▪īypass of obstructing lesions (used mostly for carcinomatosis). Resection of strangulated segment with primary anastomosis. Resection of obstructing lesions with primary anastomosis. Open or laparoscopic lysis of adhesions at the point of obstruction. 11 How can I distinguish between a complete and partial obstruction? As soon as resuscitation is complete, prompt surgical intervention is mandatory for complete obstructions and for anyone with signs and symptoms of strangulation. Nasogastric (NG) suction and intravenous (IV) fluids should be instituted to restore electrolyte and fluid balance, and a Foley catheter should be placed to monitor urine output. 10 What are the initial steps in treatment? ![]() ![]() 4Īmylase and lipase to rule out pancreatitis amylase can also be elevated, although not as high, with SBO or ischemic bowel. Urinalysis to look for urinary tract infection (which may also cause an ileus and present with a similar picture to SBO) and to assess hydration (urine-specific gravity) 3Ĭhemistry panel to check for electrolyte abnormalities such as hypokalemic or hypochloremic metabolic alkalosis (associated with vomiting of acid gastric contents), hyponatremia, and prerenal azotemia (elevated blood urea nitrogen and creatinine levels). 7 What is the most inexpensive way to confirm the diagnosis?Ĭomplete blood cell count (CBC) to check for leukocytosis or unexpected anemia 2 Check all trocar sites from previous laparoscopic surgeries. 6 Where should the examiner look for obstructing hernias?Įxamine the groins near the pubic tubercle and along the inguinal floor, check the femoral triangles for bulging or tenderness, do a rectal examination to look for obturator hernia (see question 5), and palpate all existing incisions. An obturator hernia can best be palpated transrectally or transvaginally. The rectal examination may reveal signs of cancer, such as a rigid rectal shelf from carcinomatosis, and blood on hemoccult examination may herald ischemia or strangulation or may indicate inflammatory bowel disease. 5 Is a rectal examination necessary?Ībsolutely. Palpation may increase the abdominal pain, but localized tenderness or peritoneal signs indicate likely strangulation or another diagnosis. Percussion usually reveals diffuse tympani, and thin, elderly patients may even have visible loops of distended small bowel. Bowel sounds may be hyperactive with “tinkles and rushes” or may be totally silent if the patient has delayed seeking treatment. The patient is often dehydrated and may have a low-grade fever, postural hypotension, and abdominal distention. Be sure you are getting 2-3 liter of plain water everyday, and getting about 30 grams of fiber.Any previous abdominal or pelvic surgery? ▪Īny history of cancer? What type, and how treated? Any radiation? ▪Īny previous abdominal infections or inflammation (include pelvic inflammatory disease, appendicitis, diverticulitis, inflammatory bowel disease, perforation, and trauma)? ▪Ĭurrent medications, particularly anticoagulants, anticholinergics, chemotherapy, or diuretics? 4 What are the findings on physical examination? It maybe be just that your diet, habits, or stress level changed enough to make you constipated. Infact you should probably see one anyway. If this does not help much, then you need to see a doctor immediately. Just take both enemas slowly, so that you do not produce an instantaneous, uncontrollable, urgency. It will probably put less pressure on the already extended bowel wall. I would suggest the enemas over oral laxatives for the same reason that it is easier to clean a clog pipe from the output end instead of the input end. ![]() The oil will also help soften the hard impacted stool. If you think this might be the problem then try taking a packed "oil retention" enema and hold it for 30 minutes or more before taking the warm water enema. ![]() You might try slowly taking a warm water enema and holding it for a few minutes before letting it out. It is possible to have impacted stools (bad constipation) such that only a thin string of stool can pass through the middle of the impaction.
0 Comments
Leave a Reply. |