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Intestinal Obstruction: Dr. Mohammad Jamil Alhashlamon

This document discusses intestinal obstruction, its causes, pathophysiology, symptoms, signs, investigation, and management. Intestinal obstruction can be caused by adhesions, hernias, tumors, volvulus, strictures, bolus obstruction, or internal hernias. It leads to dilation of the bowel above the obstruction and disrupted peristalsis. Symptoms include vomiting, pain, and constipation depending on the level and completeness of obstruction. Physical exam may reveal distension, peristalsis, signs of the underlying cause, and bowel sounds. Investigation involves abdominal x-rays. Management focuses on keeping the patient nil per os, providing IV fluids, using a nasogastric tube, treating the underlying

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Bheru Lal
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142 views

Intestinal Obstruction: Dr. Mohammad Jamil Alhashlamon

This document discusses intestinal obstruction, its causes, pathophysiology, symptoms, signs, investigation, and management. Intestinal obstruction can be caused by adhesions, hernias, tumors, volvulus, strictures, bolus obstruction, or internal hernias. It leads to dilation of the bowel above the obstruction and disrupted peristalsis. Symptoms include vomiting, pain, and constipation depending on the level and completeness of obstruction. Physical exam may reveal distension, peristalsis, signs of the underlying cause, and bowel sounds. Investigation involves abdominal x-rays. Management focuses on keeping the patient nil per os, providing IV fluids, using a nasogastric tube, treating the underlying

Uploaded by

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

Dr. Mohammad Jamil Alhashlamon


Intestinal Obstruction Causes
• Adhesions or Bands
– Resulting from previous surgery or intraperitonial
infection ( rarely congenital band)
• Strangulated external hernia
– Femoral or inguinal or umbilical

• Tumors
• Volvulus of small or large bowel
– A mobile or distended loop of bowel rotates causing
obstruction at its neck
• Inflammatory stricture
– e.g. diverticular disease , crohns disease ( obstruction
usually incomplete )
• Bolus obstruction
– e.g. impacted faeces , foreign body , gaalstone .
• Internal hernia

• Itussusception
– Usually initiated by a mass in the bowel
Pathophysiology
• Obstruction lead to dilation of bowel
proximally and disrupt peristalsis .

• Presentation depend on :
– Level of obstruction
– Completeness of obstruction
Symptoms of intestinal obstruction
• Vomiting
– The more proximal the obstruction the earlier it
develops .
– Nature of vomitus give important clues to the
level of obstruction .
– Change to faeculent vomiting usually take place
gradually after about 24 hours of complete
obstruction .
• Pain

– Fluid and swallowed air proximal to the


obstruction together with continuing peristalsis
cause the pain .
– Usually mild m colicky .
– Small intestine obstruction cause central
abdominal pain .
– Large intestine obstruction cause suprapupic
abdominal pain .
• Constipation

– Absolute constipation or obstipation


– The lower the obstruction the earlier the
obstipation develops .
• Symptoms develops more gradually in the
large bowel obstruction

• If the ileocecal valve remain competent , the


caecum will progressively distend and
eventually rupture .

• The ileocaecal valve become incompetent in


50% of the cases and this allow small intestine
distension and delay the onset of symptoms .
Incomplete obstruction
• If the bowel partially obstructed , the clinical
features are less clearly defined .

• The pain is often accompanied by visible


peristalsis ( this is the hallmark of partial
obstruction )

• The most common cause is slowly growing


cancer in the colon .
Physical signs of intestinal obstruction

• Dehydration
• Abdominal distension
• Visible peristalsis
• Signs of primary cause .
• Lack of tenderness “except in
strangulation “
• Mass “ if it is the cause “
• Bowel sounds will be “ loud , frequent , high
pitched and tinkling “

• Succession splash may be positive


Investigation of suspected obstruction

• Plane abdominal X-Ray

• Abdominal X-Ray with contrast


Adynamic intestinal obstruction
• Temporary disruption of normal peristaltic
activity without mechanical blockage .

• If happened in the small intestine called


“paralytic ileus “

• If happened in the large intestine called


“psudo-obstruction of the colon “
Paralytic ileus

• Most commonly post surgery .

• May also happened in :


– Hypokalemia
– Side effect of anti-parkinson medications
Psudo-obstruction of the colon
• Caused by :
– Retroperitonial inflammation or hemorrhage
– Neurological illnesses
– Anticholenergics
– Pregnancy
– Orthopedic injuries and surgery

• Physical signs : similar to those of the


mechanical obstruction except the absence of
bowel sounds
Management of intestinal obstruction

• Keep NPO
• IV fluid and correct electrolytes
• NG tube
• Treat the underlying pathology
Bowel Strangulation
• Segment of the bowel trapped so that the
lumen becomes obstructed and its blood
supply compromised

• If unrelieved , this progress into infarction and


eventually perforation .

• This happened mostly in hernia and volvulus .


symptoms and signs of strangulation

• Signs and symptoms of obstruction


• Abdominal tenderness
• The patient more unwell and tachycardia and
lucocytosis

• Management :
– If it is diagnosed or even suspected immediate
surgery .
THANK YOU

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