Small Bowel Obstruction

Mechanical blockage of the small bowel by the normal flow of intestinal contents leads to small bowel obstruction (SBO) Small bowel obstruction is the result of intrinsic, extrinsic or luminal lesions. It causes abdominal pain, constipation, and emesis. In case,of complete failure to pass flatus and stool, a surgical emergency is necessary. Studies have shown that vomiting, diarrhea and abdominal pain are the early signs of the partial blockage while constipation and absence of flatus are the signs of total blockage.

In case of a distal obstruction, diarrhea causes hyperactive sounds with increased peristalsis. Lack of sound in distal bowel may cause absence of air  as a result of loss of mechanical function. Abdominal flat plat radiography is used as initial imaging study when testing for a small bowel obstruction and ruling out multiple differentials i.e. gas, edema and constipation. A CT scan is used to locate the collapsed bowel loops, air-filled loops and define the grade of bowel insult when the results are nuclear. Patients with acute adhesive small bowel obstruction have higher rates of complications with laparoscopic surgery in comparison to conventional open surgical intervention. Surgical intervention is limited to patients with a single transition band while conventional surgical interventional is only limited to students with multiple adhesive bands.

The primary goal of advanced practice nurses (APN) is to recognize and differentiate partial obstruction from full obstruction. In case of an operation, advanced practice nurses should be aware of a full obstruction because it can lead to strangulation. However, treatments done on time usually contribute to a good prognosis. Advanced practice nurses use their knowledge and skills to implement a diagnostic work-up and a plan of care.