1. Differential Diagnosis

2. Diseases that may cause abdominal pain: • Acute Diverticulitis • Mesenteric Ischemia • Acute Mechanical Intestinal Obstruction

4. Criteria for Diagnosis • Abdominal pain and distension • Vomiting of ingested food • History of previous abdominal surgery • Increased or decreased bowel sounds • Tympanitic abdomen • Stool check for gross or occult blood

5. Criteria for Diagnosis 7. SFA (60% accurate) • Distended bowel loops + air‐fluid levels • Pattern of disten0on • Colonic gas • Pneumoperitoneum • 8. Abdominal CT • - Sensitive for complete / high grade obstruction • - Discrete transition zone with dilation of bowel proximally • - Decompression of bowel distally • - Intraluminal contrast does not pass beyond the transition zone • - Colon containing little gas or fluid

6. Management

7. Management • Conservative management • Surgery

8. Conservative management • NPO, NG suction • Fluid and electrolyte replacement • Correction of other metabolic problems • Optimization of cardiopulmonary status • Prepare for surgery

9. Conservative management Given to the patient on the 1st hospital day • NPO • NGT • IVF (D5LRS 1L) • Indwelling catheter • Ampi-Sulbactam 1.5g/IV • Pantoprazole 40mg/IV OD