inpatient / gastroenteroloy
Small Bowel Obstruction (SBO) and Ileus
Last Updated: 1/21/2023
# Small Bowel Obstruction
Assessment:
-- History: *** prior surgeries, h/o constipation, gallstones, hernia, cancer, radiation
-- Clinical/Exam: *** N/V, distention, obstipation, decreased bowel sounds, e/o peritonitis
-- Data: *** KUB, CTAP
-- Etiology/DDx: *** SBO, ileus, pesudo-obstruction
The patient's HPI is notable for ***. Exam showed ***. Labwork and data were notable for ***. Taken together, the patient's presentation is most concerning for ***, with a differential including ***.
Plan:
Workup
-- KUB vs CTAP
Treatment
-- NPO with NGT decompression if sxs
-- IVF: ***
-- Avoid constipating meds (opioids, anticholinergics, zofran); replete K
-- Consult surgery if evidence of volvulus, ischemia, perforation, or persists 3-5 days
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Clinical Pearls
- Ileus is slow gut motility without obstruction whereas SBO is obstruction of flow
- Ileus will show no transition point, whereas SBO will have a transition point
- Ogilvie’s (pseudo-obstruction) typical in elderly, severe illness - neostigmine if cecal diameter is >12cm or conservative treatment fails, however this is a medicine that some institutions require ICU-level care for since it can lead to perforation
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