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==Diagnosis==

==Diagnosis==

===Clinical Signs===

===Clinical Signs===

The clinical presentation depends on cause, severity, and site of obstruction.  Upper small intestinal obstruction causes a net fluid secretion whereas lower small intestinal obstruction causes a net fluid resoption.  Antibiotic responsive diarrhoea is more likely in distal small intestinal obstruction.  

The clinical presentation depends on the cause, severity, and the site of obstruction.  Upper small intestinal obstruction causes a net fluid secretion whereas lower small intestinal obstruction causes a net fluid resorption.  Antibiotic responsive diarrhoea is more likely to occur in distal small intestinal obstruction.  

====Simple obstruction====

====Simple obstruction====

*Vomiting; the further the obstruction is towards the mouth, the more frequent and the more volume the vomiting is

*Vomiting; the further the obstruction is towards the mouth, the frequency and the volume is higher

*Moribund or in septic shock; if part of the intestine becomes devitalised, resulting in septic peritonitis

*Moribund or in septic shock; in cases where part of the intestine becomes devitalised, resulting in septic peritonitis

*Abdominal foreign body, mass or obstructive ileus may be palpable

*Abdominal foreign body, mass or obstructive ileus may be palpable

===Diagnostic Imaging===

===Diagnostic Imaging===

====Radiography====

====Radiography====

*Plain abdominal radiography may be all that is needed to reveal the cause of the obstruction.  Gas and fluid accumulation may be visible due to intestinal dilation.  Decreased serosal detail indicates peritoneal fluid accumulation and free gas in the abdomen suggests perforated intestines.  Gravel sign due to food particle accumulation amay be present.  Displacement, bunching or plication may also be seen.

*Plain abdominal radiography may be all that is needed to reveal the cause of the obstruction.  Gas and fluid accumulation may be visible due to intestinal dilation.  Decreased serosal detail indicates peritoneal fluid accumulation and free gas in the abdomen suggests perforated intestines.  Gravel sign due to food particle accumulation may be present.  Displacement, bunching or plication may also be seen.

*Contrast radiography may be needed if ileus and obstruction cannot easily be distinguished.  However, this may not always be feasible in an emergency situation

*Contrast radiography may be needed if ileus and obstruction cannot easily be distinguished.  However, this may not always be feasible in an emergency situation.

====Ultrasonography====

====Ultrasonography====

Most of the time, this is a more sensitive technique in revealing the cause of the obstruction compared to radiography.  Dilation and thickening of the wall of the intestine may be visible.

Most of the time, this is a more sensitive technique in revealing the cause of the obstruction compared to radiography.  Dilation and thickening of the wall of the intestine may be revealed.

===Antimicrbial===

===Antimicrbial===

Broad spectrum antimicrobials, such as a ampicillin or cephalosporin combined with metronidazole, are usually given prophylactically prior to surgery.  This is vital if there are signs of sepsis or intestinal compromise.

Broad spectrum antimicrobials, such as ampicillin or cephalosporin combined with metronidazole, are usually given prophylactically prior to surgery.  This is vital if there are signs of sepsis or intestinal compromise.

===Surgery===

===Surgery===

==Prognosis==

==Prognosis==

This depends on type and severity of obstruction.  A simple obstruction with no signs of septic peritonitis has a good prognosis.  A better prognosis in cases where there is no large resection of the intestines.  On the other hand, the prognosis is grave if there are signs of metastatic neoplasia.

This depends on type and severity of obstruction.  A simple obstruction with no signs of septic peritonitis has a good prognosis.  The prognosis is better in cases where there is no large resection of the intestines.  On the other hand, the prognosis is grave if there are signs of metastatic neoplasia.