Clinical Features

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The site and nature of the obstruction and the preexisting condition of the patient will determine the clinical presentation. Almost all patients will have abdominal pain. 4 The pain is generally described as crampy and intermittent. Pain of mechanical SBO is often episodic, usually lasting for a few minutes at a time, and it may be periumbilical or more diffuse. In adynamic ileus, the pain tends to be less intense and more constant. If the obstruction is proximal, vomiting is usually present. The vomitus in proximal obstruction is usually bilious but is feculent in distal ileal obstruction. The pain of large bowel obstruction is usually hypogastric. Large bowel obstructions may be associated with fecal vomiting as well.

Other features that are consistently present with obstruction of small bowel or colon include the inability to have a bowel movement or pass flatus. Care should be taken to avoid the diagnosis of constipation, as this symptom is secondary to partial or complete obstruction. Partial bowel obstruction, however, is often associated with regular passage of stool and flatus.

Physical findings vary, depending on the site, duration, and etiology of the pathologic process. Early symptoms are usually associated with some abdominal distension, often impressive with colonic obstruction yet not readily apparent in cases of incarcerated hernia. Abdominal tenderness may be minimal and diffuse or localized and severe.34 Patients who have developed peritonitis will have severe tenderness. The abdomen may be tympanitic to percussion. Mechanical obstruction will produce active high pitched bowel sounds with occasional "rushes." If obstruction has been present for several hours, peristaltic waves and bowel sounds may be diminished. Patients with an adynamic ileus may have some abdominal distension associated with diminished or absent bowel sounds. Careful search for localized or rebound tenderness is essential to rule out the possibility of gangrenous or perforated bowel, which requires immediate surgical intervention ( Fig.75-2).

FIG. 75-2. Logic flow diagram emphasizing the clinical importance of abdominal tenderness in alimentary tract obstruction. (From Schwartz GR: Principles and Practice of Emergency Medicine, 3d ed, p 1718. Malvern, PA, Lea & Febiger, 1992, with permission.)

Elderly patients have signs and symptoms that are similar to younger patients with intestinal obstruction. Adhesions and hernias are common causes for SBO in this age group, while carcinomas are the most likely etiology of LBO because of the increased likelihood of cancer as people age. 9 Elderly patients who are debilitated or confused, or who are on multiple medications, may be unable to give a detailed history. Careful examination for characteristic bowel sounds, masses or blood in stool, and radiographic investigation will often distinguish bowel obstruction from ileus. There is also evidence that patients over 60 years old are more likely to succumb secondary to complications of bowel obstruction.3

All patients with abdominal pain or distension should be examined for signs of organomegaly or masses that may suggest a cause of the obstruction. A rectal examination may identify fecal impaction, rectal carcinoma, occult blood, or stricture. The absence of stool or air in the vault may aid in the diagnosis of bowel obstruction, but its presence does not eliminate a more proximal obstruction, as patients may not be able to evacuate preexisting rectal contents. A pelvic examination should be performed to identify any gynecologic pathology causing obstruction.

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Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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