Date:
Patient:
Reason for Visit:
Evaluation for suspected small bowel obstruction (SBO)
Follow-up for SBO (post-operative or conservative management)
Assessment of response to treatment or progression of obstruction
History:
Presenting Illness:
Onset and duration of symptoms (abdominal pain, nausea, vomiting, constipation, abdominal distention)
Frequency and character of vomiting (feculent vomiting suggests advanced obstruction)
Passage of stool or gas (absence suggests complete obstruction)
Prior abdominal surgeries (risk factor for adhesions)
History of hernias (risk factor for incarceration)
Past Medical History (PMH):
Underlying medical conditions (e.g., Crohn’s disease, diverticulitis) that may contribute to SBO
Previous episodes of SBO
Physical Exam:
General: Assess vital signs (temperature, heart rate, blood pressure, signs of dehydration).
Abdominal:
Evaluate for distention, tenderness, masses, peristaltic sounds (hypoactive or absent sounds suggest obstruction).
Check for hernial bulges.
Rectal exam: Assess for stool or blood.
Diagnostic Tests (may be ordered depending on clinical suspicion):
Imaging Studies:
Abdominal X-ray – may show signs of gas/fluid levels in the small intestine.
Abdominal CT scan with oral and intravenous contrast – most definitive imaging study for diagnosing SBO and identifying the cause.
Ultrasound (less common): May be used in some cases to assess for strangulation or presence of gallstones.
Assessment:
Clinical suspicion of SBO: Based on history, physical exam findings, and initial X-ray.
Confirmation of SBO: Typically confirmed with CT scan, which also helps identify the cause (e.g., adhesions, hernia, tumor).
Severity of obstruction: Determined by clinical presentation, imaging findings, and presence of strangulation (loss of blood supply to the bowel).
Differential diagnosis: Consider other causes of abdominal pain and vomiting (e.g., appendicitis, gastroenteritis).
Plan:
Treatment approach depends on severity and cause of SBO:
Non-surgical management (for partial obstructions or early presentation):
Nasogastric (NG) tube placement to decompress the stomach and promote bowel rest.
Intravenous fluids for hydration and electrolyte balance.
Electrolyte replacement.
Close monitoring of vital signs and clinical response.
Surgical intervention (for complete obstructions, strangulation, or failed conservative management):
Laparoscopic or open surgery to address the cause of obstruction (adhesiolysis for adhesions, hernia repair, bowel resection for gangrene).
Nutritional support: May be required after resolution of obstruction, especially if surgery was involved.
Follow-up:
For patients managed conservatively:
Monitor for improvement in symptoms and passage of stool/gas.
Consider repeat imaging if symptoms worsen.
For post-operative patients:
Monitor for surgical site infection and signs of recurrent obstruction.
Discuss long-term management strategies to reduce risk of recurrence (e.g., dietary modifications for adhesions).
Patient education: Provide information about SBO, its causes, treatment options, and potential complications.
Discuss the importance of a balanced diet and hydration to prevent constipation.
Instruct on recognizing signs and symptoms of recurrent SBO that require urgent medical attention.
Disclaimer: This information is for educational purposes only and should not be interpreted as medical advice. Please consult with a qualified healthcare professional for diagnosis and treatment of small bowel obstruction