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Overview

Clinical Features

Investigations

Initial Management

  1. At least one decent size (green or brown) venflon in the ACF.
  2. Take blood for U&E, FBC, Amylase
  3. Order CXR (erect) and AXR (supine), consider CT scan
  4. Put in a urinary catheter and ask for hourly fluid balance
  5. Use crystalloid for resuscitation.  Do not write up bag after bag of normal saline as you can induce a hyperchloraemic metabolic acidosis.  3 litres of fluid over 24 hours will only cover maintenance fluids (30-40 mls kg-1 24hr-1), you need this plus any calculated losses .  It depends on the level of obstruction what losses the patient will have, eg high SBO lose proportionately more Na+ than lower down in the GI tract
  6. NG tube in all patients even if not vomiting
  7. clear fluids by mouth are allowed once NG is in place
  8. Morphine analgesia
  9. DVT prophylaxis - all patients
  10. You do not need to start antibiotics unless there is clinical evidence of sepsis or in at-risk patients

Continuing Management

  1. You need to identify those patients with strangulated obstruction - early surgical intervention is required
  2. Get the old notes
  3. Definite obstruction in a patient with no previous abdominal surgery needs a laparotomy
  4. Adhesion obstruction not settling after 4-5/7 needs a laparotomy
  5. There is no value in serial AXRs
  6. Patients not settling with no clear indication for a laparotomy may benefit from a CT abdomen
  7. Central lines are only required in patients with difficult fluid balance problems