INTESTINAL

OBSTRUCTION
Presented by:
Maryam Nazir
Aiman Sabir
Simran Tariq
 Intestinal Obstruction
Definition :
Intestinal obstruction exists when blockage prevents the
normal flow of intestinal contents through the
intestinal tract.
Two types of processes can impede this flow:
 Mechanical obstruction:
An intraluminal obstruction or a mural
obstruction from pressure on the intestinal wall occurs.
 Functional obstruction:
The intestinal musculature cannot propel
the contents along the bowel.
CAUSES OF INTESTINAL
OBSTRUCTION
 Small bowel obstruction
Definition :
 Small bowel obstruction can
have abdominal pain with
frequent vomiting.
 True bowel obstruction can be very serious.
Pathophysiology
 Clinical Manifestations
• Crampy pain
• Voimiting
• Dehydration
• Intense thirst
• Drowsiness
• Malaise
• Aching
• Parched tongue and mucous membrane
• Acidosis
• Alkalosis
• Hypovolemic shock
• Septic shock
 Causes:
• Adhesions, or tissue that can develop after abdominal
or pelvic surgery
• Diverticulitis
• A foreign object, if swallowed
• Gallstones, though this is a rarer cause of obstruction
• Hernias
• Impacted stools
• Infection
• Inflammatory bowel diseases (IBDs)
• Intussusception, which is when a segment of the bowel
pushes into the next segment, making it collapse
• Meconium plug, which is the first stool that newborns
pass
• Tumors, twisted bowel.
 Complications
• Dehydration
• Electrolyte imbalance
• Tissue death in the bowels
• Abscess within the abdomen
• Kidney failure
• A hole in the bowel, which could lead to infection
• Pulmonary aspiration, wherein a person inhales solids such as vomit
• Sepsis a potentially fatal blood infection
 Risk factors:
• Cancer, especially in the abdomen.
• Crohn's disease or other IBDs, which can
thicken the walls of the intestines.
• Previous abdominal or pelvic surgery, which
may increase the risk of adhesions.
• Radiation therapy.
• Bulging through the incision (incisional
hernia)
• Narrowing (stricture) of the opening (stoma)
• Blockage (obstruction) of the intestine from
scar tissue
 Diagnosis
• Abdominal x-ray and CT findings include
abnormal quantities of gas, fluid, or both in the
intestines.
• Laboratory studies (ie, electrolyte studies and a
complete blood cell count) reveal a picture of
dehydration, loss of plasma volume, and
possible infection.
 Treatment
Treatment options for small bowel obstruction can
include:
• Medication.
• Observation
• Nasogastric tube
• Surgery
• Therapeutic enema
 Medical Management
• Decompression of the bowel through a nasogastric tube is successful in
most cases.
• When the bowel is completely obstructed, the possibility of strangulation
and tissue necrosis (ie, tissue death) warrants surgical intervention.
• Before surgery, IV fluids are necessary to replace the depleted water,
sodium, chloride, and potassium.
• Analgesic
• Antibiotcs
• For the most common causes of obstruction, such as hernia and
adhesions, the surgical procedure involves repairing the hernia or
dividing the adhesion to which the intestine is attached.
• In some instances, the portion of affected bowel may be removed and an
anastomosis performed.
 Sugical management
Principles:
• Management of segment at site of obstruction.
• Management of distended proximal bowel.
• Management of underlying cause of obstruction.
Steps:
• Nasogastric intubation and suction
• Anaesthesia
• Incision
• Handling of gut
• Assess the viability of the bowel
• Prevention of reperfusion
• Closing the abdomen
 Nursing Management
• Nasogastric tube is inserted for feeding.
• Provide liquid diet rich in protein and high caloric diet.
• Encourage patient and assisst in doing oral care.
• Monitor intake output chart.
• Assessing improvement (eg, return of normal bowel sounds,
decreased abdominal distention, subjective improvement in
abdominal pain and tenderness, passage of flatus or stool).
• Mantain nutritional status:
 Eat 6 to 8 small meals a day
 Only drink ½ cup (4 ounces) of liquids during each
meal
 Include enough nutrients in your meals to help you
heal.
Large bowel obstruction
Definition :
 A large bowel obstruction is when the large
intestine, which is also known as the colon or
large bowel, is partially or completely blocked.
 Large bowel obstruction is less common & can be
from cancer or diverticulitis.
 Lack of bowel movement with colon obstruction.
Pathophysiology
 Clinical manifestations
• Constipation
• Anemia
• Weakness
• Weight loss
• Anorexia
• Crampy lower abdominal pain
• Fecal voimiting
• shock
 Causes
• Adhesions
• Constipation
• Fecal impaction
• Hernias
• Neoplasm
• Strictures
• Volvulus
• Adhesions
• Diverticulitis
 Complications
• Infection
• Tissue death
• Intestinal perforation
• Sepsis
• Multisystem organ failure
• Death
 Risk factor
• Colon cancer
• Diverticulitis
• Sigmoid volvulus
• Cecal volvulus
• Previous abdominal or pelvic radiation.
• Hernias.
• Twists in the bowel
 Diagnosis
• Abdominal x-ray and CT findings include abnormal
quantities of gas, fluid, or both in the intestines.
• Laboratory studies (ie, electrolyte studies and a
complete blood cell count) reveal a picture of
dehydration, loss of plasma volume, and possible
infection.
 Treatment
• Fluid replacement therapy
• Electrolyte correction
• Surgery
• Stent
• Medications
 Medical managment
• NG aspiration and decompression are instituted immediately.
• A colonsocopy may be performed to untwist.
• A cecostomy, in which a surgical opening is made into ceacum
may be performed in patient who are poor surgical risks and
urgently need relief from [Link] procedure provides an
outlet for releasing gas and a small amount of drainage.
• Rectal tube may be used to decompress an area that is lower
bowel.
• An ileoanal anastomosis may be performed if removal of the
entire large if neccessary.
Surgical management
• Resuscitation
• Operative intervention
• Exploratory laparotomy- frozen abdomen, no frank perforation.
• Abdominal washout
• Generous use of fibrin glue
• Drainage with large Jackson Pratt tubes
 Nursing managment
• Nasogastric tube is inserted for feeding.
• Provide liquid diet rich in protein and high caloric diet.
• Encourage patient and assisst in doing oral care.
• Monitor intake output chart.
• Assessing improvement (eg, return of normal bowel sounds, decreased
abdominal distention, subjective improvement in abdominal pain and
tenderness, passage of flatus or stool).
• Mantain nutritional status:
 Eat 6 to 8 small meals a day
 Only drink ½ cup (4 ounces) of liquids during each meal
 Include enough nutrients in your meals to help you heal.