intestinal obstruction
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Clinical manifestations
- abdominal pain
- cramping, localized or diffuse
- constant pain suggests strangulation
- nausea/vomiting
- obstipation: feces distal to the obstruction may still pass
- bloat
- abdominal distension
- bowel sounds may be high-pitched or absent
- lower GI bleeding
- fever suggests strangulation or perforation
- dehydration may accompany obstruction
Laboratory
- blood work generally of no value
Radiology
- plain abdominal radiograph (KUB) supine & upright
- CT of abdomen (first line in patients with ovarian cancer)
- more sensitive & specific than plain radiograph[4]
- barium or Gastrografin (water soluble) enema
- water soluble agents are safer if perforation occurs
Differential diagnosis
- large vs small bowel obstruction
- symptoms of small bowel obstruction are slower to develop
- abdominal films show dilated colon in large bowel obstruction
- paralytic ileus
- pain is generally constant & mild
- abdominal distension
- radiographs show gas in both small & large bowel
- pseudo-obstruction
- mesenteric ischemia
Management
- nasogastric tube decompression
- intravenous fluids
- surgical consultation
- broad-spectrum antibiotic coverage
- avoid cathartics or stimulants to GI motility
- nothing by mouth (NPO)
- parenteral nutrition for surgical candidates with complete or partial bowel obstruction[3]
- palliative care
More general terms
More specific terms
- colon obstruction
- fecal impactation
- intussusception
- peritoneal band; Ladd's band
- small intestinal obstruction
- volvulus
Additional terms
References
- ↑ Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 337-38
- ↑ 2.0 2.1 Correia-Pinto J and Ribeiro A Congenital Duodenal Obstruction and Double-Bubble Sign. N Engl J Med 2014; 371:e16. September 11, 2014 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25207787 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMicm1313374
- ↑ 3.0 3.1 NEJM Knowledge+
- ↑ 4.0 4.1 Mooney SJ, Winner M, Hershman DL et al Bowel obstruction in elderly ovarian cancer patients: a population-based study. Gynecol Oncol. 2013 Apr;129(1):107-12. PMID: https://www.ncbi.nlm.nih.gov/pubmed/23274561 PMCID: PMC3731031 Free PMC article.