Bowel obstruction
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What is it?
Medical Emergency - Bowel obstruction is a mechanical or functional obstruction of the bowels, preventing anything passing down 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.