A 78-year old man presents with abdominal pain and decreased oral intake. His vitals are normal but he looks uncomfortable. After you introduce yourself, you palpate his abdomen which is diffusely tender. Your immediate gestalt is “Small Bowel Obstruction” but you’re not sure why. Frankly, you think, “I can do better than gestalt.”
1. What are the various positive and negative likelihood ratios for clinical and radiographic features of a small bowel obstruction? (recall +LR>10 is considered useful for genuinely increasing suspicion of disease, -LR <0.1 is considered useful for genuinely decreasing suspicion of disease).
1a. Previous surgery?
1b. Abdominal distension?
2. What is the sensitivity and specificity of imaging modalities for small bowel obstruction?
2a. A normal abdominal X-ray?
2b. Air fluid levels seen on abdominal X-ray
2c. CT findings.
3. In a trained EM provider, what are the likelihood ratios for small bowel obstruction using bedside ultrasound?