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    GIS-K-26 Intestinal Obstruction: Syahbudin Harahap

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    lidz_margaret
    This document discusses intestinal obstruction, including its definition, types, etiology, pathophysiology, clinical presentation, diagnostic studies, and management principles. Intestinal obstruction can involve the small intestine (SBO) or large intestine (LBO) and can be mechanical, due to a physical blockage, or non-mechanical/functional. Mechanical obstructions have various causes depending on age and can lead to fluid and electrolyte disturbances, bacterial overgrowth, bowel distension, and potentially ischemia or perforation if untreated. Clinical features include abdominal distension, pain, nausea/vomiting, and decreased bowel movements. Diagnostic studies involve imaging such as x-rays and labs to evaluate fluid/electrolyte

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    GIS-K-26 Intestinal Obstruction: Syahbudin Harahap

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    lidz_margaret
    27 views23 pages
    This document discusses intestinal obstruction, including its definition, types, etiology, pathophysiology, clinical presentation, diagnostic studies, and management principles. Intestinal obstruction can involve the small intestine (SBO) or large intestine (LBO) and can be mechanical, due to a physical blockage, or non-mechanical/functional. Mechanical obstructions have various causes depending on age and can lead to fluid and electrolyte disturbances, bacterial overgrowth, bowel distension, and potentially ischemia or perforation if untreated. Clinical features include abdominal distension, pain, nausea/vomiting, and decreased bowel movements. Diagnostic studies involve imaging such as x-rays and labs to evaluate fluid/electrolyte

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    K26~ILEUS OBSTRUCTION

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    This document discusses intestinal obstruction, including its definition, types, etiology, pathophysiology, clinical presentation, diagnostic studies, and management principles. Intestinal obstruction can involve the small intestine (SBO) or large intestine (LBO) and can be mechanical, due to a physical blockage, or non-mechanical/functional. Mechanical obstructions have various causes depending on age and can lead to fluid and electrolyte disturbances, bacterial overgrowth, bowel distension, and potentially ischemia or perforation if untreated. Clinical features include abdominal distension, pain, nausea/vomiting, and decreased bowel movements. Diagnostic studies involve imaging such as x-rays and labs to evaluate fluid/electrolyte

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    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    27 views23 pages

    GIS-K-26 Intestinal Obstruction: Syahbudin Harahap

    Uploaded by

    lidz_margaret
    This document discusses intestinal obstruction, including its definition, types, etiology, pathophysiology, clinical presentation, diagnostic studies, and management principles. Intestinal obstruction can involve the small intestine (SBO) or large intestine (LBO) and can be mechanical, due to a physical blockage, or non-mechanical/functional. Mechanical obstructions have various causes depending on age and can lead to fluid and electrolyte disturbances, bacterial overgrowth, bowel distension, and potentially ischemia or perforation if untreated. Clinical features include abdominal distension, pain, nausea/vomiting, and decreased bowel movements. Diagnostic studies involve imaging such as x-rays and labs to evaluate fluid/electrolyte

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    of 23

    GIS-K-26

    INTESTINAL
    OBSTRUCTION
    Syahbudin Harahap
    DEFINITION
    • Bowel /Intestinal obstruction occurs when the normal
    propulsion and passage of intestinal contents does not
    occur
    BO can involve:
    – SBO  Small intestine
    – LBO  Large intestine
    – Generalized Ileus
    -via systemic alterations
    -involving both the small and large intestine
    Etiopathogenesis
    - Mechanical obstruction
    - Non mechanical (Functional ) obstruction

    Mechanical obstruction (Dynamic ) ileus refers to a lack


    of passage due to an “obstruction of the bowel”,
    which can be located anywhere in the bowel

    Non mechanical Obstruction (Paralytic )(adynamic)


    (Fungsional) ileus
    Paralytic ileus refers to a lack of passage due to
    “paralysis of the bowel”
    Intestinal /Bowel Obstruction
    Classified according to :
    Time of presentation and duration of
    obstruction:
    - Acute
    - Chronic
    The extent of obstruction
    -Partial
    -Complete
    The type of obstruction
    -Simple
    -Closed-loop
    -Strangulation
    Nonmechanical Obstruction
    Paralytic (adynamic) (Fungsional) ileus due to :
    1. After abdominal operations
    2. Inflammation Peritonitis
    3. Systemic disorders e.g. sepsis, hyponatremia, hypokalemia,
    hypomagnesemia
    4. Retroperitoneal disorders e.g. ureter, spine fractures ,
    hematoma
    5. Thoracic conditions e.g. pneumonia, rib fractures
    6. Drugs e.g opiates, psychotropics , General anesthesie

     Pseudo-Obstruction
    Imbalance in the parasympathetic and sympathetic influences
    on Colonic motility.
    Acute colonic pseudo-obstruction, also known as Ogilvie
    syndrome.
    MECHANICAL OBSTRUCTION
    at each age group

    • Neonate • Middle age


    Congenital atresia
    Volvulus neonatum Adhesesion and band
    Strangulated Ing.hernia
    Meconeum ileus
    Strangulated fem.hernia
    Hirschsprung”s disease Carcinoma colon
    Imperforate anus Volvulus
    • Infant
    Stranggulated inguinal hernia
    • Elderly
    Intussuception
    Complication of Meckel”s diverticulum Adhesion and bands
    Hischsprung”s diseases Strangulated Ing.hernia
    Strangulated fem.hernia
    • Young adult Carcinoma colon
    Adhesions and bands Volvulus
    Impacted faeces
    Strangulated ing.hernia
    Incidence Mechanical Obstruction
    • May occur at any age
    • 70 percent small bowel obstruction (SBO)
    • 30 percent large bowel obstruction (LBO)

    Common Causes SBO Common Causes of LBO

    Adhesion 60% Colon cancer 65 %


    Neoplasma 20% Diverticulitis 20 %
    Hernia 10% Volvulus 5%
    Crohn 5% Miscellaneous 10 %
    Miscellaneus 5%
    Pathophysiology
    Dependent upon :
    1. Degree of obstruction
    2. Duration of obstruction
    3. Presence and severity of ischaemia

    Result in :
    1. Accumulation of fluid and air(Sequestration within the dilated
    loop)
    Fluid disturbances massive third space losses
    8 – 10 L of fluid are secreted
    Hypovolumic shock oliguria, hypotension,hemoconcentration
    2. Electrolyte depletion
    3. Bacterial overgrowth Rapid colonisation
    -Maximal by 24 hrs after obstruction
    -Bacterial translocation to node and portal system
    4. Bowel distension
    -Chest compression by pushing up diaghragma muscle
    -Decreases the ability mucosa to absorb ,stasis intestinal content
    of fluids and electrolytes
    -Increased intraluminal pressure  oedematous cyanosis
    intraperitoneal exudation necrosis perforationperitonitis
    -ACS  impediment in venous returnarterial insufficiency

    5. LBO
    Ileocaecal valve plays prominent role in pathophysiology of LBO.
    If competent valve = Closed loop obstruction
    In 10 – 20 % of individual ICV incompetent
    Caecal around 10 – 12 cm  the risk of perforation
    Clinical Picture
    Mechanical obstruction

    The classic quartet


    1. Abdominal distension
    2. Colicky abdominal pain
    3. Nausea and Vomiting
    4. Decreased passage of
    stool or flatus
    Clinical Manifestations

    Hypovolumic shock
    Altered mental state
    Vital Sign
    Tachicardia
    Hypotension
    Tachipnoe
    Fever
    Oliguria
    Abdominal Examination

    Patient Supine position with the legs flexed at the hip

    Abdominal Colicky pain


    The periodicity of pain:
    3 to 4 minutes pain from proximal intestinal obstruction
    15 to 20 minutes pain from distal small bowel or colon

    On Inspection
    Abdominal distension
    Visible peristalsis
    Abdominal Scars  Adhesion
    On Auscultation
    Performed for at least 3 to 4 minutes
    Metallic sound
    Borborygmi
    The absence of bowel tones :
    Is typical of intestinal paralysis .
    LateQuiet abdomen (may also indicate
    intestinal fatigue from long-standing
    obstruction).
    On Palpation
    Inguinal ,Femoral , Umbilical ,Incisional Hernias
    Palpable mass

    On Percuss
    Dull  Fluid or Mass
    Tympanic  Air (Intraluminal or not )
    Peritoneal irritation

    DRE (Digital Rectal Examination )


    For Mass , Impacted faeces
    Vomiting – NG tube Aspirates

    Consists food and gastric chyme bile 


    faeculent

    GOO  Clear , food and gastric chyme


    Mid to distal SBO  Bilious/Bile
    Distal SBO to LBO  Feculent
    Diagnoctic Studies

    Laboratory test

    • Fecal Occult Blood Test


    • CBC
    • Serum electrolyte concentrations
    • The serum creatinine concentration / BUN
    • The coagulation profile
    • Urinalysis should be done to check for hematuria
    • Liver function profile
    Imaging
    Chest x-ray
    Exclude a pneumonic process
    To look for subdiaphragmatic air.

    Plain abdominal X ray


    Erect and lying down  routinely

    Water soluble enema to exclude


    Colonic pseudo obstruction
    LBO + incompetent ileocecal thereby mimicking
    small bowel obstruction.
    SBO
    Colon in loop:
    SIGMOID VOLVULUS
    bent inner tube = Coffe bean” appearance “Bird Beak “
    Management of Bowel Obstruction
    Principles
    • Fluid resuscitation
    Requirements = Deficit + Maintenance + Ongoing losses
    • Close monitoring hemodinamic
    – Foley catheter urine output
    – CVP
    • Electrolyte, acid-base correction
    • NGT decompression
    • Antibiotics
    • Diagnostic study
    • Informed concent
    • Exploratory laporotomy

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