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Small Bowel Obstruction (Metabolism) - Coggle Diagram
Small Bowel Obstruction (Metabolism)
Patho/ etiology
Mechanical (blockage, intussusception, volvulus, hernia) vs Non mechanical (Paralytic ileus)
Obstruction causes back up of secretions and swallowed air
Dilation of small bowel proximal to obstruction
Cell secretory activity stimulated leading to more fluid accumulation
increased peristalsis proximal and distal to obstruction causes loose stools and flatus early in course
Distention causes increased intraluminal pressure which compresses mucosal lymphatics leading to massive intraluminal hydrostatic pressure
Increased hydrostatic pressure at capillary beds causes third spacing of fluids, electrolytes and proteins into the intestinal lumen which reduces F/E absorption into vascular space
Continued fluid loss into the intestinal lumen can ultimately lead to hypovolemic shock
constriction of the mesenteric artery can lead to bowel ischemia and necrosis greatly increasing risk of perforation, peritonitis and death
8 liters of fluid can accumulate in the intestinal lumen with in 24 hours
Complications
bowel ischemia and necrosis
bowel perforation
peritonitis
compartment syndrome
toxemia
abscesses
hypovolemic shock
Risk factors
Hx of hernia unrepared
constipation
bowel surgery (adhesions and ileus)
tumor
age (very young)
abd infection
narcotic use
hypokalemia
prior radiation
Labs/ diagnostics
imaging
CBC
Cr/BUN
electrolytes
Collaborative treatment
NPO
NG decompression
bowel resection for necrotic tissue
surgical intervention
fluid resuscitation
correct F/E imbalance
administer drugs for comfort (analgesia antiemetics)
ABX
S&S
Loose stools and flatus early on
Vomitting
abd pain
abd distention
obstipation
fever/ tachycardia
hyperactive bowel sounds (borborygmus)
hypotensive