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17 results

  • 3.5.4 - Ileus and Bowel Obstruction

  • from Section 3.5 - Acute Gastrointestinal Failure
  • Edited by Ned Gilbert-Kawai, The Royal Liverpool Hospital, Debashish Dutta, Princess Alexandra Hospital NHS Trust, Harlow, Carl Waldmann, Royal Berkshire Hospital, Reading
  • Book:
    Intensive Care Medicine
    Published online:
    27 July 2023
    Print publication:
    01 December 2021, pp 214-215

  • Summary

    Key Learning Points

    1. 1. Ileus is the absence of bowel motility and is common in intensive care patients.

    2. 2. Ensure early surgical input to all cases of mechanical bowel obstruction.

    3. 3. In adults, large bowel obstruction is most commonly caused by cancer.

    4. 4. Resuscitation and correction of electrolyte disturbance are required in all cases.

    5. 5. Untreated bowel obstruction leads to dilation and increases the risks of perforation and ischaemia.

  • 21 - Traumatic brain injury

  • from Section 4 - Neurointensive care
  • Edited by Basil F. Matta, David K. Menon, Martin Smith
  • Book:
    Core Topics in Neuroanaesthesia and Neurointensive Care
    Published online:
    05 December 2011
    Print publication:
    13 October 2011, pp 315-340

  • Summary

    The risk of morbidity/mortality exists with any surgical/ anaesthetic procedure, but the risk to the central nervous system may be compounded in a patient undergoing a major neurosurgical procedure. The purpose of the pre-operative assessment includes the identification of modifiable risk factors, optimization of the patient's condition, explanation of the risks and formulating the best possible anaesthetic plan for the patient. The general physical examination should focus on the patient's level of consciousness, degree of neurological impairment, mental status, nutrition and vital parameters for baseline. Focused neurological assessment and careful documentation allow the establishment of baseline status and facilitate anaesthetic planning, as well as anticipation of potential perioperative complications. The risk of perioperative respiratory complications is increased in the presence of pre-existing obstructive or restrictive pulmonary disease. Patients at risk of aspiration include those with full stomachs, delayed gastric emptying, bowel obstruction, and gastro-oesophageal reflux.

  • 33 - CT of the Abdomen and Pelvis

  • from PART III - COMPUTED TOMOGRAPHY
  • Edited by J. Christian Fox, University of California, Irvine
  • Book:
    Clinical Emergency Radiology
    Published online:
    07 December 2009
    Print publication:
    29 September 2008, pp 473-481

  • Summary

    Computed tomography (CT) scanning has widely become the diagnostic test of choice for patients presenting with abdominal or pelvic pain and for the stable trauma patient to evaluate for intra abdominal injury. Due to the limitations of plain radiographs, CT scanning is also being increasingly used in cases of bowel obstruction to help delineate the location, severity, and underlying cause of the obstruction. First-generation, single-slice CT scanners have almost been completely replaced with multidetector CT (MDCT) scanners. The faster acquisition of images has reduced motion artifact because the entire abdomen can be scanned on a single breathhold. Conditions in the right upper quadrant that can be easily diagnosed by CT are pancreatitis, ascending cholangitis, perforated hollow viscus, and hepatic tumor or abscess. A major disadvantage of MDCT is the massive amount of data that are generated during image acquisition. This makes efficient transfer of image data to hard copies challenging.

  • 9 - Plain Film Radiographs of the Pediatric Abdomen

  • from PART I - PLAIN RADIOGRAPHY
  • Edited by J. Christian Fox, University of California, Irvine
  • Book:
    Clinical Emergency Radiology
    Published online:
    07 December 2009
    Print publication:
    29 September 2008, pp 153-175

  • Summary

    Plain film radiographs of the pediatric abdomen ordered from the ED are indicated in stable patients to provide contributory information in the diagnostic process of abdominal health complaints. The criteria for distinguishing a bowel obstruction from an ileus include roughly four findings: gas distribution, bowel distention, air fluid levels and orderliness. The differential diagnosis of a bowel obstruction can be remembered with the mnemonic A-A-I-I-M-M, (adhesions, appendicitis, incarcerated hernia, intussusception, malrotation (with midgut volvulus), and Meckel's diverticulum (with a volvulus or intussusception)). A sigmoid occurs more often in elderly patients, whereas a midgut volvulus is a true surgical emergency. Plain film radiographs have a limited role in diagnosing appendicitis. It can be highly diagnostic of intussusception. Abdominal foreign bodies are usually not visible on plain film radiographs, with the exception of metallic and calcific foreign bodies. Uric acid and most calcium oxalate stone are not radiopaque on plain film radiographs.

  • 24 - Abdominal Ultrasound

  • from PART II - ULTRASOUND
  • Edited by J. Christian Fox, University of California, Irvine
  • Book:
    Clinical Emergency Radiology
    Published online:
    07 December 2009
    Print publication:
    29 September 2008, pp 337-346

  • Summary

    Abdominal ultrasound has become an extremely useful imaging modality in emergency medicine. Acute appendicitis can be diagnosed with ultrasound and is the preferred initial imaging modality by some clinicians for certain populations, such as in pregnant patients, to avoid ionizing radiation. Ultrasound can be a useful imaging modality for evaluation of abdominal wall hernias, such as ventral wall hernias, incisional hernias, spigelian hernias, femoral hernias, and inguinal hernias. The diseases of the GI tract that can be detected by ultrasound, but may be more appropriately detected by CT scan, are diverticulitis, bowel obstruction, and Crohn disease. Ultrasound imaging of the pancreas is not routinely sought in the ED, but rather more often done on an inpatient or outpatient basis for ultrasound-guided procedures. Ultrasound can be a challenging modality in obese patients and thus has some limitation in the evaluation of various intraabdominal diseases, such as appendicitis.