腸梗阻病例討論優(yōu)質(zhì)課件

腸梗阻病例討論腸梗阻病例討論1

A

60-year-oldfemaleisadmittedtotheemergencyroomwith

a48-hourhistoryoflowerabdominalpain,nausea,vomitingandconstipation.Thepatientdescribesthepainascrampyinearlyandnotesthatherabdomenhasbecomedistendedoverthelast12hours.Herlastbowelmovementwasthreedayspriortopresentation.CASE1A60-year-oldfemaleisad2女性，60歲，“腹痛、嘔吐、腹脹和肛門停止排便排氣2天,加重12小時”急診入院女性，60歲，“腹痛、嘔吐、腹脹和肛門停止排便排氣2天,加重3Question

1.what’swrongwiththeoldwoman?

2.whatcausesit?

3.Howcanshegetwell?Operationisneedornot?Question4Doctorneedtoanswer:DiagnosisEtiologyTreatmentDoctorneedtoanswer:Diagnosi5What

shouldbedonenext?Whatshouldbedonenext?6Herpastmedicalhistoryisremarkableinthatsheunderwentanappendectomyforacuteappenditistenyearsago.Sheisotherwisehealthyandtakesnomedications.Physicalexamrevealsatemperatureof38℃.Herabdomenisdistended.Herpastmedicalhistoryisre7

ClinicalManifestationsAbdominalpainNauseaandvomitingObstipationDistention

ClinicalManifestations8Abdominalpain

Colickyabdominalpain

inearlyperiod

lasting

abdominalpain

later

Abdominalpain

Colickyabdo9Nauseaandvomiting

1).Thenatureofthevomitus.

undigestedfoodparticles.

becomesbilious.

feculent.

2).Theonsetandcharacterofvomiting.

Recurrentvomitingofbile-stainedfluid

Prolongednauseaprecedesvomiting,feculent.

Nauseaandvomiting

1).Then10

Contispationandobstipation

Theonsetofobstipation,alatedevelopmentStillpassflatus:

thedistal,unobstructedintestineempties.

partialorincompleteobstruction

Contispationandobstipation11Distention

Developlaterinthecourseoftheobstruction

littlebylittleDistention

Developlaterint12PhysicalExaminationInspectionPalpationPercussionAuscultationPhysicalExaminationInspection13Inspection

rightupperquadrantrightlowerquadrantleftupperquadrantLeftlowerquadrantInspectionrightupperquadran14Palpation

mildtendernessinRLQbutnoguardingorrebound

Mass5cmX4cm，

NoperitonitisPalpationmildtendernessin15Percussion

shiftingdullnessINRLQPercussionshiftingdullnessI16Auscultationnoisyandisheardasrushes.Duringattacksofcolic,thesoundsbecomeloud,high-pitchedandmetallic.Auscultationnoisyandisheard17Rectalexamination:Lowrectalcarcinomaandintussusceptedsegmentdon’tbepalpatedrectalexamrevealsnostoolintherectum.Knee-elbowPositionRectalexamination:Lowrectal18Ahemoglobinof16,hematocrit48,whitebloodcellcount12,200with74polys.Serumelectrolytesshowthelevelofserumsodiumandpotassiumis130mol/land3.0mol/l.ArterialbloodgasanalysisrevealsthattheresultofPHis7.30.AnabdominalX-RAYrevealsmultipledilatedloopsofsmallbowelwithnumerousair-fluidlevels.ThereisnogasorstoolvisibleinthecolonAdmittinglaboratorydataAhemoglobinof16,hematocrit19RadiologicalExaminations

2008-12-42008-12-5X-rays

UprightRadiologicalExaminations

20020SupineX-rays2008-12-52008-12-4SupineX-rays2008-12-52008-12-421腸梗阻病例討論優(yōu)質(zhì)課件22CTscanCTscan23B-UltraSound2008-12-4

distendedsmallintestine;

noliquidintheabdomen2008-12-5

dilatedloopsofsmallintestine;liquidinRLQ(7CMDeep)B-UltraSound2008-12-4distende24Summury

Summury

25SymptomsofthepatientsPainVomitingObstipationAbdominaldistentionSymptomsofthepatientsPain26SignsofthepatientsVitalSigns:temperatureof38℃Hisabdomenisdistended.Mildtendernessperiumbilicallybutnoguardingorrebound.High-pitchedbowelsoundsRectalexamrevealsnostoolintherectumSignsofthepatientsVitalSig27LaboratoryStudyAhemoglobinof16,hematocrit48,whichshowshemoconcentrationWhitebloodcellcount12,200,whichshowsinflammation.Serumelectrolytesareabnormal,whichshowsbodyliquidimbalancewithhyponatremiaandhypokalemia.ArterialbloodgasanalysisrevealsacidosisLaboratoryStudyAhemoglobino28RadiographyexamAnabdominalX-RAYrevealsmultipledilatedloopsofsmallbowelwithnumerousairfluidlevels.ThereisnogasorstoolvisibleinthecolonToconfirmthediagnosis:intestinalobstrutionRadiographyexamAnabdominalX29Diagnosis

mustmakeclearthefollowingquestions:

Diagnosis

mustmakeclearthe301.Whetherintestinalobstructionexists:

Throughsymptomsandsigns,thediagnosiscanbemadewithoutdifficulty.1.Whetherintestinalobstructi312.Whethertheobstructionismechanicalordynamic:

mechanicalobstruction:typicalsymptomsandsigns.

paralyticobstruction:episodicandcrampingabdominalpainisabsent;

distentionisprominent

2.Whethertheobstructionism323.Whethertheobstructionissimpleorstrangulationobstruction:

Indicationsforstrangulation:

1).Abruptonsetwithcontinuousacuteabdominalpain,

2).Shock

3).Manifestationofperitonitis:leukocytosis,sepsis,reboundandguarding

3.Whethertheobstructioniss33

4).Asymmetricaldistention,localbulge,ormasswithtenderness.

5).Hematicvomitus,

6).Conservativetreatmentinvainandnoimprovementinsymptomsandsigns.

7).Isolated,bulged,anddistendedintestinallooponabdominalplainfilm.4).Asymmetricaldistention,344.Whethertheobstructionishighorlow:

Vomitinginproximalintestinalobstruction.

Distentioninlowobstruction,feculentvomitus

4.Whethertheobstructionish355.Whethertheobstructioniscompleteorincomplete:

frequencyofvomiting,extentofdistention,

Contispationandobstipation5.Whethertheobstructionisc366.Whichcausesleadstoobstruction:

Accordingtotheage,history,symptomsandsigns.

Postoperativeadhesions;postinflammatory

Henias

Congenitalmalformations

Intestinalintussusception

Obstructionofparasiteorigin

Carcinomasanddryfeces.6.Whichcausesleadstoobstru37EtiologyEtiology38Etiologyfor

mechanicalIntestinal

obstruction1.

Obstructionarisingfromextraluminalcauses2.

Obstructionintrinsictothebowelwall3.

Intraluminalobturatorobstruction腸壁外因素腸壁因素腸腔內(nèi)因素outsideoninsideEtiologyfor

mechanicalInte39Outside:Adhesions

Volvulus

Hernias

Tumor

Outside:AdhesionsVolvulus

40On:Tumor

Intussusception

On:TumorIntussusception41Inside:

fecalimpaction

Inside:fecalimpaction42Intestinalobstruction

Intestinalobstruction

43

Classification

1

Mechanicalobstruction機(jī)械性腸梗阻

2

Paralyticileus動力性腸梗阻

3Strangulating

obstruction血運(yùn)性腸梗阻

4原因不明的假性腸梗阻

Classification1Mechanical44others：根據(jù)有無血運(yùn)障礙：單純性Simpleobstruction,

絞窄性strangulationobstruction

梗阻部位：高位Proximalintestinal

低位distalintestinal

大腸largebowel

小腸

smallbowel

梗阻程度:

不完全性Incompleteobstruction

完全性

completeobstruction

發(fā)展過程:

急性Acuteobstruction

慢性chronicobstructionothers：45Diagnosis

1.老年女性，急性病程2.典型臨床表現(xiàn)：痛、嘔、閉、脹3.腹部體征4.X-Rays和腹部CT表現(xiàn)5.既往腹部手術(shù)病史急性粘連性小腸低位完全梗阻Diagnosis

1.老年女性，急性病程急性粘連性小腸低位46DoesStrangulatingobstructionexist？MechanicalobstructionParalyticileusStrangulatingobstructionDoesStrangulatingobstruction47DifferentialDiagnosisuppergastrointestinalperforationacutepancreatitisacutecholecystisisacutecholangitisDifferentialDiagnosisupperga48TreatmentTheprinciple:

correctionofsystemicdisturbance

reductionofobstruction.Treatment49Conservativetreatment

1).Gastrointestinaldecompression:

Nasogastricsuction

2).Correctionofwater-electrolytic

disturbance,acid-baseimbalance

3).Preventionandtreatmentofinfectionandtoxemia:AntibioticsConservativetreatment

1).Gas50Surgical

intervention1)Lysisofadhesion,reductionofintussusception,

2)Enterectomyandanastomosis.3)Bypassprocedurefornonresectablelesions.4)Enterostomyandexteriorizationofintestine.Surgicalintervention1)Lysiso51本病例治療方案：病人腹痛逐漸加重，且嘔吐頻繁，保守?zé)o效體溫從36.5度升高至38度查體：腹脹加重，右下腹壓痛明顯，腸鳴音變?nèi)醺勾河醒砸夯灒篧BC及中性粒細(xì)胞均升高超過正常X-rays:可見固定腸袢，腸管擴(kuò)張明顯，加重laparetomy本病例治療方案：病人腹痛逐漸加重，且嘔吐頻繁，保守?zé)o效lap52InoperationpostoperationInoperationpostoperation53Case2Marryisan87-year-oldwomanwitha3-dayhistoryofintermittentabdominalpain,abdominalbloating,nauseaandvomiting.MarrymovedfromItalytojoinhergrandsonandhisfamilyonly2monthsago,andshespeakslittleEnglish.Allinformationwasobtainedthroughhergrandson.

Case2Marryisan87-year-old54Pastmedicalhistory(PMH)includescolectomyforcoloncancer6yearsagoandfemoralherniarepair2yearsago.Shehasnohistoryofcoronaryarterydisease(CAD),diabetesmellitus(DM),orpulmonarydisease.Shetakesnodrugs.AllergiesincludePenicillindrugsandDolantin.Pastmedicalhistory(PMH)inc55Marry’stentativediagnosisissmallbowelobstruction(SBO)secondarytoadhesion.Marryisbeingadmittedtoyourfloorfordiagnosticwork-up.Hervitalsignsarestable,shehasanIVofwith20mmolKCIat100ml/hr,and3Loxygenbynasalcannula(O2/NC).Marry’stentativediagnosisis561.Basedonthenurse’sreport,whatsignsofbowelobstructiondidMarrymanifest?

QUESTION1.Basedonthenurse’sreport,57·Intermittentabdominalpain–mostSBOcausewavesofcrampingabdominalpainaroundtheperiumbilicalarea.

·Abdominalbloating-Blockagesmaycausebloatinginthelowerabdomen.Youmayalsoheargurglingsoundscomingfromyourbelly.Withacompleteobstruction,yourdoctormayhearhigh-pitchedsoundswhenlisteningwithastethoscope.Thesoundsdecreaseasmovementofthebowelslows.

·Intermittentabdominalpain–58·Nauseaandvomiting-Thevomitisusuallygreeniftheobstructionisintheuppersmallintestineandbrownifitisinthelowersmallintestine.·Nauseaandvomiting-Thevom592.ArethereothersignsandsymptomsthatyoushouldobserveforwhileMarryisinyourcare?

2.Arethereothersignsandsy60·Continuousseverepaininoneareacanmeanthattheblockagehascutoffthebowel'sbloodsupply.Thisiscalledabowelstrangulationandrequiresemergencytreatment.

·Continuousseverepaininone61·Constipation(latefinding)andinabilitytopassgasarecommonsignsofabowelobstruction.However,whenthebowelispartiallyblocked,youmayhavediarrhea(earlyfinding)andpasssomegas.Ifyouhaveacompleteobstruction,youmayhaveabowelmovementifthereisstoolbelowtheobstruction.

·Feverandtachycardia–latesign;mayberelatedtostrangulation

·Constipation(latefinding)a62·Peritonealsigns

·Abdominaldistention

·HyperactivebowelsoundsoccurearlyasGIcontentsattempttoovercometheobstruction;hypoactivebowelsoundsoccurlate

·Grossoroccultblood-latestrangulationormalignancy

·Masses-obturatorhernia·Peritonealsigns

·Abdominald633.Marryandhergrandsonarriveonyourunit.YouadmitMarrytoherroomandintroduceyourselfashernurse.Ashergrandsoninterpretsforher,shepatsyourhand.Youknowthatyouneedtocompleteaphysicalexaminationandtakeahistory.Whatwillyoudofirst?

3.Marryandhergrandsonarriv64·Builduparelationshipoftrust;attempttoobtainpatient’scooperation

·Builduparelationshipoftr654.Thegrandson,anattorney,tellsyouelderlyItalianwomenareextremelymodestandmaynotanswerquestionscompletely.Howmightyougatherinfointhiscase?

4.Thegrandson,anattorney,t66·Explainingtothepatientthattheinfoshegiveswillbetreatedasconfidential,andmaintainingthisconfidentiality

·Givethepatientanunderstandingofherproblem

·Benon-judgmental·Explainingtothepatienttha675.Whatkeyquestionsmustyouaskthispatientwhileyouhavetheuseofaninterpreter?

5.Whatkeyquestionsmustyou68·Askaboutthelocation,duration,intensity,andfrequencyofabdominalpain

·Onset,frequency,color,odor,andamountofvomitus

·Bowelandrenalfunctioning

·Nutritional/diet

·Health/medicalhistory

·Anyotherallergies?

·Datesandtypeofimmunizationsreceived

·Askaboutthelocation,dura696.Howwouldthedescriptionofpaindifferifshehasasmallversuslargebowelobstruction?

6.Howwouldthedescriptionof70·SBOpainiscolicky,cramp-like,andintermittent

·LBOpainislow-grade,crampingabdominalpain·SBOpainiscolicky,cramp-li71SummaryEtiologyManifestationsDiagnosisTreatmentSummaryEtiology72Reference吳階平，裘法祖主編《黃家駟外科學(xué)》（第六版）人民衛(wèi)生出版社黃志強(qiáng)，黎鰲，張肇祥主編《外科手術(shù)學(xué)》（第二版）人民衛(wèi)生出版社SabistonTextbookofSurgery,18thed

Reference73Thankyou!Thankyou!74腸梗阻病例討論腸梗阻病例討論75

A

60-year-oldfemaleisadmittedtotheemergencyroomwith

a48-hourhistoryoflowerabdominalpain,nausea,vomitingandconstipation.Thepatientdescribesthepainascrampyinearlyandnotesthatherabdomenhasbecomedistendedoverthelast12hours.Herlastbowelmovementwasthreedayspriortopresentation.CASE1A60-year-oldfemaleisad76女性，60歲，“腹痛、嘔吐、腹脹和肛門停止排便排氣2天,加重12小時”急診入院女性，60歲，“腹痛、嘔吐、腹脹和肛門停止排便排氣2天,加重77Question

1.what’swrongwiththeoldwoman?

2.whatcausesit?

3.Howcanshegetwell?Operationisneedornot?Question78Doctorneedtoanswer:DiagnosisEtiologyTreatmentDoctorneedtoanswer:Diagnosi79What

shouldbedonenext?Whatshouldbedonenext?80Herpastmedicalhistoryisremarkableinthatsheunderwentanappendectomyforacuteappenditistenyearsago.Sheisotherwisehealthyandtakesnomedications.Physicalexamrevealsatemperatureof38℃.Herabdomenisdistended.Herpastmedicalhistoryisre81

ClinicalManifestationsAbdominalpainNauseaandvomitingObstipationDistention

ClinicalManifestations82Abdominalpain

Colickyabdominalpain

inearlyperiod

lasting

abdominalpain

later

Abdominalpain

Colickyabdo83Nauseaandvomiting

1).Thenatureofthevomitus.

undigestedfoodparticles.

becomesbilious.

feculent.

2).Theonsetandcharacterofvomiting.

Recurrentvomitingofbile-stainedfluid

Prolongednauseaprecedesvomiting,feculent.

Nauseaandvomiting

1).Then84

Contispationandobstipation

Theonsetofobstipation,alatedevelopmentStillpassflatus:

thedistal,unobstructedintestineempties.

partialorincompleteobstruction

Contispationandobstipation85Distention

Developlaterinthecourseoftheobstruction

littlebylittleDistention

Developlaterint86PhysicalExaminationInspectionPalpationPercussionAuscultationPhysicalExaminationInspection87Inspection

rightupperquadrantrightlowerquadrantleftupperquadrantLeftlowerquadrantInspectionrightupperquadran88Palpation

mildtendernessinRLQbutnoguardingorrebound

Mass5cmX4cm，

NoperitonitisPalpationmildtendernessin89Percussion

shiftingdullnessINRLQPercussionshiftingdullnessI90Auscultationnoisyandisheardasrushes.Duringattacksofcolic,thesoundsbecomeloud,high-pitchedandmetallic.Auscultationnoisyandisheard91Rectalexamination:Lowrectalcarcinomaandintussusceptedsegmentdon’tbepalpatedrectalexamrevealsnostoolintherectum.Knee-elbowPositionRectalexamination:Lowrectal92Ahemoglobinof16,hematocrit48,whitebloodcellcount12,200with74polys.Serumelectrolytesshowthelevelofserumsodiumandpotassiumis130mol/land3.0mol/l.ArterialbloodgasanalysisrevealsthattheresultofPHis7.30.AnabdominalX-RAYrevealsmultipledilatedloopsofsmallbowelwithnumerousair-fluidlevels.ThereisnogasorstoolvisibleinthecolonAdmittinglaboratorydataAhemoglobinof16,hematocrit93RadiologicalExaminations

2008-12-42008-12-5X-rays

UprightRadiologicalExaminations

20094SupineX-rays2008-12-52008-12-4SupineX-rays2008-12-52008-12-495腸梗阻病例討論優(yōu)質(zhì)課件96CTscanCTscan97B-UltraSound2008-12-4

distendedsmallintestine;

noliquidintheabdomen2008-12-5

dilatedloopsofsmallintestine;liquidinRLQ(7CMDeep)B-UltraSound2008-12-4distende98Summury

Summury

99SymptomsofthepatientsPainVomitingObstipationAbdominaldistentionSymptomsofthepatientsPain100SignsofthepatientsVitalSigns:temperatureof38℃Hisabdomenisdistended.Mildtendernessperiumbilicallybutnoguardingorrebound.High-pitchedbowelsoundsRectalexamrevealsnostoolintherectumSignsofthepatientsVitalSig101LaboratoryStudyAhemoglobinof16,hematocrit48,whichshowshemoconcentrationWhitebloodcellcount12,200,whichshowsinflammation.Serumelectrolytesareabnormal,whichshowsbodyliquidimbalancewithhyponatremiaandhypokalemia.ArterialbloodgasanalysisrevealsacidosisLaboratoryStudyAhemoglobino102RadiographyexamAnabdominalX-RAYrevealsmultipledilatedloopsofsmallbowelwithnumerousairfluidlevels.ThereisnogasorstoolvisibleinthecolonToconfirmthediagnosis:intestinalobstrutionRadiographyexamAnabdominalX103Diagnosis

mustmakeclearthefollowingquestions:

Diagnosis

mustmakeclearthe1041.Whetherintestinalobstructionexists:

Throughsymptomsandsigns,thediagnosiscanbemadewithoutdifficulty.1.Whetherintestinalobstructi1052.Whethertheobstructionismechanicalordynamic:

mechanicalobstruction:typicalsymptomsandsigns.

paralyticobstruction:episodicandcrampingabdominalpainisabsent;

distentionisprominent

2.Whethertheobstructionism1063.Whethertheobstructionissimpleorstrangulationobstruction:

Indicationsforstrangulation:

1).Abruptonsetwithcontinuousacuteabdominalpain,

2).Shock

3).Manifestationofperitonitis:leukocytosis,sepsis,reboundandguarding

3.Whethertheobstructioniss107

4).Asymmetricaldistention,localbulge,ormasswithtenderness.

5).Hematicvomitus,

6).Conservativetreatmentinvainandnoimprovementinsymptomsandsigns.

7).Isolated,bulged,anddistendedintestinallooponabdominalplainfilm.4).Asymmetricaldistention,1084.Whethertheobstructionishighorlow:

Vomitinginproximalintestinalobstruction.

Distentioninlowobstruction,feculentvomitus

4.Whethertheobstructionish1095.Whethertheobstructioniscompleteorincomplete:

frequencyofvomiting,extentofdistention,

Contispationandobstipation5.Whethertheobstructionisc1106.Whichcausesleadstoobstruction:

Accordingtotheage,history,symptomsandsigns.

Postoperativeadhesions;postinflammatory

Henias

Congenitalmalformations

Intestinalintussusception

Obstructionofparasiteorigin

Carcinomasanddryfeces.6.Whichcausesleadstoobstru111EtiologyEtiology112Etiologyfor

mechanicalIntestinal

obstruction1.

Obstructionarisingfromextraluminalcauses2.

Obstructionintrinsictothebowelwall3.

Intraluminalobturatorobstruction腸壁外因素腸壁因素腸腔內(nèi)因素outsideoninsideEtiologyfor

mechanicalInte113Outside:Adhesions

Volvulus

Hernias

Tumor

Outside:AdhesionsVolvulus

114On:Tumor

Intussusception

On:TumorIntussusception115Inside:

fecalimpaction

Inside:fecalimpaction116Intestinalobstruction

Intestinalobstruction

117

Classification

1

Mechanicalobstruction機(jī)械性腸梗阻

2

Paralyticileus動力性腸梗阻

3Strangulating

obstruction血運(yùn)性腸梗阻

4原因不明的假性腸梗阻

Classification1Mechanical118others：根據(jù)有無血運(yùn)障礙：單純性Simpleobstruction,

絞窄性strangulationobstruction

梗阻部位：高位Proximalintestinal

低位distalintestinal

大腸largebowel

小腸

smallbowel

梗阻程度:

不完全性Incompleteobstruction

完全性

completeobstruction

發(fā)展過程:

急性Acuteobstruction

慢性chronicobstructionothers：119Diagnosis

1.老年女性，急性病程2.典型臨床表現(xiàn)：痛、嘔、閉、脹3.腹部體征4.X-Rays和腹部CT表現(xiàn)5.既往腹部手術(shù)病史急性粘連性小腸低位完全梗阻Diagnosis

1.老年女性，急性病程急性粘連性小腸低位120DoesStrangulatingobstructionexist？MechanicalobstructionParalyticileusStrangulatingobstructionDoesStrangulatingobstruction121DifferentialDiagnosisuppergastrointestinalperforationacutepancreatitisacutecholecystisisacutecholangitisDifferentialDiagnosisupperga122TreatmentTheprinciple:

correctionofsystemicdisturbance

reductionofobstruction.Treatment123Conservativetreatment

1).Gastrointestinaldecompression:

Nasogastricsuction

2).Correctionofwater-electrolytic

disturbance,acid-baseimbalance

3).Preventionandtreatmentofinfectionandtoxemia:AntibioticsConservativetreatment

1).Gas124Surgical

intervention1)Lysisofadhesion,reductionofintussusception,

2)Enterectomyandanastomosis.3)Bypassprocedurefornonresectablelesions.4)Enterostomyandexteriorizationofintestine.Surgicalintervention1)Lysiso125本病例治療方案：病人腹痛逐漸加重，且嘔吐頻繁，保守?zé)o效體溫從36.5度升高至38度查體：腹脹加重，右下腹壓痛明顯，腸鳴音變?nèi)醺勾河醒砸夯灒篧BC及中性粒細(xì)胞均升高超過正常X-rays:可見固定腸袢，腸管擴(kuò)張明顯，加重laparetomy本病例治療方案：病人腹痛逐漸加重，且嘔吐頻繁，保守?zé)o效lap126InoperationpostoperationInoperationpostoperation127Case2Marryisan87-year-oldwomanwitha3-dayhistoryofintermittentabdominalpain,abdominalbloating,nauseaandvomiting.MarrymovedfromItalytojoinhergrandsonandhisfamilyonly2monthsago,andshespeakslittleEnglish.Allinformationwasobtainedthroughhergrandson.

Case2Marryisan87-year-old128Pastmedicalhistory(PMH)includescolectomyforcoloncancer6yearsagoandfemoralherniarepair2yearsago.Shehasnohistoryofcoronaryarterydisease(CAD),diabetesmellitus(DM),orpulmonarydisease.Shetakesnodrugs.AllergiesincludePenicillindrugsandDolantin.Pastmedicalhistory(PMH)inc129Marry’stentativediagnosisissmallbowelobstruction(SBO)secondarytoadhesion.Marryisbeingadmittedtoyourfloorfordiagnosticwork-up.Hervitalsignsarestable,shehasanIVofwith20mmolKCIat100ml/hr,and3Loxygenbynasalcannula(O2/NC).Marry’stentativediagnosisis1301.Basedonthenurse’sreport,whatsignsofbowelobstructiondidMarrymanifest?

QUESTION1.Basedonthenurse’sreport,131·Intermittentabdominalpain–mostSBOcausewavesofcrampingabdominalpainaroundtheperiumbilicalarea.

·Abdominalbloating-Blockagesmaycausebloatinginthelowerabdomen.Youmayalsoheargurglingsoundscomingfromyourbelly.Withacompleteobstruction,yourdoctormayhearhigh-pitchedsoundswhenlisteningwithastethoscope.Thesoundsdecreaseasmovementofthebowelslows.

·Intermittentabdominalpain–132·Nauseaandvomiting-Thevomitisusuallygreeniftheobstructionisintheuppersmallintestineandbrownifitisinthelowersmallintestine.·Nauseaandvomiting-Thevom1332.ArethereothersignsandsymptomsthatyoushouldobserveforwhileMarryisinyourcare?

2.Arethereothersignsandsy134·Continuousseverepainino