Intestinal obstruction

 



DEFINITION:-

·         Intestinal obstruction exist when blockage prevent the normal flow of intestinal content through the intestinal tract. 

·         TYPES:-

1.      MECHANICAL:- It occur due to pressure in the intestinal wall. Ex- Intussusception(one part of intestine slip in to another part located below) , volvulus( bowel twist and turn on it self occlude the blood supply), hernia( protrusion of intestine through an weakened area in the abdominal muscle wall),  adhesion( loop of the intestine become adherent to anus that heal slowly or scar after abdominal surgery), Polypoid tumor , Stenosis, stricture & abscess.

2.     FUNCTIONAL OBSTRUCTION:- Here intestinal musculature cannot propel the content along the bowel. EX- muscular dystrophy, amyloidosis, endocrine disorder, DM, neurologic disorder, Parkinson’s disease

CAUSES:-

  1. Intestinal adhesion:- Band of fibrous tissue in the abdominal cavity that can form after abdominal or pelvis surgery
  2. Colon cancer
  3. Intussusception
  4.  Hernias
  5.  Inflammatory bowel disease such as crohn’s disease.
  6.  Diverticulitis:- it is a condition in which there is small & bulging pouch (diverticula) in the digestive tract become inflamed & infected.

SIGN & SYMPTOMS:-

  • Crampy abdominal pain
  • Loss of appetite
  •  Constipation
  •  Vomiting
  • Inability to pass gas
  •  Swelling of abdomen
  • Nausea
  •  Distention

PATHOPHYSIOLOGY:-

v  DUE TO ETIOLOGY

FLUID, GAS, & INTESTINAL CONTENT ACCUMULATE PROXIMAL TO THE OBSTRUCTION & COLLAPS DISTAL BOWEL

DISTENTION OF BOWEL CAUSE REDUCE ABSORPTION OF FLUID & STIMULATE INTESTINAL SECRETION

BACTERIA DEVELOP DUE TO OBSTRUCTION CAUSE ADDITIONAL SECRETION OF FLUID

PROXIMAL BOWEL BECOME MORE DISTENDED& INTRA MURAL BOWEL PRESSURE RAISE

INCREASE PRESSURE CAUSE INCREASE CAPILLARY PERMIABILITY & EXTRAVASATION OF FLUID IN TO THE PERITONIAL CAVITY

v  FLUID RETAINTION IN INTESTINE & PERITONIUM DEREASE CIRCULATING BLOOD VOLUME & HYPOTENSION & HYPOVOLEMIC SHOCK

v  DECREAE BLOOD FLOW CAUSE ISCHEMIA
NECROSIS

BOWEL RUPTURE.

DIAGNOSIS:-

  •  History collection
  • Physical examination:- abdominal swollen & tender
  • X-Ray
  • CT Scan to take cross sectional image
  • Ultrasound:- To check intestinal coiled within the intestine
  • Barium enema
  • CBC, Serum amylase, electrolyte, BUN, Decreased Hb%, K+ concentration. NA+, chloride

MANAGEMENT:-

  • Decompression of bowel through a nasogastric tube
  • IV fluid to replace the depleted water, Na+, chloride & k+.
  • Cecustomy:- to release gas & small amount of drainage.

 

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