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Q1: Diagnosis (2 min)
"How do you distinguish SBO from LBO on AXR?"
- SBO: central dilated loops, valvulae conniventes cross FULL width
- LBO: peripheral dilated loops, haustra do NOT cross full width
- SBO: pain every 3-5 min, early bilious vomiting
- LBO: pain every 10-15 min, late faeculent vomiting, more distension
Q2: Causes (2 min)
"What are the commonest causes of SBO and LBO?"
- SBO: adhesions (60%), hernias (15%), malignancy (15%)
- LBO: colorectal cancer (60%), volvulus (15%), diverticulitis (10%)
- Always CHECK HERNIAL ORIFICES
Q3: Strangulation (3 min)
"How do you recognise strangulation, and what do you do?"
- Signs: CONSTANT severe pain (not colicky), tachycardia, fever, peritonism (guarding, rigidity)
- Raised lactate = tissue ischaemia
- Management: EMERGENCY LAPAROTOMY (no further conservative trial)
- At surgery: assess bowel viability (colour, peristalsis, mesenteric pulse)
- Resect non-viable bowel, primary anastomosis or stoma
Q4: Bologna guidelines (2 min)
"What do the Bologna guidelines recommend for adhesive SBO?"
- Conservative trial first (NBM + NG + IV fluids) for 48-72h if NO strangulation
- 70-80% resolve spontaneously
- Water-soluble contrast (Gastrografin): diagnostic + therapeutic
- If reaches colon within 24h: 99% will resolve
- If not: surgery indicated
- Laparoscopic adhesiolysis in selected cases (single band, no severe distension)