What do we wanna do for these patients?
So we’ve gotten our diagnosis.
We’ve asked all the appropriate questions for the patient.
We wanna start out by giving IV fluids.
So IV fluids are gonna help rehydrate a patient.
Oftentimes, these patients when they come in
have a lot of nausea and vomiting.
So IV fluids are gonna help resuscitate them.
They’re gonna hopefully help get them feeling better.
Anti-emetics can also be very, very helpful.
They can help with the vomiting.
They can help hopefully slow some of that down.
NG or nasogastric tube placement is a little bit debatable.
There is little evidence that says that it definitely helps a lot
with patients but sometimes the surgery team will request it.
You wanna think about doing this for patients
with altered mental status who are at risk for aspiration.
It’s not without risk and it can be a painful procedure for patients.
So we wanna make sure that we’re selecting the right patient
population to perform this in.
NG tubes can potentially go in the lungs,
they can increase risk for aspiration in certain patients,
and again, it’s a very uncomfortable procedure for patients.
What you would do is if you put an NG tube,
you would hook that up to wall suction.
So essentially, what you will be doing
is you’d be helping relieve some of that obstruction.
For some patients,
it definitely does anecdotally make them feel a lot better.
So when I’m taking care of patients with a bowel obstruction,
sometimes they report that an NG tube makes them feel a lot better
because it decreases some of that fluid build-up.
Lastly, you wanna think about giving empiric antibiotics.
That would be coverage against gram negative
as well as anaerobic flora.
For the most part,
those wanna be used for patients who have perforations.
So patients who their bowel wall got so ischemic
with decreased blood flow that it ruptured
and that’s definitely you wanna make sure you give
those patients empiric antibiotics.
Also, for patients who are going for operative management.
Now, who in fact goes for operative management for bowel obstruction,
for small bowel obstruction?
This is for patients who have perforation.
That’s an obvious kind of an indication, right?
You have a hole in your bowel.
You’re spilling your intestinal contents into your abdominal cavity.
That’s a surgical emergency.
That patient needs to get to the operating room immediately.
Strangulation of the bowel is when there is a portion
of the bowel in which the blood supply is cut off.
Those patients also have a surgical emergency.
Time is bowel.
The sooner you get that relieved,
the quicker those patients will feel better.
And peritonitis and perforation go hand in hand.
So when you have that perforation,
you’re gonna have the bowel contents in the abdomen and that irritation.
Those patients needs to go emergently to the operating room.
Again, for the most part, this diagnosis is gonna be based
on your imaging study, based on your CT scan,
but possibly also on that plain film x-ray.
What’s the recurrence rate?
So are people gonna go for an operation
and never have a small bowel obstruction again?
That’s definitely not true.
So certain patients who go for an operation,
about 27% of them will actually have a recurrent
bowel obstruction at some point.
Non-operative management though,
the recurrence rate is a little bit higher, so it’s about 40%.
So definitely, this can be a condition that can recur.
So patients can get repetitive small bowel obstruction.
Sometimes patients will come in and say,
“This feels like when I had a bowel obstruction before.”
And more often than not, they’re likely right in when they report that.