Mechanical !Bowel Obstruction
| Condition | Causes / Risk Factors | Presentation | Investigations | Management |
|---|---|---|---|---|
| Ileus | Surgical/pharmacologic: abdominal surgery, opioids |
Patient factors: electrolyte imbalances, immobility, sepsis, peritoneal irritation, spinal cord injury, metabolic acidosis | Nausea, vomiting, abdominal distension, decreased bowel sounds, no flatus or stool, can't tolerate diet | Electrolytes, BUN, creatinine, ‣ | Bowel rest, IV fluids, electrolyte correction, NG decompression if vomiting, early ambulation, parenteral nutrition if >7 days | | Mechanical Obstruction | Same risk factors as ileus; may be due to adhesions, hernia, tumors | Similar to ileus – distension, nausea, vomiting, no flatus/stool; must differentiate with imaging | Same as ileus (labs + imaging) | Identify and treat underlying cause; surgical intervention may be required if complete or high-risk obstruction | | GI Bleeding | Post-op bleeding at anastomosis, stress ulcers/gastritis;
risk factors: burns, head trauma, sepsis, multiorgan failure | Hematemesis, coffee ground emesis, melena; may show hemodynamic instability and ↓ hemoglobin | ‣ for anemia; hemodynamic signs; upper ‣ to diagnose and possibly treat | Prevention: PPIs or H2 blockers for all high-risk patients
Treatment: endoscopy ± cautery/clips/hemostatic agents |
Drugs: dexamethasone, ondansetron, dimenhydrinate
Other measures: use of regional anesthesia, propofol (TIVA), avoidance of nitrous oxide and volatile agents, intra-operative supplemental oxygen, adequate hydration, minimizing perioperative opioids, and minimizing use of neostigmine