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Small Bowel Obstruction, Swallowed gas, History of adult worm in stool,…
Small Bowel Obstruction
Extrinsic disease
Adhesions (due to previous abdominal surgery)
Internal Hernias
External Hernias
Neoplasms (most common: ovarian)
Endometriosis
Intraperitoneal abscess
Idiopathic sclerosis
Intrinsic abnormalities
Congenital
Malrotation
atresia
stenosis
intestinal duplication
cyst formation
congenital bands
Inflammation
Inflammatory bowel disease (Crohn's disease)
Diverticulitis
tuberculosis
radiation
lymphogranuloma venereum
schistosomiasis
Neoplasia
Traumatic
Hematoma formation
Anastomotic strictures
Other
Intussusception
Volvulus
Obstruction of duodenum by superior mesenteric artery
ischemic injury
aganglionosis (hirschsprung's disease)
Definition: mechanical blockage of the bowel
Classification
Partial
Complete
Non Strangulated
Strangulated
Intraluminal abnormalities
Bezoarr
Foreign bodies (including barium, gallstones, parasites)
Helminth
History
past history: helminth in fecal materials
Social history:
Open defecation
Endemic STH area
Ground floor house
River as water source
vomiting of ingested matter
Failure to pass motion and flattus
Physical Examination
lean body mass
Further investigations
Low HB level
Low blood protein
Elevated WBC, elevated eosinophil count
parasites larvae or eggs found in fecal examination
Intraluminal adult helminth
Adult helminth overgrowth
Enterolith
Intestine proximal to the obstruction filled GI Secretions
Intestinal Dilatation
Intestinal distention
intraluminal pressure builds up
Intraluminal pressure exceeds venous pressure
venous and lymphatic drainage is impeded
Edema
Hypoxemia
Epithelial necrosis
Parietal peritoneum involvement
Intraabdominal pressure elevated
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C and A delta nerve fibers
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Peristalsis slows
ROS builds up in the bowel wall
Activates neutrophils and macrophages
Disruption of secretory and neuromotor process
Nutrition and electrolyte loss
Microvascular leak
Hypovolemia
Vascular instability
Hemodynamic compromise
Visceral peritoneum strecth
Stimulation of C fibers
Abdominal pain
Luminal content Fermentation
Gas accumulation
Bacterial count increases
acteria pathogens enter mesenteric lymph nodes and blood steram
History and Physical examination:
Abdominal tenderness
distended abdomen
failure to pass motion and flattus
Worsening abdominal pain
Swallowed gas
History of adult worm in stool
Ground floor house
Parasite infection
Low HB
High WBC (neutrophil and eosinofil count elevated)
Low total serum protein
Low Albumin
Lean body mass
Small bowel dilatation
Intestinal obstruction
Intestine proximal to obstruction
Failure to pass motion and flatus
Open defecation
River as clean water source
Intermittent crampy peri-umbilical abdominal pain
Vomiting of ingested matter
Progressive abdominal distension
Failure to pass motion and flatus
Acutely sick looking
Rapid Heart Rate
Hyperactive bowel sounds
Abdominal mass on right lower quadrant
unfertilized egg found in feces by direct smear
Peripherally located multiple air-fluid levels