Cramping abdominal pain with distention, N/V should make you think SBO

Air-fluid levels in the small bowel but no gas in the colon tells you it's an upper GI issue

Hyperactive bowel sounds + pneumobilia = gallstone ileus

Very few things put air in the liver

• Patient has signs of a small bowel obstruction (abdominal distention, abdominal pain, vomiting, high-pitched bowel sounds with air-fluid levels on x-ray)
• Most common causes of small bowel obstruction are adhesions, hernia and malignancy, but this patient has air in the liver which is basically pathognomonic for gallstone ileus (can also have air in the biliary tree)

She has signs of a small bowel obstruction. no hx telling us any other cause. With air in the liver, we think that something has recently passed through to make the bile ducts dilate.