Diffuse Abdo Pain

-simple obstruction
-closed loop obstruction = 2 points of obstruction (ex: 2 adhesions or a loop of bowel within a hernia sac) that prevent anterograde or retrograde flow of contents
—-rapidly progresses to ischemia and infarction
—-loop often twists on itself –> occludes large arteriesG
-can still have BMs with a complete SBO as residual stool is emptied

-exam may be impressive – may have acute abdomen
-3x nl lipase, peaks within 12-36h, NOT representative of severity
-if nl, consider early or acute-on-chronic –> CT
-fluid resuscitate! May need 10L/d
-abx (-penams) only for the sickest, ie severe sepsis or septic shock
-CT if diagnosis unclear or sick (eval for complication: necrotizing pancreatitis, pseudocyst)
-RUQ US to r/u surgical cause
-Complications: hypoCa, DKA, AKI, ARDS, pleural effusions, ?GIB

-elderly pt with new “renal colic” (back pain, hematuria), syncope + abdo pain, hip weakness/neuropathy (retroperitoneal rupture –> compression of femoral/obturator nerve)

Mesenteric Ischemia

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