Bowel obstruction physical examination: Difference between revisions
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==Overview== | ==Overview== | ||
Patients with bowel obstruction usually appear distressed with a distended abdomen with or without fever. Physical examination of patients with bowel obstruction is usually remarkable for tympanic or hyperresonant abdomen, orthostatic | Patients with bowel obstruction usually appear distressed with a [[distended abdomen]] with or without [[fever]]. [[Physical examination]] of patients with bowel obstruction is usually remarkable for tympanic or hyperresonant [[abdomen]], [[orthostatic hypotension]], [[tachycardia]], and dry mucus [[membranes]]. | ||
==Physical Examination== | ==Physical Examination== | ||
Physical examination of patients with bowel obstruction is usually remarkable for: tympanic or hyperresonant abdomen, orthostatic | [[Physical examination]] of patients with bowel obstruction is usually remarkable for: tympanic or hyperresonant [[abdomen]], [[orthostatic hypotension]], [[tachycardia]], and dry mucus [[membranes]].<ref name="pmid17230614">{{cite journal |vauthors=Markogiannakis H, Messaris E, Dardamanis D, Pararas N, Tzertzemelis D, Giannopoulos P, Larentzakis A, Lagoudianakis E, Manouras A, Bramis I |title=Acute mechanical bowel obstruction: clinical presentation, etiology, management and outcome |journal=World J. Gastroenterol. |volume=13 |issue=3 |pages=432–7 |year=2007 |pmid=17230614 |pmc=4065900 |doi= |url=}}</ref><ref name="pmid21255429">{{cite journal |vauthors=Catena F, Di Saverio S, Kelly MD, Biffl WL, Ansaloni L, Mandalà V, Velmahos GC, Sartelli M, Tugnoli G, Lupo M, Mandalà S, Pinna AD, Sugarbaker PH, Van Goor H, Moore EE, Jeekel J |title=Bologna Guidelines for Diagnosis and Management of Adhesive Small Bowel Obstruction (ASBO): 2010 Evidence-Based Guidelines of the World Society of Emergency Surgery |journal=World J Emerg Surg |volume=6 |issue= |pages=5 |year=2011 |pmid=21255429 |pmc=3037327 |doi=10.1186/1749-7922-6-5 |url=}}</ref><ref name="pmid28050445">{{cite journal |vauthors=Pujahari AK |title=Decision Making in Bowel Obstruction: A Review |journal=J Clin Diagn Res |volume=10 |issue=11 |pages=PE07–PE12 |year=2016 |pmid=28050445 |pmc=5198398 |doi=10.7860/JCDR/2016/22170.8923 |url=}}</ref> | ||
===Appearance of the Patient=== | ===Appearance of the Patient=== | ||
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===Vital Signs=== | ===Vital Signs=== | ||
*High-grade fever | *High-grade [[fever]] | ||
**May indicate an infection such as the presence of an abscess, ischemia or necrosis. | **May indicate an [[infection]] such as the presence of an [[abscess]], [[ischemia]] or [[necrosis]]. | ||
*[[Tachycardia]] with regular pulse | *[[Tachycardia]] with regular [[pulse]] | ||
**May indicate dehydration | **May indicate [[dehydration]] | ||
*Low blood pressure with narrow pulse pressure | *[[Low blood pressure]] with [[narrow pulse pressure]] | ||
**Dehydration may lead to orthostatic hypotension and a decreased urine output | **[[Dehydration]] may lead to [[orthostatic hypotension]] and a [[decreased urine output]] | ||
===Skin=== | ===Skin=== | ||
*Dry mucous membranes | *Dry mucous [[membranes]] | ||
**May indicate severe dehydration | **May indicate [[severe dehydration]] | ||
===Abdomen=== | ===Abdomen=== | ||
*[[Abdominal distention]] | *[[Abdominal distention]] | ||
**Tympanic, hyperresonant, bowel sounds are hypoactive and fluid thrill may be present | **Tympanic, hyperresonant, [[bowel]] sounds are hypoactive and fluid thrill may be present | ||
*[[Abdominal tenderness]] in the right/left upper/lower abdominal quadrant | *[[Abdominal tenderness]] in the right/left upper/lower [[abdominal]] quadrant | ||
*A palpable abdominal mass | *A [[palpable]] [[abdominal]] [[Mass (medicine)|mass]] | ||
**May be an abscess, volvulus, hernia, tumor or impacted feces | **May be an [[abscess]], [[volvulus]], [[hernia]], [[tumor]] or impacted [[feces]] | ||
*Abdominal scarrring | *Abdominal scarrring | ||
**May indicate previous abdominal surgery | **May indicate previous [[abdominal surgery]] | ||
*Hernia | *[[Hernia]] | ||
**Most importanly incisional hernias, also femoral, obturator, umbilical and inguinal hernias that may have strangulated | **Most importanly incisional hernias, also [[femoral]], [[obturator]], [[umbilical]] and [[inguinal hernias]] that may have strangulated | ||
*Peritoneal signs | *[[Peritoneal]] signs | ||
**Including guarding, tenderness and rebound tenderness | **Including [[guarding]], [[tenderness]] and [[rebound tenderness]] | ||
*Occult fecal blood | *[[Occult Blood|Occult]] [[fecal]] [[blood]] | ||
**With rectal exam, blood may be noted, which suggests late strangulation, incarceration or malignancy | **With [[rectal exam]], [[blood]] may be noted, which suggests late [[strangulation]], incarceration or [[malignancy]] | ||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
[[Category:Surgery]] | [[Category:Surgery]] | ||
[[Category:Gastroenterology]] | [[Category:Gastroenterology]] | ||
[[Category:Up-To-Date]] | [[Category:Up-To-Date]] | ||
[[Category:Emergency medicine]] | | ||
[[Category:Emergency medicine]] | |||
{{WikiDoc Help Menu}} | {{WikiDoc Help Menu}} | ||
{{WikiDoc Sources}} | {{WikiDoc Sources}} | ||
Revision as of 23:16, 7 February 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Hadeel Maksoud M.D.[2]
Overview
Patients with bowel obstruction usually appear distressed with a distended abdomen with or without fever. Physical examination of patients with bowel obstruction is usually remarkable for tympanic or hyperresonant abdomen, orthostatic hypotension, tachycardia, and dry mucus membranes.
Physical Examination
Physical examination of patients with bowel obstruction is usually remarkable for: tympanic or hyperresonant abdomen, orthostatic hypotension, tachycardia, and dry mucus membranes.[1][2][3]
Appearance of the Patient
Patients with bowel obstruction usually appear distressed with sunken eyes.
Vital Signs
- High-grade fever
- Tachycardia with regular pulse
- May indicate dehydration
- Low blood pressure with narrow pulse pressure
- Dehydration may lead to orthostatic hypotension and a decreased urine output
Skin
- Dry mucous membranes
- May indicate severe dehydration
Abdomen
- Abdominal distention
- Tympanic, hyperresonant, bowel sounds are hypoactive and fluid thrill may be present
- Abdominal tenderness in the right/left upper/lower abdominal quadrant
- A palpable abdominal mass
- Abdominal scarrring
- May indicate previous abdominal surgery
- Hernia
- Most importanly incisional hernias, also femoral, obturator, umbilical and inguinal hernias that may have strangulated
- Peritoneal signs
- Including guarding, tenderness and rebound tenderness
- Occult fecal blood
- With rectal exam, blood may be noted, which suggests late strangulation, incarceration or malignancy
References
- ↑ Markogiannakis H, Messaris E, Dardamanis D, Pararas N, Tzertzemelis D, Giannopoulos P, Larentzakis A, Lagoudianakis E, Manouras A, Bramis I (2007). "Acute mechanical bowel obstruction: clinical presentation, etiology, management and outcome". World J. Gastroenterol. 13 (3): 432–7. PMC 4065900. PMID 17230614.
- ↑ Catena F, Di Saverio S, Kelly MD, Biffl WL, Ansaloni L, Mandalà V, Velmahos GC, Sartelli M, Tugnoli G, Lupo M, Mandalà S, Pinna AD, Sugarbaker PH, Van Goor H, Moore EE, Jeekel J (2011). "Bologna Guidelines for Diagnosis and Management of Adhesive Small Bowel Obstruction (ASBO): 2010 Evidence-Based Guidelines of the World Society of Emergency Surgery". World J Emerg Surg. 6: 5. doi:10.1186/1749-7922-6-5. PMC 3037327. PMID 21255429.
- ↑ Pujahari AK (2016). "Decision Making in Bowel Obstruction: A Review". J Clin Diagn Res. 10 (11): PE07–PE12. doi:10.7860/JCDR/2016/22170.8923. PMC 5198398. PMID 28050445.