Common Questions about Intestinal obstruction (IO)

 1. What are the cardinal symptoms of IO?

-, colicky abdominal pain, abdominal distention and vomiting, no BO, no flatus (obstipation/ absolute constipation)

- other history you want to establish 

• chief complain
• to explore regarding the cardinal Sx
• duration of symptoms
• abdominal pain: to see the location so we can locate either small or large bowel. 
• if its small bowel pain : felt in the upper abdomen and central (periumbilicus) while if large bowel pain is felt in lower abdomen
• these are all visceral pains that is why you referred to area of referred pain

- onset of pain? which one comes earlier? small or large?

• small bowel first
• proximal, smaller in diameter- which would cause distension early, higher level of obstruction 
• small bowel is also active in peristalsis, so once they are obstructed they will cause intense colicky pain. 

- vomiting

• onset : 
• small bowel is active in absorption of nutrients in GI tract. It produces a lot of fluids. If it is obstructed there will be a lot of fluid accumulation so the vomiting will occur early. 
• while in large bowel there is not much of fluid and it is distal, the vomiting occurs late

• content : we will be able to observe the content either from vomiting, or from an NG tube insertion. then we can see the colour content in the bag
• if its feculant material : lower small bowel
• greenish or bile content : high small bowel

Q2. causes of IO and how do you classify

• dynamic
• adynamic
• first we need to rule out mechanical obstructions first
• intraluminal : tumor
• impacted stool: rare, usually in pt with hirchsprung disease
• colon tumor: left sided tumor (Large bowel obstruction)
• small pellet stool, constitutional symptoms, blood in stool
• bowel habit
• PR bleed
• mucous discharge
• tenesmus
• family hx of colon Ca
• intramural, 
• extramural : adhesion, hernia 
• hernia usually affects the small bowel. so if the patient with cardinal symptoms mention above leading towards SBO, remember to confirm regarding their abdominal surgery and hernia. 

Q3. Complications of IO

• perforation
• pain became severe and intolerable
• localised pain became generalised
• presence of high grade fever
• abdomen become more distended