluid and gas ==> increased intraluminal pressure ==> decreased](https://reader034.vdocuments.us/reader034/viewer/2022042200/5e9fad1197a00f0ad40991de/html5/thumbnails/21.jpg)
![Page 22: Small bowel Obstruction€¦ · •Partial VS complete ; Pathophysiology : blockage of passage ==> increased intraluminal fluid and gas ==> increased intraluminal pressure ==> decreased](https://reader034.vdocuments.us/reader034/viewer/2022042200/5e9fad1197a00f0ad40991de/html5/thumbnails/22.jpg)
![Page 23: Small bowel Obstruction€¦ · •Partial VS complete ; Pathophysiology : blockage of passage ==> increased intraluminal fluid and gas ==> increased intraluminal pressure ==> decreased](https://reader034.vdocuments.us/reader034/viewer/2022042200/5e9fad1197a00f0ad40991de/html5/thumbnails/23.jpg)
![Page 24: Small bowel Obstruction€¦ · •Partial VS complete ; Pathophysiology : blockage of passage ==> increased intraluminal fluid and gas ==> increased intraluminal pressure ==> decreased](https://reader034.vdocuments.us/reader034/viewer/2022042200/5e9fad1197a00f0ad40991de/html5/thumbnails/24.jpg)
![Page 25: Small bowel Obstruction€¦ · •Partial VS complete ; Pathophysiology : blockage of passage ==> increased intraluminal fluid and gas ==> increased intraluminal pressure ==> decreased](https://reader034.vdocuments.us/reader034/viewer/2022042200/5e9fad1197a00f0ad40991de/html5/thumbnails/25.jpg)
![Page 26: Small bowel Obstruction€¦ · •Partial VS complete ; Pathophysiology : blockage of passage ==> increased intraluminal fluid and gas ==> increased intraluminal pressure ==> decreased](https://reader034.vdocuments.us/reader034/viewer/2022042200/5e9fad1197a00f0ad40991de/html5/thumbnails/26.jpg)
![Page 27: Small bowel Obstruction€¦ · •Partial VS complete ; Pathophysiology : blockage of passage ==> increased intraluminal fluid and gas ==> increased intraluminal pressure ==> decreased](https://reader034.vdocuments.us/reader034/viewer/2022042200/5e9fad1197a00f0ad40991de/html5/thumbnails/27.jpg)
![Page 28: Small bowel Obstruction€¦ · •Partial VS complete ; Pathophysiology : blockage of passage ==> increased intraluminal fluid and gas ==> increased intraluminal pressure ==> decreased](https://reader034.vdocuments.us/reader034/viewer/2022042200/5e9fad1197a00f0ad40991de/html5/thumbnails/28.jpg)
Enterolysis ( Small bowel
contrast study )
![Page 29: Small bowel Obstruction€¦ · •Partial VS complete ; Pathophysiology : blockage of passage ==> increased intraluminal fluid and gas ==> increased intraluminal pressure ==> decreased](https://reader034.vdocuments.us/reader034/viewer/2022042200/5e9fad1197a00f0ad40991de/html5/thumbnails/29.jpg)
![Page 30: Small bowel Obstruction€¦ · •Partial VS complete ; Pathophysiology : blockage of passage ==> increased intraluminal fluid and gas ==> increased intraluminal pressure ==> decreased](https://reader034.vdocuments.us/reader034/viewer/2022042200/5e9fad1197a00f0ad40991de/html5/thumbnails/30.jpg)
![Page 31: Small bowel Obstruction€¦ · •Partial VS complete ; Pathophysiology : blockage of passage ==> increased intraluminal fluid and gas ==> increased intraluminal pressure ==> decreased](https://reader034.vdocuments.us/reader034/viewer/2022042200/5e9fad1197a00f0ad40991de/html5/thumbnails/31.jpg)
Treatment
• NPO.
• IVF ( maintenance and deficit ).
• NGT drainage.
• Serial abdominal examination
• Serial laboratory work up
![Page 32: Small bowel Obstruction€¦ · •Partial VS complete ; Pathophysiology : blockage of passage ==> increased intraluminal fluid and gas ==> increased intraluminal pressure ==> decreased](https://reader034.vdocuments.us/reader034/viewer/2022042200/5e9fad1197a00f0ad40991de/html5/thumbnails/32.jpg)
Surgery
• Indications ;
• Non adhesive mechanical small bowel obstruction.
• Bowel ischemia or perforation.
• Closed loop obstruction ( emergency )
• Failure of adhesive SBO to resolve ( 48-72 hrs ?).
![Page 33: Small bowel Obstruction€¦ · •Partial VS complete ; Pathophysiology : blockage of passage ==> increased intraluminal fluid and gas ==> increased intraluminal pressure ==> decreased](https://reader034.vdocuments.us/reader034/viewer/2022042200/5e9fad1197a00f0ad40991de/html5/thumbnails/33.jpg)
![Page 34: Small bowel Obstruction€¦ · •Partial VS complete ; Pathophysiology : blockage of passage ==> increased intraluminal fluid and gas ==> increased intraluminal pressure ==> decreased](https://reader034.vdocuments.us/reader034/viewer/2022042200/5e9fad1197a00f0ad40991de/html5/thumbnails/34.jpg)
![Page 35: Small bowel Obstruction€¦ · •Partial VS complete ; Pathophysiology : blockage of passage ==> increased intraluminal fluid and gas ==> increased intraluminal pressure ==> decreased](https://reader034.vdocuments.us/reader034/viewer/2022042200/5e9fad1197a00f0ad40991de/html5/thumbnails/35.jpg)
![Page 36: Small bowel Obstruction€¦ · •Partial VS complete ; Pathophysiology : blockage of passage ==> increased intraluminal fluid and gas ==> increased intraluminal pressure ==> decreased](https://reader034.vdocuments.us/reader034/viewer/2022042200/5e9fad1197a00f0ad40991de/html5/thumbnails/36.jpg)
![Page 37: Small bowel Obstruction€¦ · •Partial VS complete ; Pathophysiology : blockage of passage ==> increased intraluminal fluid and gas ==> increased intraluminal pressure ==> decreased](https://reader034.vdocuments.us/reader034/viewer/2022042200/5e9fad1197a00f0ad40991de/html5/thumbnails/37.jpg)
![Page 38: Small bowel Obstruction€¦ · •Partial VS complete ; Pathophysiology : blockage of passage ==> increased intraluminal fluid and gas ==> increased intraluminal pressure ==> decreased](https://reader034.vdocuments.us/reader034/viewer/2022042200/5e9fad1197a00f0ad40991de/html5/thumbnails/38.jpg)