INTESTINAL

OBSTRUCTION
 INTRODUCTTION
▪ Intestinal obstruction means blockage of intestinal pathway
that prevents the normal flow of products of intestine.

▪ It is also known as bowel obstruction.

 DEFINITION
▪ Intestinal obstruction is a significant or mechanical
blockage of intestine that occurs when food or stool
can not move through the intestine.
▪ These obstruction may be complete or partial.
 CAUSES
MECHANICAL CAUSES:

An intraluminal obstruction or a mural obstruction from

pressure on the intestinal wall occurs e.g.. Tumour &
neoplasm, stenosis, hernia, abscess.
 FUNCTIONAL OBSTRUCTION:
The intestinal mass culture can’t propel the contents the bowel.
e.g.. Amyloidosis (It is a group of disease in which abnormal
protein known as amyloid fibrils builds up in tissue, it cause &
change in shape, work & also called organ failure.)
-Muscular dystrophy
-Endocrine disorder such as diabetes
-Neurological disorders
 CLASSIFICATON
ON THE BASIS OF CHANGES & MOVEMENTS
Dynamic\ a dynamic

ON THE BASIS OF DURATION

Subacute & acute chronic

ON THE BASIS OF LOCATION

Small bowel obstruction & large bowel obstruction
ON THE BASIS OF CHANGES & MOVEMENTS
DYNAMIC: It occurs when peristalsis is working against a mechanical
obstruction.
ADYNAMIC: It may occur in two forms:
1. Where peristalsis may be absent. Occurring secondarily to
neuromuscular failure in the mesentery.

2.Where peristalsis may be present in non-propulsive form (pseudo-

obstruction).

* In both form mechanical elements is absent.

 ON THE BASIS OF NATURE IT IS
CALSSIFIED INTO

SUBACUTE & ACUTE: It usually occurs in small bowel

obstruction with sudden onset of severe colicky central
abdominal pain distension & early vomiting & constipation.

CHRONIC OBSTRUCTION : Usually seen in large bowel

obstruction with lower abdominal colic and absolute
constipation, followed by distension.
 ON THE BASIS OF LOCATION
▪ Small bowel obstruction: duodenum, jejunum, and ilium are
the part of the small intestine, when the obstruction occur in
this part of intestine.

▪ High bowel wash: ascending colon, transverse colon,

descending colon, cecum, rectum when the obstruction occur
in this part of intestine.
 SMALL BOWEL OBSTRUCTION
▪ duodenum, jejunum, and ilium are the part of the small
intestine, when the obstruction occur in this part of
intestine.
 CAUSES
Adhesion 60%
Hernia 20%
Neoplasm 5%
Volvulus 5%.
Others: IBD - gall stone - foreign body – intussusception
Atresia
Stenosis
ADHESION
▪ Superior mesenteric artery syndrome: compression of duodenum
by superior mesenteric artery in abdominal aorta
INTUSSUSCEPTION
VOLVLUS
 LARGE BOWEL OBSTRUCTION
▪ Descending colon, sigmoid colon rectum and anal canal
is part of large intestine

▪ Large bowel obstruction occur when if obstruction in

these part of intestine
 CAUSES
Cancer 60%.
Diverticular disease 15%.
Volvulus 15%.
Others: hernia – fecal impaction - IBD.
Inflammatory bowel disease
Constipation
Adhesion
Faecaloma extreme form of faecal immobilization
Colon atresia- narrowing of colon
 PATHOPHYSIOLOGY
Due to etiological factor

Impairment of passage of material through bowel

Accumulation of flatus,feaceas and retention of fluid,

reduce the fluid absorption and stimulate more gastric
secretion
 PATHOPHYSIOLOGY
Distension of proximal intestine with solid fluid and gas

With increasing distension, increase intestinal lumen pressure

Decrease in venous in increase in capillary pressure

Oedema, congestion with decrease capillary
pressure

Rapture of perforation of intestine

Peritonitis
 CLINICAL MANIFESTATION
▪ Initial symptoms is usually crampy pain that is wave like and colicky.
▪ Classical symptoms is nausea vomiting and constipation
▪ Without treatment abdominal pain may increase as a result of
perforation
▪ Ischemia
▪ Absence of passage of flatus abdominal distension
▪ Fever
▪ Tachycardia
 HIGH
Difference between High & Low
LOW
BEGINNING Acute obstruction
intestinal Slow, insidious
GENERAL CONDITION Early compromission preserved
PAIN Crampy pain in paroxism Less intensity

VOMITING Early, profuse, biliary Late, feculent may

be absent

ABDOMINAL Moderate, upper

DISTENTION quadrant Early, intense
CONSTIPATION + +++
ELECTOLYTES Cl, K, Na rapid loss Late hydro electrolytic
imbalance
 COMPLICATION
▪ Intestinal perforation
▪ Peritonitis due to perforation
▪ Sepsis- mostly in which delay in diagnosis or treatment.
▪ Intraabdominal abscess.
▪ Dehydration
▪ Electrolyte disturbance
▪ Multiple organ failure(rarely)
▪ Death
 DIAGNOSTIC EVALUATION
HISTORY COLLECTION
present medical and surgical history
past medical and surgical history
PHYSICAL EXAMINATION
LABORATORY TEST
 RADIOLOGICAL TEST
 PHYSICAL EXAMINATION
INSPECTION
Abdominal Distention, scar, visible peristalsis,
PERCUSION
Tympani, dullness
AUSCULTATION
Bowel sounds
PALPATION
Mass, tenderness, gaurding
 LABORATORY FINDINGS
• CBC:
– Increase PCV (dehydration ) and increase in WBC.
• KFT:
– Increase in BUN and creatinine .
• Lactate concentration-amylase-lactic dehydrogenase useful but
not sensitive
– To rule out necrosis
• ABG:
– metabolic alkalosis and respiratory acidosis.
RADIOLOGICAL EVALUATION
 SIGMOIDOSCOPY (FLEXIBLE)
▪ it is a minimal invasive endoscopic procedure for large
intestine from the rectum through the last part of the colon
 COLONOSCOPY
▪ it is the endoscopic procedure for large intestine and
digital part of the small with fibber optic camera on a
flexible tube passed through the anus and it provide
the visual diagnosis show location of obstruction
CT SCAN
 MEDICAL MANAGEMENT
 Fluid replacement with aggressive intravenous resuscitation using
isotonic saline or ringer lactate is indicate.
 Antibiotic therapy for gram negative bacteria such as cefazolin and
cefotaxime and meropenem
 Antiemetic for symptomatic relief of nausea and vomiting such as
ondansetron
 Analgesic to relief pain such as morphine, fentanyl and diclofenac.
▪ Diuretics to reduce the fluid retention such as
furosemide.
▪ Stool softener such as duphalac for relief
constipation
 SURGICAL MANAGEMENT
▪ Bowel resection (enterotomy) - it is a surgical procedure in
which a part of bowel is removed, from either small
intestine or large intestine.
▪ Colostomy
▪ Bypass surgery
 DIETARY MANAGEMENT
Clear liquid diet- a Clear liquid diet starting with soups and
advancing to half cup to one cup portions.

Food allowed on clear liquid diet, fruit juice after 1 to 2 weeks.

Low fibber diet- temporarily limiting the amount of fibber for

bowel healing
Low fibber rich diet such as white bread with outs nuts and seeds
White rice, plain white pasta
Well cooked vegetables and fruits without skin and seeds
Avoid hot spicy and cholesterol rich diet
Avoid alcohol
Avoid smoking
 Acute pain related to intestinal obstruction as
evidence by patient verbalization.
Goal- resolved the pain
Intervention-
▪ assess level, frequently and type of pain.
▪ Provide comfortable position
▪ Administer the prescribed medication provide diversional
therapy
▪ Provide calm environment
 Imbalance nutrition less than body requirement related to
altered nutritional absorption as evidence by aversion to
eating

Goal: Enhance the nutritional status

Intervention:

▪ Recommend bed rest before meal

▪ Provide oral hygiene
▪ Avoid food that cause abdominal cramping
▪ Record intake and output
▪ Promote patient participation in dietary planning as possible
 Risk for deficit fluid volume related to vomiting as
evidence by skin turgidity
Goal: maintain adequate fluid and volume level
Intervention:
▪ Monitor intake and output
▪ Note possible condition that may lead to deficient fluid loss.
▪ Monitor vital sign
▪ Observe the skin condition
▪ Administration preantral fluid
 Anxiety related to changes in health status as
evidence by somatic complaints
Goal: Patient feel relaxed
Intervention
▪ Review physiological factor such as active medical condition
▪ Observe and note behaviour
▪ Encourage verbalization of feeling