Bowel obstruction physical examination
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. ;Associate Editor(s)-in-Chief: Hadeel Maksoud M.D.
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 of patients with bowel obstruction is usually remarkable for: Tympanic or hyperresonant abdomen, orthostatic hypotension, tachycardia, and dry mucus membranes.
Appearance of the Patient
Patients with bowel obstruction usually appear distressed with sunken eyes.
- 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
- Dry mucous membranes
- May indicate severe dehydration
- 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
- 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
- ↑ 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.