| home | lectures | notes | images | flashcards | case of the week archives |  | bone | cardiac | chest | gi | miscellaneous | med students | most common lists | quizzes |   return to case small bowel obstruction     ·         general considerations o       small bowel obstruction, as the term is used here, is due to physical and organic changes which produce mechanical obstruction to the passage of the bowel contents somewhere in the small bowel o       the bowel proximal to the point of obstruction dilates with swallowed air and secreted fluid, §         vomiting may release some of the proximal bowel contents and reduce the amount of proximal dilation o       the bowel hyperperistalses o       bowel distal to the point of obstruction (i. cocalicovalleyhs.org/cyo-buy-viagra-cheap-price-wu/ buy viagra usa online E. cheap viagra difference entre viagra y viagra Colon and sometimes distal small bowel) empties over time o       strangulation of the bowel may result from vascular compromise of the affected loops and is a cause of increased mortality ·         causes o       overwhelmingly, the most common cause of a mechanical small bowel obstruction are adhesions related to prior surgery (60%) §         the most common prior surgeries associated with a subsequent sbo include appendectomy, colorectal surgery and gynecologic surgery §         bowel may become kinked under an adhesion §         the obstruction is frequently partial or intermittent o       hernias §         most often femoral or inguinal o       intussusception o       volvulus o       tumor, either primary or metastatic o       wall lesions such as leiomyomas or strictures o       crohn’s disease o       foreign bodies o       gallstones §         such as in gallstone ileus (which is actually a mechanical obstruction, usually at the ileocecal valve) ·         clinical findings o       abdominal pain and distension §         most marked in patients with distal sbo although its onset in distal obstructions is later in the course of the disease than in proximal obstruction §         typically colicky in nature and progressively worsening over time o       nausea o       vomiting §         an earlier sign of a proximal than a distal obstruction §         fluid and electrolyte imbalances from vomiting increase mortality o       constipation o       history of prior abdominal or pelvic surgery o       bowel sounds are hyperactive and high-pitched §         absence of bowel sounds may indicate bowel ischemia or peritonitis ·         imaging findings o       conventional radiography is the study of first choice §         loops proximal to the point of obstruction will become dilated and fluid-filled ·         usually greater than 2. viagra goes generic in march viagra online without prescription 5-3 cm in size §         differential height of air-fluid levels in the same loop of small bowel no longer considered reliable sign of mechanical sbo §         absence of, or disproportionately smaller amount of, gas in the colon, especially the rectosigm. generic viagra sales online over the counter alternative to viagra buy cheap viagra generic viagra without prescription

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