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Small Intestines
Small Bowel Obstruction
With Dr. Kevin Pei
Shikhar Mishra, shikkiinternational2@gmail.com

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Clinical Case
65-year-old woman who has history of hysterectomy

presents with nausea, vomiting, abdominal pain.

Learning Objectives
We will learn about common history and

physical findings.
This lecture teaches you diagnosis and learn

management.

Background
Very common
> 300,000 small bowel

obstructions procedures are
performed
Etiology
Adhesions
Tumors
Volvulus
Hernias
Hic et nunc, PD
Background
Very common

performed
Etiology
Adhesions
Tumors
Volvulus
Hernias
Cnichoisonpath, Glomus
Shikhar tumor.
Mishra, 20X, https://flic.kr/p/bzDBZ3, cropped, CC BY 2.0, flickr
shikkiinternational2@gmail.com
Background
Very common

performed
Etiology
Adhesions
Tumors
Volvulus
Hernias
SuSanA Secretariat,
ShikharAscaris
Mishra,infection: Antimesenteric splitting of the outer layers of the bowel wall due to a large amount of ascaris (South
Africa), https://flic.kr/p/q5LKz4, no changes,
www.lecturio.com | This documentCC BY 2.0
is protected by copyright.
Background
Very common

performed
Etiology
Adhesions
Tumors
Volvulus
Hernias
Mikael Hggstrm, CC0
Shikhar 1.0 shikkiinternational2@gmail.com
Mishra,
Small Bowel Obstruction Examination
Abdominal pain Nausea/vomiting Obstipation
F.l.t.r.: MabelAmber,
ShikharPD, Pixabay;
Mishra, geralt, PD, Pixabay; jarmoluk, PD, Pixabay
Small Bowel Obstruction Examination
General mid abdomen tenderness
Paulsen Friedrich & Waschke

Shikhar Mishra, Jens, General Anatomy and Musculoskeletal System, 15th Edition, 2013, p. 6, Atlas of Human Anatomy (Elsevier)
Labs Examination
Chloride is low, bicarb is high, creatinine might be high

Labs Examination
Hypovolemic
Hypokalemia
Hypochloremic metabolic alkalosis with emesis loss of

chloride through stomach acids
Kidneys try to preserve volume through aldosterone

which stimulates hydrogen and potassium excretion

Labs Examination
3 Na
Tubule
+
High-yield
2K
H+

Abdominal Xray Diagnosis
El Bouhaddouti H, Lamrani J, Louchi A, El Yousfi M, Aqodad N, Ibrahimi A, Boubou M, Kamaoui I, Tizniti S, Torsion of a wandering spleen,
https://openi.nlm.nih.gov/detailedresult.php?img=PMC2995100_SJG-16-288-g001&query=Abdominal+x-ray&it= xg&req =4&npos=373, no
change, CC BY www.lecturio.com
2.0 | This document is protected by copyright.
CT Abdome Diagnosis
Arkadopoulos N, Dellaportas D, Yiallourou A, Koureas A, Voros D, Ovarian vein thrombosis mimicking acute abdomen: a case report and
Shikhar
literature review, Mishra, shikkiinternational2@gmail.com
https://openi.nlm.nih.gov/detailedresult.php?img=PMC3257196_1749-7922-6-45-1&query= abdomen
www.lecturio.com
+ct&it=xg&req=4&npos=21, no change, | ThisCC
document
BY 2.0 is protected by copyright.
Labs Diagnosis
Lactate
NEUROTtiker,Shikhar
PD Mishra, shikkiinternational2@gmail.com
Lactate Cori Cycle Diagnosis
End product of glycolysis during anaerobic

metabolism
Persistence of lactate may indicate ischemic

bowel
Ivanisevic J, Elias D, Deguchi H, Averell PM, Kurczy M, Johnson CH, Tautenhahn R, Zhu Z, Watrous J, Jain M, Griffin J, Patti GJ, Siuzdak G,
ArteriovenousShikhar Mishra, shikkiinternational2@gmail.com
Blood Metabolomics: A Readout of Intra-Tissue Metabostasis, https://openi.nlm.nih.gov/detailedresult.php?img
=PMC4525490_srep12757-f6&query=Lactate+%26ndash%3B+Cori+Cycle&it=xg&req=4&npos=5,
www.lecturio.com | This document is protected by copyright. no change, CC BY 4.0
Question
What if the lactate is elevated?

Answer
If the lactate is elevated it suggests anaerobic

metabolism and potential intestinal compromise.

Question
What if the difference between complete and

incomplete SBO?

Answer
Complete bowel obstruction suggests complete absence of

flatus/BM and may lead to ischemic bowel.
Special type: closed loop bowel obstruction: obstructed in 2

locations.

Closed Loop Bowel Obstruction Management
Hans, PD, Pixabay

Schematic of Managing SBO Management
Small
bowel
obstruction
Complete Incomplete
No
Peritoneal peritone
signs al signs
Surgery Trial of
nonoperative
Surgery
management
NPO NGT
IVF

Non Surgical Management
NGT
NPO
Ambulation
Minimize narcotic medications
Agarwal P, Bagdi R, Thoracoscopic

Shikhar removal of oesophageal duplication cyst, https://openi.nlm.nih.gov/detailedresult.php?
Mishra, shikkiinternational2@gmail.com
img=PMC3078479_JMAS-7-147-g002&query=Nasogastric+intubation&it=xg&req=4&npos=149, no change, CC BY 2.0
Surgery Management
Ileus
Kayastha K, Mirza B, Sheikh

Shikhar A,shikkiinternational2@gmail.com
Mishra, Volvulus of small bowel in a case of simple meconium ileus, https://openi.nlm.nih.gov/detailedresult
.php?img=PMC3418008_ajcr-2-7.f2&query=Ileus&it=xg&req=4&npos=246, no change, CC BY 3.0
Abdominal Surgery and Patients
Clinical pearl
Patients who have never had abdominal
surgery are unlikely to have adhesive
disease.

Clinical Scenarios
Incarcerated hernias should be on your

differential diagnosis for small bowel High-yield
obstructions.
Post surgery adhesive disease is one of

the most common etiologies.

Learning Outcomes
We learned about the recognize small bowel

obstruction.
Now you know diagnosis and treatment of

small bowel obstruction based on acuity.

This document is a property of: Shikhar Mishra
Note: This document is copyright protected. It may not be copied, reproduced, used, or
distributed in any way without the written authorization of Lecturio GmbH.


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Small Intestines

Small Bowel Obstruction

With Dr. Kevin Pei

Shikhar Mishra, shikkiinternational2@gmail.com

65-year-old woman who has history of hysterectomy

Shikhar Mishra, shikkiinternational2@gmail.com

We will learn about common history and

This lecture teaches you diagnosis and learn

Shikhar Mishra, shikkiinternational2@gmail.com

> 300,000 small bowel

> 300,000 small bowel

> 300,000 small bowel

> 300,000 small bowel

Abdominal pain Nausea/vomiting Obstipation

General mid abdomen tenderness

Paulsen Friedrich & Waschke

Chloride is low, bicarb is high, creatinine might be high

Shikhar Mishra, shikkiinternational2@gmail.com

Hypochloremic metabolic alkalosis with emesis loss of

Kidneys try to preserve volume through aldosterone

Chloride is low, bicarb is high, creatinine might be high

Shikhar Mishra, shikkiinternational2@gmail.com

Chloride is low, bicarb is high, creatinine might be high

Shikhar Mishra, shikkiinternational2@gmail.com

End product of glycolysis during anaerobic

Persistence of lactate may indicate ischemic

What if the lactate is elevated?

Shikhar Mishra, shikkiinternational2@gmail.com

If the lactate is elevated it suggests anaerobic

Shikhar Mishra, shikkiinternational2@gmail.com

What if the difference between complete and

Shikhar Mishra, shikkiinternational2@gmail.com

Complete bowel obstruction suggests complete absence of

Special type: closed loop bowel obstruction: obstructed in 2

Shikhar Mishra, shikkiinternational2@gmail.com

Hans, PD, Pixabay

Shikhar Mishra, shikkiinternational2@gmail.com

Minimize narcotic medications

Agarwal P, Bagdi R, Thoracoscopic

Kayastha K, Mirza B, Sheikh

Shikhar Mishra, shikkiinternational2@gmail.com

Incarcerated hernias should be on your

Post surgery adhesive disease is one of

Shikhar Mishra, shikkiinternational2@gmail.com

We learned about the recognize small bowel

Now you know diagnosis and treatment of

Shikhar Mishra, shikkiinternational2@gmail.com

Shikhar Mishra, shikkiinternational2@gmail.com

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