Compare conditions

Put any two — or three — conditions side by side, adult or pediatric, to spot the look-alike differences fast, row by row.

Sbo

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In one line

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Normal physiology

·The small bowel is a long, coiled tube (about 20 feet in an adult) that runs from the stomach to the colon. Smooth muscle in its wall squeezes in slow, rhythmic waves (peristalsis) to push partly digested food, water, and waste steadily forward — like squeezing toothpaste through a tube.

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What goes wrong

·Something — a scar, a hernia, a tumor, or a twist — blocks the small bowel so nothing can squeeze past. The loop above the block swells up with food, fluid, and gas. If the block also twists the bowel or traps it in a tight space, the blood vessels get pinched and the tissue starts to die.

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Hallmark signs

·Crampy belly pain that comes and goes in waves
·Throwing up — early (green or yellow) if the block is high in the small bowel, late (brown, foul-smelling) if the block is lower down
·Belly bloating and swelling
·No poop and no passing gas
·Loud, high-pitched bowel sounds early on (hyperactive bowel sounds)
·Quiet or silent belly sounds later (hypoactive or absent bowel sounds)
·History of past belly surgery (especially adhesions from old cuts or infections)
·Fever and constant, severe belly pain (not crampy)

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Red flags · escalate now

·Fever above 100.4°F (38°C) with steady, severe belly pain — warns that the bowel may be losing blood flow or tearing
·Fast heart rate (tachycardia over 100 beats per minute) or low blood pressure — signs the body is losing fluid fast or going into shock
·Belly is rigid, very tender to touch, or shows guarding (muscles tighten to protect) — suggests the bowel may have torn and spilled contents into the belly (peritonitis)
·Vomit or belly pain that smells like feces — late sign of a low, complete blockage or dead bowel
·No urine output or very dark urine — the body is dangerously low on fluid

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Workup

·Upright abdominal X-ray (KUB: kidney, ureter, bladder)
·CT abdomen/pelvis with IV contrast (oral contrast often skipped in acute setting)
·Basic metabolic panel (BMP: sodium, potassium, chloride, CO₂, creatinine, glucose)
·Complete blood count (CBC)
·Lactate (serum lactic acid)
·Water-soluble contrast study (Gastrografin by mouth or NG tube)

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Treatment

·NPO (nothing by mouth) + nasogastric (NG) tube decompression
·IV fluids (normal saline or lactated Ringer's) + electrolyte replacement (potassium chloride, sodium chloride)
·Water-soluble contrast (Gastrografin) by mouth or NG tube
·Surgery (exploratory laparotomy or laparoscopy): lysis of adhesions, hernia repair, bowel resection, or bypass
·Pain control (IV opioids like morphine or fentanyl, used carefully)
·Treat the underlying cause (chemotherapy for cancer, biologics or steroids for Crohn's stricture, antibiotics for TB)

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NCLEX trap

·In SBO, you stop all food and drink by mouth (NPO). The bowel needs rest. A tube in the nose drains the backup. IV fluids replace what vomiting lost. Food makes swelling worse.
·In SBO, quiet bowel sounds are a red flag, not a good sign. Quiet means the bowel stopped fighting, which can mean the tissue is dying or about to die. More loud sounds would be better.
·In SBO, fix the patient first (safety), then figure out what is wrong (exam and imaging). Dehydration and wrong electrolytes can stop the heart. Imaging comes after the patient is stable.
·In SBO, the key clues are: old belly surgery, crampy pain (not steady), no poop or gas for days, and X-ray showing puffed-up small bowel loops. Gastroenteritis has diarrhea and usually no old scars. Do not mix them up.
·In SBO, most small blocks get better with rest in 72 hours. But if pain stays bad, fever shows up, belly is rigid, or lactate is high, surgery cannot wait. Waiting risks a hole and blood poisoning (sepsis).
·In SBO, vomiting is just the downstream signal. The real problem is the block upstream (scar, hernia, or twist). Fixing vomiting alone will not fix SBO. Find and fix the block.

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