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Small Bowel Obstruction - Dr. Robertson

1/9/2014

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Picture

Basics
  • Account for approximately 20% of all admissions for acute abdominal pain
  • Mortality approaches 5% for non-strangulated obstructions and 30% for strangulated obstructions
  • 90% with abd surg get adhesions, 25% will develop SBO
  • Causes  to consider = duodenum stenosis, stricture (adhesion, bezoars), gallstone ileus, femoral hernia, parastomal hernia, internal hernia. Also SB volvulus, intussusception (mech in adults)

Type

  •    Mechanical closed loop- twisting, increased likelihood of vascular compromise
  •    Neurogenic- disturbance in movt, ileus. Panc, metabolic disturb, mess, any bowel inflamm, trauma, infection
  •    Pseudo obstruction- decreased motility due to systemic medical condition

Patho
  •     Distention, poor absorption, edema--- intraperitoneal sequestration.
  •     Closed loops- venous congestion, source of hemorrhage - Risk of strangulation dramatically increased with closed loop obstructions

Presentation

  • Intermittent pain, change to constant concern for strangulation (ischemia, perf)
  • Constipation OR diarrhea
  • Difficult to predict strangulation

Risk factors
  • Prior SBO - Greatest risk factor.
  • Abd surg
  • Hernia

Diagnosis
  • Labs generally unhelpful, but help with resusc
  • CT abd specificity = 94, sensitivity = 56  for strangulation

Therapy
  • NPO
  • IVF
  • Antibiotics (?) - depending on severity and possibility of going to the OR
  • NGT (?) - Need to weigh Risks vs Benefits.

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M&M - Dr. Keller

1/9/2014

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Picture
Elderly Demented Pt s/p "Fall"
  • First, define and characterize the "fall" as best you are able. 
  • Be careful focusing only on mechanical issues.  Was this Syncope?
  • Learning point - abdominal aortic aneurysm
        - rare before age 50,
        - family hx is the greatest risk factor - increases risk 10 fold
        - smoking is the most important modifiable risk factor

            - Triad of pain, hypotension, pulsatile mass = 10%
            - 60% of patients with ruptured AAA - normal vitals signs
            - bedside US - sensitivity/ specificity 98%

Sore Throat After Intubation


  • Post intubation sore throat - usually gone by 5th  day -- persistent pain warrants concern.
  • Common traumas
            - dental injury or lip abrasion
            -  foreign body
            - vocal cord laceration
            - tracheal or esophageal perforation

Is that a Pneumothorax

    > Pneumothorax ex vacu - forms adjacent to atelectatic lobe, results from bronchial obstructions - do not treat with chest tube - relieve but fixing obstruction

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Department of Emergency Medicine
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​
  • Prospective Applicants
    • 2020 MATCH
    • About CMC
    • Our Curriculum
    • Our Residents
    • Our Fellowships
    • Program Leadership
    • Explore Charlotte
    • Official Site
  • ROTATING STUDENTS
    • Prospective Visiting Students
    • UNC Students
    • Healthcare Disparities Externship
    • Current Students
  • Current Residents
    • Airway Lecture!
    • PGY - 1
    • PGY - 2
    • PGY - 3
    • Simulation Reading
    • Blogs >
      • EM GuideWire
      • CMC ECG Masters
      • Core Concepts
      • #FOAMed
      • Cardiology Blog
      • Dr. Patel's Coding Blog
      • Global Health Blog
      • Ortho Blog
      • Pediatric Emergency Medicine
      • Tox Blog
    • Board Review
    • Journal Club
    • Resident Wellness
    • Resident Research
  • Top 20
  • Chiefs Corner
    • Schedules >
      • Conference/Flashpoint
      • Block Schedule
      • ED Shift Schedule
      • AEC Moonlighting
      • Journal Club/OBP/Audits Schedule
      • Simulation
    • Individualized Interactive Instruction
    • Evaluations/Interview Season
    • Contact Info
    • Resume Builder