James talks to Dr Rewa Keegan about bowel obstruction, a common surgical presentation.
Rewa Keegan is a general surgeon and is currently working as the surgical superintendent at Royal Prince Alfred Hospital. She completed her intern and resident years at Royal Prince Alfred, and commenced general surgical training in 2010, successfully gaining her fellowship in 2014. Rewa loves clinical teaching from a medical student to registrar level, particularly in the areas of surgical simulation and working with aspiring surgeons on developing their career plans. She is very interested in surgical education, and has undertaken a number of research projects looking at how registrars perceive their experience in surgical training. Rewa plans to undertake further training in oncoplastic breast surgery, and she and her husband ultimately plan to settle in a regional coastal centre after completing fellowships overseas.
With Dr Rewa Keegan, General Surgeon and Surgical Superintendent at Royal Prince Alfred Hospital, New South Wales, Australia
Bowel obstruction is a common surgical presentation. It can be categorised into small and large bowel obstruction, with key implications for management.
Case 1 – It is 10pm and you are a covering an after hours shift on a medical ward. You are asked to see a 77 year old man admitted with community acquired pneumonia. The nurse looking after the patient tells you that he has not opened his bowels in 4 days and is now complaining of some abdominal pain and nausea.
Case 2 – You are the surgical intern on the ward during the day. You are asked to review a patient who is day 4 post-appendicectomy but hasn’tyet opened their bowels. They are describing some colicky abdominal pain associated with nausea and vomiting.
Case 3 – an 88 year old man from a nursing home presents to the Emergency Department with a history of constipation and abdominal pain. Past history of stroke and COPD. On examination, he is tachycardic but afebrile. His abdomen is distended and tender, predominatly on the left-side. PR reveals an empty rectum.
If you enjoyed listening to this week’s podcast feel free to let us know what you think by posting your comments or suggestions in the comments box below.
If you want to listen to this episode while not connected to WiFi or the internet, you can download it. To find out more go to Apple support (https://support.apple.com/en-us/HT201859)