History taking

in Intestinal obstruction
Symptoms
Cardinal features of acute obstruction
Abdominal colicky pain

Cardinal features Abdominal

Vomiting Distension

Constipation/obstipation
 Pain
Special points

Very severe pain indicates strangulation

Pain may not be significant in post operative

simple mechanical obstruction

Not present usually in paralytic ileus

 Vomiting
Onset timing depends on site

Character alters from digested food, bile

stained food to faeculent matter

Location
- Proximal small bowel: Severe
- Distal small bowel : Late and Less severe
 Distension
Degree of distension depends on site of
obstruction

Visible peristalsis may be present

Delayed in colonic obstruction &

minimal /absent in mesenteric vascular
occlusion
 Constipation
Types -- 1. absolute (neither feces nor flatus )
2. relative (where only flatus is passed )
Absolute constipation is cardinal feature of
complete obstruction

Some patients pass feces or

flatus due to distal bowel content
 Dehydration
Mostly in small bowel obstruction due to
repeated vomiting

Dry tongue, dry skin , sunken eye , oliguria

Secondary polycythemia
 Abdominal tenderness

Initially localised , later diffuse

Rebound phenomenon & guarding will not

be present in simple obstruction
 Other symptoms

Cancer symptoms
Recent unintentional weight loss
Bowel habit change
Bloody emesis
 History
Surgical & medical history
Previous abdominal operations
Suspicious of intraabdominal neoplasia or previous
radiation for cancer
History of vental,incisional,inguinal hernia
Review of medications
History of inflammatory bowel disease or
diverticulitis
 1
54
.

2
 Temperature

Fever signifies inflammation in bowel wall /

ischemia / perforation
 Inspection

Abdominal distention
Few images of
visible peristalsis in
obstruction
Presence of mass or hernia
Note any abdominal surgical scar
 Bowel sounds
High pitched metallic to metallic tinkling
sound of dilated bowel

Once fatigue silent abdomen peritonitis

In paralytic ileus no return of bowel sound on

auscultation
 Percussion
Tympany to percussion
However fluid filled loop : dullness
Tympanicity over the liver :
intraabdominal free air
Tenderness to light percussion: Peritonitis
 Palpation

Abdominal tenderness
 Features of strangulation
Continuous severe pain

Shock indicates underlying ischemia

Symptoms commence suddenly and recur regularly

Local tenderness associated with rigidity and

rebound tenderness ( Blumberg sign )
 DRE

Empty rectal vault

Cardiovascular exam

Tachycardia
 Gastric outlet obstruction
History
- N/V, early satiety, epigastric fullness, and weight loss

Etiology
1. Chronic PU
2. CA stomach
3. Periampullary CA
Physical Examination
- Dehydration
- Distended upper abdomen
- Presence of splashing sound
-


acute gastroenteritis

 Small bowel obstruction
History
- Sudden, sharp, colicky abdominal pain and cramping.
- N/V soon after the onset of pain and may relieve the pain
Etiology
1st Post-op adhesion
2nd External hernia
3rd Tumor
Physical Examination
- Previous incision, hernia, peristaltic wave
- Hyperactive bowel sound (later absence BS)
- More abdominal distension in more distal obstruction
- PR: empty rectum (complete obstruct)
 Colonic obstruction
History
- Constipation and gradual abdominal distension. Pain is minimal or
absent unless peritonitis occurs. Nausea and vomiting do not usually
occur until the late stage of the disease
- Etiology: The most common causes include CA colon (80%), acute di
verticulitis, and volvulus
- CA colon


N/V
Physical Examination
- The abdomen appears distended and tympanic to percussion.
- Minimal abdominal tenderness unless peritonitis or peritoneal
irritation exists
- PR: mass, rectal shelf
- lymph node supra
clavicular area CA