Bowel obstruction
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What is it?
It is separated into small bowel (duodenum to ileum) and large bowel (caecum to rectum).
How does it present?
- Anorexia - loss of appetite
- Nausea
- Vomiting, with relief of symptoms afterwards
- Colicky abdominal pain
- Abdominal distension
- May be constipated, or have paradoxical diarrhoea.
In cases of underlying GI cancer, you might get weight loss, or blood in stool.
What should you do?
Make some key decisions:
- Is it small or large bowel? The clues are earlier vomiting, less distension, higher up pain in small bowel.
- Is it functional or mechanical? Functional is ileus, a paralysis of bowel. There will be no pain, and no bowel sounds on auscultation.
- Is the bowel strangulated? Patient will be more ill than you expected, with lots of pain, and in there will be peritonism - a solid, distended, intensely painful bowel.
What causes it?
- Small bowel - Adhesions, hernias, intussusception, Crohn's disease, GI cancer, foreign body, eg. smuggled cocaine.
- Large bowel - GI cancer, volvulus, faeces, diverticulitis.
What is the treatment?
It splits basically into two categories: conservative options and surgery:
- Conservative - Generally used for severe constipation. Give IV fluids to rehydrate, and laxatives to get to work on the hard, compacted poo. Also try enemas.
- Surgery - Go in and chop everything out. Especially if they have cancer. You nearly always need to do surgery to treat volvulus and strangulation.
