GENERAL SURGERY
GENERAL SURGERY
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SMALL BOWEL OBSTRUCTION
SMALL BOWEL OBSTRUCTION
ABOUT THIS SESSION
ABOUT THIS SESSION
This is a self-directed learning resource designed to be worked through in the clinical environment.
Learning objectives:
Learning objectives:
- Demonstrate focused history taking and abdominal examination from a patient with suspected small bowel obstruction
- Suggest relevant imaging required to aid diagnosis of small bowel obstruction
- Suggest initial management of small bowel obstruction
- Recognise common causes of small bowel resection
Total time:
60 minNumber of students:
1-5Grade of students:
3rd to 5th year medical studentsCreated by:
Dr Harriet MitchellUploaded:
20th September 2019Last updated:
20th September 2019Resources needed for this session:
Resources needed for this session:
Resources linked to this session:
Resources linked to this session:
Activity 1: History Taking and Examination Skills
20 minActivity 1: History Taking and Examination Skills
Identify a suitable patient on the ward and take a focused history and perform the relevant abdominal examination from a patient with suspected small bowel obstruction (20 minutes maximum).
Activity 2: Case-Based Discussion and Diagnostic Reasoning
10 minActivity 2: Case-Based Discussion and Diagnostic Reasoning
Document your findings on a clerking proforma or continuation paper. Summarise the key findings of the case suggest at least three key differential diagnoses.
Consider:
- Which differential diagnosis is most likely and why?
- What initial investigations would be useful to aid diagnosis? What are they expected to show?
Activity 3: Initial Investigations
5 minActivity 3: Initial Investigations
If possible, view the patient's abdominal x-ray. If none is available, use the example opposite.
Consider:
- What is the key abnormality on the abdominal x-ray?
- How is it possible to differentiate between small and large bowel obstruction on a plain abdominal x-ray?
- What further imaging may be helpful?
- When is a CT indicated?
- What are the risks/considerations before requesting a CT?
Activity 4: Advanced Imaging
5 minActivity 4: Advanced Imaging
If possible, review the patient's CT abdomen/pelvis. If none is available, use the example opposite.
Orientate yourself and try to identify a few key structures e.g.
- kidneys
- vertebral column
- small bowel
Can you see any obvious abnormalities?
Activity 5: Further Management
15 minActivity 5: Further Management
Consider the acute management of the patient you have seen, in paticular:
- supportive management
- specific management
- medical management
- surgical management
Activity 6: Fluid Prescribing
10 minActivity 6: Fluid Prescribing
Find a drug chart and prescribe some appropriate fluids for the patient - you may need to look up the patient's latest blood results. If none are available, use the example below:
Patient EX is normotensive and not tachycardic, but is vomiting frequently. Their latest blood tests showed:
Na+ 144
K+ 3.2
Urea 8.1
eGFR 82mls/min
Summary and Feedback
Summary and Feedback
Highlight three key things you have learned today. Summarise them on a post-it note and keep it somewhere you will find in a week or two.
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References and Further Reading
References and Further Reading
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