Intestinal Obstruction

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Contents 1 More Specific Terms 2 Clinical-manifestations 3 Laboratory 4 Radiology 5 Differential-diagnosis 6 Management 7 More General Terms 8 Additional Terms 9 References

More Specific Terms

• colon obstruction
• small intestinal obstruction

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 distention
• 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

• dilated loops of bowel
• air-fluid levels
• gas is usually absent distal to the obstruction
• free air under the diaphragm indicates bowel perforation

• 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 distention
• radiographs show gas in both small & large bowel

• pseudo-obstruction
• mesenteric ischemia

Management

• nasogastric tube decompression
• intravenous fluids
• surgical consultation
• broad-spectrum antibiotic coverage

• gram-negative bacteria
• gram-positive bacteria
• anaerobes

• avoid cathartics or stimulants to GI motility
• nothing by mouth ( NPO)
• palliative care

• see management of bowel obstruction without a tube

More General Terms

• intestinal disease

Additional Terms

• ileus
• intestinal pseudo-obstruction
• management of bowel obstruction without a tube
• obstipation

References

Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 337-38

intestinal obstruction