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Bowel obstruction (Clinical presentation (Nausea/vomiting
Coffee ground,…
Bowel obstruction
Clinical presentation
Nausea/vomiting
Coffee ground, faecal, etc.
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Constipation
Complete, no flatus
Pain
Site: poorly localised
Onset: insidious
Character: colicky
Radiation: nil
Associated symptoms: vomiting,
nausea, anorexia, bloating, constipation
Timing: wax and wane
Diagnosis
History
PMH/PSH
Prior surgery
IBD, diverticular disease,
previous cancers
PC/HPC
Pain, constipation, distension, faeculent vomiting,
fever, weight loss
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FH
Bowel disease, other chronic disease
SH
Occupation, smoking, alcohol
Examination
Abdo exam
Surgical scars, hernias, distension, tenderness, peritonism
Bowel sounds (tinkling - partial; silent - total)
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Investigations
Bloods
VBG, FBC, CRP, U+E, lactate, amylase,
clotting, group&save/crossmatch
Imaging
Erect CXR: exclude perforation
Erect AXR: large vs smalll BO;
distended central loops with valvulae conniventes >3cm (small), distended peripheral loops with haustra >6cm (large)
fluid levels: Y-shaped gas shadow RIF =
gallstone ileus from fistula to the biliary tree
CT abdo: cause and level of obstruction, Gastrograffin for visualising partial small bowel obstruction, also therapeutic
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Pathophysiology
Aetiology
Paralytic
Rare - no peristalsis, adynamic bowel
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Open vs
closed
Open
Incopetent ileo-caecal valve, can backtrack and decompress
Fermentation of GI contents = faeculent vomiting
(faecal vomiting only with colonic fistula to proximal GIT)
Closed
Competent ileocaecal valve, no decompression
so no faeculent vomiting, more likely to perforate
Type
Loop
Obstruction at 2 points e.g. volvulus
Loop of distended bowel, risk of perforation
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Management
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Definitive
Conservative
Refer to surgical team ASAP
Catheterise and fluid balance (monitor fluid level)
NG tube (decompression, alleviates vomiting)
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Surgical
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Surgical repair
Indication: strangulation, perforation,
closed-loop obstruction
MOA: surgical repair, stenting
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