Intestinal Obstruction So If lo, what heed to ask?

Scenano :30 Ylo mah comes with Vemiting,Abd pain Ab. ()cardinal featutes of 10
for 3 days Distenion ) Abd patn hature ot Paih
) Vomiing→ whtt confen+?
Ļo Yto female preschted with vhitihg, Aod pain h 3) Aled distensio h
Abd. Distension for 3 days
4) Absolute Consipatian
Catdinal Symptoms of Io Sask bowel freguenc9
Dx olhtestihorl abstruction
(anychahges ih bowel habit)
2)AcutepancreatHis b
Path
perferated PUD
V
) omiting 9 canpass atus ( feces?
3) Distenson SOCRATES for each Cardinal features
GRuphared ectopic preghancy )Absolute Constipaion
S)Ovarian Cyst
RF
Teenage
Causes ot IOSpnerttulardy
AdultdoHe elderly
yomif is uhusual is a lateSympton
lavge bowel obstmchoh; in pt with large bowel obsrucho • Hiam mato ty
- Hernia •(arcinóha
- Ohset
Contentepehds oh
high smallbdwel;greenish-blue,
lestanedvthit asses(eppenlicits) Adhesioh i • o atma oh
(divertculiks)
- (antet of
o bstrucion ntussustephion ot
n ammahoh
aloic obstruction:hateeyloworSmallboweliBtowh rohit

-frequenc9+
aci foul shellbhg Meckels dtvericulum
of polyp
tppendiciis, Chrohns)
•(arahon a risaes
• Sghoid
volvulus

-Amount Abd, istensioh 1o diff SB LB of IÒ

-tte loirer the ohstruc on,hmore bowel
-Pre-vomihng avai la ble to distendeed
sympto hms SB LB
-Nature of voniting -paticularly t pt vonittrequent (ower third of abdomen
Abd paih centre
(Projecile) ench 3o mihS
Absolute constipation 2-20 mlns
ohce obstruction is (omp lete yomitihg Pylotic: watery uhcamhoh
-Ag4tavated facor bowel belon enpty, absojutecohshpation (ate symptom of LB
aủd
develop. nether fecés nor Hatus pasçed,
Occur early : lower large bowel 'obstruitisn High SB ;Bilestaineo obstr ucton
Abd. Paih OCcure :high small bowel obstuchoh lowerSB: brown,
Small bowel), colic felt foul smelling)
- SOCRATES ObstuctJ' at cehtre I 220 mìn ocCur early
true colic parn Absoption oCCur late
(largebawel), lower thitd every 30 min
(cbstr above). coic isuncommgn obstruc+' otabdomen Prominent # pttrequent
Pylo tus Abt.istenson Vomit

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 Expected PE
Qcauses based aueshions
General
Intraluminal Pt might appear
Dynami.
)Hs of gellstoes
fatigue dt vomihng,pprominent
aln (achexia
mavilla, blyngeye,sunhfn cye,jwnken
teistalsis
) Forighbodies . Sighs of dehydrathon (temperal fesa)
+chstruction
5) lmpacted stools • vital sign/sigh of shock
• Palor lJaundice (1RO Colon (a)
-|ntramural family Hr
Abd Examinafon R)F
• Dstended Hard and tender . visible peristakis(i
t8 confactOFever
)hicture-2' to T6 LOA Ooccuponhoh
Ch dx
\çhieni/Dry
(ovgk
Exframural
)Adhesich R* of abdeminal srgery

) Hernia - Hxsurgical,
ateshihalHrnia
>velvulus- NVt Abdpai tidirly,bediddin

abassuscephion
) ely+ hmp inAhdone

omiting
kdynamic Paralyic ileus. →Signi tant after
•Hx of Abd- Surger9 12 hrs laporotamy
-no bawel sound
•electrolyies Imbalante
-no passage ofsteo
- hypok/mg/NaHryoid
uremia
Oother Hx Palpitahon, soB,dininess
lethargy (Ahaemicsynptems(malignan(9))
Excessive thist -Dehydrahoh
Dizin eS
Prymouth - Dehydrahona
urihe output-Dehydraion Ny (NV,headahe,msleweaknes)
Sun ptoms of electolyte Imbalane y k (weauheSymyslecramp,ralpihhA)

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 Abd. pain Abd. Distensioh,Vomiting, for 3 days

(ardihal symptom
DPaih
IO 2) Yomiting
3) Distension
9 Absolute Consipation

Nepented voming
* pain is Cardinal synptoh retching
) Hx otGallstone alohol abuse ydvelop guickly
reach max withia mihufes Atachypneaa
Tachycardie shocle it
shock I#
AAk Acute Pest -€RCP pesist for haurs /Aays
Should be Pancreattis e,cohstant vefrotarymin hypätensiah J gravely ill
3) ScorpGh bite
h most s Padiate to back
)Mumps
s)phigs (crticostersids) ķvalproic aid >pelrewed by sittihg @ lenning foruard
9 RUQ pain
)BiliarySurgery y Radiate to chest can s mylate myocardial infarchon
* cotee grdundvemitus/meleng Pheu mon\a/pleuriic pain
tnemic Sympfoms
+ RUG pain + Hx of NSAIDS,Steroi ds Duodenal Gastic
Pertorated A Hx ot peptic ulcer o Pain at RIF4 epl9 5 trlum Hunger paİh tain during focd intale
PUD + Sudden ohset sevve qenerlised s id takdowh pelieved affer pelieved by vomitin 9
RUQ, RIF,€pigastricparn abdomihal pain the Hght paacolicgater food intake
-earlysaiety
• DyspepPSiaKoatihg aid inperifoneum * comm0n site perforatiợn * Hy Stomach (ahcer
AH-Pglori past infcion
burplng + Rigidity of Abdonen SAnteriar aspectof G ask course of regintn
burning Sensahon duodeny m
Abdomen dosnot more sepic 3 prlls and How many weeks
with respltaffoh Peritohits ADyspepSiq
kuptured
eitopic
Prègnah(y

Ovarian
cyst

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