Compare conditions

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

Small Bowel Obstruction

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In one line

·Scar tissue from past surgery is the most common reason the small bowel gets blocked.

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Normal physiology

·The small bowel is a twenty-foot-long muscular tube that moves food from the stomach to the large intestine, absorbs most of the water and nutrients your body needs, and keeps everything flowing in one direction.

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What goes wrong

·Something pinches, twists, blocks, or narrows the small bowel so food and fluid cannot pass through.

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Hallmark signs

·Crampy belly pain that comes and goes in waves
·Belly swelling (distention) and a tight, drum-like feel
·Throwing up, often green or yellow-brown and foul-smelling
·No bowel movements and no passing of gas
·High-pitched, tinkling bowel sounds early on, then silence later
·Severe, constant belly pain (not crampy waves anymore)
·Fever and fast heart rate
·Severe tenderness in one spot, with guarding or rebound pain

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Red flags · escalate now

·Severe, constant belly pain instead of crampy waves—suggests strangulation (blood supply cut off) or dead bowel
·Fever, fast heart rate, or signs of shock (low blood pressure, confusion, cold skin)—suggests infection, perforation, or dying tissue
·Severe tenderness in one spot with guarding or rebound pain—suggests peritonitis from a perforated or dead loop of bowel
·Bloody stool or vomit—suggests bleeding from damaged bowel wall or starved blood flow (ischemia)
·Sudden silence of bowel sounds after they were active—suggests the bowel has stopped working (ileus) or has perforated

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Workup

·Complete blood count (CBC)
·Serum lactate
·Basic metabolic panel (BMP)
·Abdominal X-ray (supine and upright or left lateral decubitus)
·CT scan of the abdomen and pelvis with IV contrast
·Water-soluble contrast study (Gastrografin challenge)

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Treatment

·NPO (nothing by mouth) + IV fluids (normal saline or lactated Ringer's) + electrolyte replacement
·Nasogastric (NG) tube decompression
·Water-soluble contrast study (Gastrografin challenge)
·Surgery (exploratory laparotomy or laparoscopy): cut adhesions, repair hernia, remove tumor, untwist bowel, or resect dead bowel
·Pain control with IV opioids (morphine, hydromorphone) or regional anesthesia

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NCLEX trap

·NPO (nothing by mouth) immediately in small bowel obstruction. Food and drink will back up behind the blockage and make vomiting worse. The bowel needs complete rest so it can heal.
·Place the NG tube first in small bowel obstruction to decompress (drain the backed-up fluid and gas). Pain relief comes after the tube is in, because the tube itself helps the pain by lowering the pressure.
·Most partial small bowel obstructions get better with NPO, IV fluids, and NG decompression (draining through a tube). Surgery is only for strangulation (dying tissue cutting off blood flow), closed-loop obstruction (twisted loop trapping blood), signs of perforation (tear in the bowel wall), or no improvement after 3 to 5 days of conservative care.
·Brown vomit (feculent vomit, meaning it looks and smells like stool) in small bowel obstruction means the blockage has been there so long that bacteria have grown and stool contents have backed all the way up into the stomach — this is late obstruction and a danger sign that the bowel is exhausted.
·Rigid belly with guarding (the patient tightening muscles to protect the belly when you press) is strangulation (tissue dying from lost blood flow) or perforation (hole in the bowel wall) until proven otherwise in small bowel obstruction. This is the critical red flag that means surgery now.
·Silence after rushing tinkling sounds in small bowel obstruction is a bad sign — it means the bowel is exhausted and may be dying. Early obstruction makes loud, high-pitched sounds as the bowel fights the blockage. When those sounds disappear and the belly goes silent, the bowel has stopped fighting. This is the danger transition point.

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