Intestinal Blockage Question

Obstruction can be characterized as either partial or complete versus simple or strangulated.

• Abdominal pain (characteristic with most patients)
  • Pain, often described as crampy and intermittent, is more prevalent in simple obstruction.
  • Often, the presentation may provide clues to the approximate location and nature of the obstruction. Usually, pain that occurs for a shorter duration of time and is colicky and accompanied by bilious vomiting may be more proximal. Pain lasting as many as several days, which is progressive in nature and with abdominal distention, may be typical of a more distal obstruction.
  • Changes in the character of the pain may indicate the development of a more serious complication (ie, constant pain of strangulated or ischemic bowel).
• Nausea
• Vomiting, which is associated more with proximal obstructions
• Diarrhea (an early finding)
• Constipation (a late finding) as evidenced by the absence of flatus or bowel movements
• Fever and tachycardia - Occur late and may be associated with strangulation
• Previous abdominal or pelvic surgery,  previous radiation therapy, or both (may be part of patient's medical history)
• History of malignancy (particularly ovarian and colonic)

Physical

• Abdominal distention
  • Duodenal or proximal small bowel has less distention when obstructed than the distal bowel has when obstructed.
  • Hyperactive bowel sounds occur early as GI contents attempt to overcome the obstruction.
  • Hypoactive bowel sounds occur late.
  • Exclude incarcerated hernias of the groin, femoral triangle, and obturator foramina.
  • Proper genitourinary and pelvic examinations are essential.
  • Look for the following during rectal examination:
    • Gross or occult blood, which suggests late strangulation or malignancy
    • Masses, which suggest obturator hernia
  • Check for symptoms commonly believed to be more diagnostic of intestinal ischemia, including the following:
    • Fever (temperature >100°F)
    • Tachycardia (>100 beats/min)
    • Peritoneal signs
  • No reliable way exists to differentiate simple from early strangulated obstruction on physical examination. Serial abdominal examinations are important and may detect changes early