Small bowel obstruction (SBO): The Daily PANCE Blueprint

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Small bowel obstruction (SBO): The Daily PANCE Blueprint

A 52-year-old female with a history of previous abdominal surgeries presents to the ER with nausea, emesis, abdominal pain, and inability to pass gas. On physical exam, you notice abdominal distention and auscultate high-pitched tinkering sounds in the upper abdominal quadrants. Which of the following is the most likely diagnosis?

A. Mesenteric ischemia
B. Diverticulitis
C. Gastric ulcer perforation
D. Small bowel obstruction
E. Ischemic colitis

Answer and topic summary

The answer is D. Small bowel obstruction

A bowel obstruction happens when the normal flow of the GI tract is interrupted. The most common cause of small bowel obstruction is intraperitoneal adhesions (s/t previous surgeries). Other causes include hernias or neoplasms. Clinical features include nausea, vomiting, crampy abdominal pain, and obstipation (inability to pass stool). On physical exam you may note abdominal distention, tinkling high-pitch sounds on auscultation, and hyperresonance to percussion. Initial diagnostic modalities include an abdominal x-ray and CT with contrast. These patients need to be admitted for further evaluation and management. Surgery should be consulted.

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Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint GI and Nutrition ⇒ Diseases of the Small Intestine ⇒ Small bowel obstruction

Also covered as part of the Family Medicine EOR, Emergency Medicine EOR, and General Surgery EOR topic list