CASE DISCUSSION SMALL BOWEL OBSTRUCTION EMERGENCY DEPARTMENT STAFF MON 12 MARCH 2018 Aldara Hospital and Medical Center | OBJECTIVES By the end of this case discussion we should be able to: 1- Differentiate between types of intestinal obstruction. 2- Understand causes and pathophysiology of intestinal obstruction. 3- Recognize signs and symptoms of small intestinal obstruction. 4- Start lab and radiology workup for cases of intestinal obstruction. 5- Start early management for these cases. 6- Help prevent complications of intestinal obstruction. CME PROGRAM 2018 Aldara Hospital and Medical Center | 2 1- types of intestinal obstruction: Or Complete IO Partial IO VERSUS Simple CME PROGRAM 2018 or strangulated Aldara Hospital and Medical Center | 3 2- causes and pathophysiology of intestinal obstruction: Adhesions Hernias IBD Volvulus Malignancy Parasites CME PROGRAM 2018 Aldara Hospital and Medical Center | 4 3- signs and symptoms of small intestinal obstruction: History Previous surgery Nausea & Vomiting Constipation (relative/absolute) Previous Malignancy IBD Radiation therapy Abdominal Distention Hyper/hypo-peristalsis Parasitic infection Peritoneal Signs Fever & Tachycardia Guarding Rigidity Rebound tenderness CME PROGRAM 2018 Aldara Hospital and Medical Center | 5 4- WORKUP: Laboratory Requests CBC Urea & creatinine Electrolytes ABG Serum lactate ABO/Rh PT, PTT, INR CME PROGRAM 2018 Aldara Hospital and Medical Center | 6 RADIOLOGICAL REQUESTS i) Plain Radiographs: ii) CT Scans: Normal CME PROGRAM 2018 Small Intestinal Obstruction Aldara Hospital and Medical Center | 7 iii) Ultrasound: iv) Role of MRI: CME PROGRAM 2018 Aldara Hospital and Medical Center | 8 5- Early management: i) Emergency Department Care: Bowel decompression Aggressive fluid resuscitation Analgesia & Antiemetic Early start of antibiotics Monitor ABCs Early Surgical Consultation ii) Non-operative management: Treatment of the cause Oral ws contrast medium iii) Operative management: Laparoscopic versus open surgery CME PROGRAM 2018 Aldara Hospital and Medical Center | 9 THANK YOU….. CME PROGRAM 2018 Aldara Hospital and Medical Center | 10 For more information, please contact brand@aldaramed.com Aldara Hospital and Medical Center | 11