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Intestinal Obstruction PDF

Intestinal obstruction is caused by a blockage in the intestine that impairs the normal passage of contents. Common causes include adhesions, hernias, and tumors. Symptoms depend on the location and severity of the obstruction, but generally include abdominal cramps, vomiting, and distention. Diagnosis is made initially through abdominal x-rays showing dilated intestinal loops. Treatment involves nasogastric decompression, IV fluids, and antibiotics if ischemia is suspected, with surgery often needed to resolve the obstruction.

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60 views4 pages

Intestinal Obstruction PDF

Intestinal obstruction is caused by a blockage in the intestine that impairs the normal passage of contents. Common causes include adhesions, hernias, and tumors. Symptoms depend on the location and severity of the obstruction, but generally include abdominal cramps, vomiting, and distention. Diagnosis is made initially through abdominal x-rays showing dilated intestinal loops. Treatment involves nasogastric decompression, IV fluids, and antibiotics if ischemia is suspected, with surgery often needed to resolve the obstruction.

Uploaded by

Kiiza Aloysius
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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INTESTINAL OBSTRUCTION

Intestinal obstruction is significant mechanical impairment or complete arrest of the passage


of contents through the intestine due to pathology that causes blockage of the bowel.

Etiology of Intestinal Obstruction


Overall, the most common causes of mechanical obstruction are
 adhesions,
 hernias,
 and tumors.
Other general causes are
 diverticulitis,
 foreign bodies (including gallstones),
 volvulus (twisting of bowel on its mesentery),
 intussusception (telescoping of one segment of bowel into another),
 and fecal impaction.
TABL
Location Cause

Tumors (usually in left colon), diverticulitis (usually in sigmoid),


Colon volvulus of sigmoid or cecum, fecal impaction, Hirschsprung
disease, Crohn disease

Duodenum

Adults Cancer of the duodenum or cancer of the head of pancreas, ulcer disease

Neonates Atresia, volvulus, bands, annular pancreas

Jejunum and
ileum

Hernias, adhesions (common), tumors, Meckel diverticulum, Crohn


Adults disease (uncommon), Ascaris infestation, midgut volvulus, intussusception
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by tumor (rare), foreign body, gallstones (rare)


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Location Cause

Neonates Meconium ileus, volvulus of a malrotated gut, atresia, intussusception

Pathophysiology of Intestinal Obstruction


In simple mechanical obstruction, blockage occurs without vascular compromise. Ingested
fluid and food, digestive secretions, and gas accumulate above the obstruction. The proximal
bowel distends, and the distal segment collapses. The normal secretory and absorptive
functions of the mucosa are depressed, and the bowel wall becomes edematous and congested.
Severe intestinal distention is self-perpetuating and progressive, intensifying the peristaltic
and secretory derangements and increasing the risks of dehydration and progression to
strangulating obstruction.
Strangulating obstruction is obstruction with compromised blood flow; it occurs in nearly
25% of patients with small-bowel obstruction. It is usually associated with hernia, volvulus,
and intussusception. Strangulating obstruction can progress to infarction and gangrene in
as little as 6 hours. Venous obstruction occurs first, followed by arterial occlusion, resulting
in rapid ischemia of the bowel wall. The ischemic bowel becomes edematous and infarcts,
leading to gangrene and perforation. In large-bowel obstruction, strangulation is rare
(except with volvulus).
Perforation may occur in an ischemic segment (typically small bowel) or when marked
dilation occurs. The risk is high if the cecum is dilated to a diameter ≥ 13 cm. Perforation
of a tumor or a diverticulum may also occur at the obstruction site.
Symptoms and Signs of Intestinal Obstruction
Obstruction of the small bowel causes symptoms shortly after onset:
 Abdominal cramps centered around the umbilicus or in the epigastrium,
 Vomiting,
 Patients with partial obstruction may develop diarrhea.
 Severe, steady pain suggests that strangulation has occurred.
 Hyperactive.
 High-pitched peristalsis with rushes coinciding with cramps is typical.
 Sometimes, dilated loops of bowel are palpable.
 Abdomen becomes tender.
 Auscultation reveals a silent abdomen or minimal peristalsis.
 Shock.
 Oliguria.
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Note.
Obstruction of the large bowel usually causes milder symptoms that develop more
gradually than those caused by small-bowel obstruction. Increasing constipation leads to
obstipation and abdominal distention. Vomiting may occur (usually several hours after
onset of other symptoms) but is not common. Lower abdominal cramps unproductive of feces
occur. Physical examination typically shows a distended abdomen with loud borborygmi.
There is no tenderness, and the rectum is usually empty. A mass corresponding to the site of
an obstructing tumor may be palpable. Systemic symptoms are relatively mild, and fluid and
electrolyte deficits are uncommon.
Volvulus often has an abrupt onset. Pain is continuous, sometimes with superimposed
waves of colicky pain.
Volvulus
Volvulus is a twisting of the colon around itself, sometimes causing strangulation with
ischemia and necrosis. Occasionally, the rotation can be reduced noninvasively with an
endoscope.
Small-Bowel Obstruction (Supine)
Supine abdominal x-ray showing obstruction of the small bowel. Dilated loops of small
bowel should be noted.
On plain x-rays, a ladderlike series of distended small-bowel loops is typical of small-bowel
obstruction but may also occur with obstruction of the right colon. Fluid levels in the bowel
can be seen in upright views. Similar, although perhaps less dramatic, x-ray findings and
symptoms occur in ileus (paralysis of the intestine without obstruction); differentiation can
be difficult. Distended loops and fluid levels may be absent with an obstruction of the
proximal jejunum or with closed-loop strangulating obstructions (as may occur with
volvulus). Infarcted bowel may produce a mass effect on x-ray. Gas in the bowel wall
(pneumatosis intestinalis) indicates gangrene.
In large-bowel obstruction, abdominal x-ray shows distention of the colon proximal to the
obstruction. In cecal volvulus, there may be a large gas bubble in the mid-abdomen or left
upper quadrant. With both cecal and sigmoid volvulus, a contrast enema shows the site of
obstruction by a typical “bird-beak” deformity at the site of the twist; the procedure may
actually reduce a sigmoid volvulus. If contrast enema is not done, colonoscopy can be used to
decompress a sigmoid volvulus but rarely works with a cecal volvulus.

Diagnosis of Intestinal Obstruction


1. Supine and upright abdominal x-rays should be taken and are usually
adequate to diagnose obstruction.
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2. CT. scan
3. Abdominal ultra sound scan.
4. Laparatomy.
Treatment of Intestinal Obstruction
 Nasogastric suction
 IV fluids
 IV antibiotics if bowel ischemia suspected
Plan for surgery.

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