INTESTINAL OBSTRUCTION

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INTESTINAL OBSTRUCTION
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CLASSIFICATION

• 1, Mechanical obstruction
• obturation obstructoin
• intestine compression
• lesions in the intestinal wall
• 2, Nonmechanical obstruction
• dynamic ileus-----gtincluding paralytic ileus
  
• blood ileus

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• According to the blood circulation to the bowel,
  no impaired or impaired
• simple ileus
• strangulation ileus

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PATHOPHYSIOLOGY
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Local Effects of Obstruction

• 1, peristalsis-gthyperperistalsis-gtabnormal
  peristalsis
• 2,secretion increase and absorption decrease
• 3, accumulation of fluids and electrolytes
• 4, distension of intestinal lumen
• 5, edema of the bowel wall -gtanoxemia-gtnecrosis

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Systemic Effects of Obstruction

• 1, water and electrolyte losses
• 2, toxic materials and toxemia
• 3, cardiopulmonary dysfunction
• 4, shock

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Closed-loop Obstruction

• 1.It is dangerous form because of the propensity
  for rapid progression to strangulaton of the
  blood supply
• 2, the secretory pressure in the closed loop
  quite rapidly reaches a level sufficient to
  interfere with venous return from the loop.

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Colon Obstruction

• 1, usually not strangulation
• 2, fluid and electrolyte sequestration progresses
  more slowly

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CLINICAL FEATURES

• 1, Abdominal pain
• 2, Vomiting
• 3, Obstipation
• 4, Distention

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Physical Examination

• 1, Inspection state of nutrition , behavior
  ,skin color , and turgor and warmth of the skin
• 2, Palpation demonstrating the sites of the
  distress, then localizing the anatomic areas of
  possible abnormality.
• 3, Auscultation simple one ----noisy and is
  heard as rushes. During attacks of colic ,the
  sounds become loud ,high-pitched and metallic .
• 4, Digital examination of the rectum

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Laboratory Examination

• 1, complete blood count
• 2, serum electrolytes and amylase determination
• 3, arterial blood gas analysis
• 4, urine specific gravity test

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Radiologic Examination

• X-ray is the most important diagnostic procedure.
  Intestinal gas often is found. Not so often.
  Sometimes can display the intestinal loop.

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DIAGNOSIS

• 1, Whether obstruction according to clinical
  manifestation ,we can know.
• 2, Mechanical or dynamic one .
• 3, Simple or strangulated one.

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• Differentiation
• 1, continuous rather than intermittent pain
  .
• 2, the presence of shock and rapid pulse,
  elevated temperature and white
  blood count.
• 3, the presence of peritoneal irritation
• 4, a palpable tender abdominal mass.
  
• 5, vomitus , gastrointestinal decompression
  is bloody.
• 6, active nonoperative treatment is no
  use.
• 7, X-ray examination show isolated. large
  intestinal loop.

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TREATMENT
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Nonoperative Treatment

• Basic treatment 1, gastrointestinal
  decompression .
• 2, redress water ,
  electrolyte and
  acid-base balance .
• 3, antibiotic
  treatment.

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Surgical Treatment

• 1, principle of operation
• 1, For strangulation and closed-loop
  obstruction the operation is required as soon as
  possible.
• 2, For simple one ,if the nonoperative
  method is no use ,the operation is needed.
  Especially more than 48 hours.

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The Procedure of Operation

• Procedures not requiting opening of bowel
• Enterotomy for removal of obturation obstruction
• Resection of the obstructing lesion or
  strangulated bowel with primary anastomosis.
• Bypass anastomosis around an obstruction.
• Formation of a cutaneous stoma proximal to the
  obstruction .
• The selection depend on the etiological
  causes.

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Postoperative Care

• The principles are fluid and electrolyte
  management ,antibiotics and gastrointestinal
  decompression.

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Common Types of Intestinal Obstruction
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Peritoneal Adhesions and Bands

• Congenital less
• Acquired more usual. Most are due to injure
  ,operation and infection.

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Diagnosis

• 1, History of operation, injure ,infection.
• 2, Clinical manifestation .
• 3, maybe no manifestation in long time , suddenly
  the symptoms appears ,and the pain is severe.

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PROPHYLAXIS

• 1, Avoiding any unnecessary trauma ,strangulation
  of tissue and contamination during operative
  procedures.
• 2, All debris should be removed and any
  unnecessary foreign material, excessive suture
  material and mass ligation in the wound should be
  avoided.

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TREATMENT

• 1, Intestinal decompression by nasogastric
  incubation.
• 2, operation sewing the intestine to itself so
  that the loops of intestine are arranged in an
  orderly ,ladder like fashion.

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VOLVULUS

• Volvulus is a twisting or rotation of bowel upon
  its mesentery , often resulting in intestinal
  obstruction. Circulatory impairment may follow ,
  particularly when the twist is more than 180
  degree .

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DIAGNOSIS

• 1, Sigmoid volvulus
• 1,common in the elderly with chronic
  constipation.
• 2, cramping abdominal pain is a constant
  complaint.
• 3, nausea and vomiting are inconstant
  symptoms. And tend to occur late
• 4, there is an enormous gas -filled loop of
  the large intestine.

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• 2, Small bowel volvulus
• 1, common in the young person.
• 2, presents following labor activity after
  eating.
• 3, sudden onset of severe abdominal pain
  ,nausea, vomiting and distention.
• 4, shock in the early stage with the necrosis
  of a large segment or entire small intestine.
• 5, not easy differentiated from other types
  of mechanical intestinal obstruction until
  laparotomy.

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TREATMENT

• 1, Sigmoidoscopic reduction with a large rectal
  tube or fiber optic colonoscopic reduction.
• 2, The most volvulus should be approached by
  transabdominal operation , and the surgeon should
  choose the necessary procedure.

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INTUSSUSCEPTION

• 1, An intussusception is an invagination of part
  of the intestinal tract into the lumen of the
  adjacent intestine.
• 2, 80 of intussusception occur in children under
  2 years. In adults ,in contrast to children, the
  cause is usually related to intestinal tumors.

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TREATMENT

• 1,hydrostatic pressure
• 2, use barium enema
• 3, resection of the involved bowel including the
  leading point with end-to-end anastomosis.

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Pseudo-Obstruction of The Colon

• 1, Cause surgical or blunt trauma but may be
  related to other extracolonic or extraabdominal
  disease.
• 2, Signs massive dilatation of the cecum and
  ascending and transverse colon with no vomiting
  and no peritoneal signs. No air in distal portion
  of colon.
• 3, Treatment conservative methods. If
  conservative methods fail ,and cecum is greater
  than 12cm, laparotomy is indicated. And if signs
  of acute abdomen. Usually cecostomy is the
  choice.