INTESTINAL
OBSTRUCTION
BY
ZAINAB ALIYU LAWAN
(RN,,BNSC,PGDE AND CRNA)
DEFINITION
Partial or complete blockage of the
intestinal lumen of the small or large
intestine causing an interruption in the
normal flow of intestinal contents along
the intestinal tract.
CLASSIFICATION
90%- Small bowel obstruction ileum
Large bowel obstruction sigmoid colon
EITHIOLOGY
This may be within the wall or lumen of
the intestine itself (Intrinsic) or
extrinsic
it may be classify as mechanical or
non mechanical
MECHANICAL CAUSES OF
INTESTINAL OBSTURCTION
1. Intussusceptions ( telescoping of one segment
of bowel into another)
2. Adhesion or Scar that form after surgery.
3. Tumor blocking the intestine
4. Gall stone (rare).
5. Impacted stool
6. Hernia
7. Congenital malformation such as atrexia or
stenosis.
8. Valvulus
9. Foreign body
NON MECHANICAL CAUSES OF
INTESTINAL OBSTURCTION
1. Neurological disturbances.
Paralytics illus or adynamic illus
Dynamic illus
2. Interrupted blood supply
Mesenteric thrombosis
Strangulation of blood vessels
secondary to incarcerated hernia
PATHOPHYTHIOLOGY
(SMALL BOWEL OBSTRUCTION)
Intestinal obstruction occur as result of tumor
or adhesion or any of the mechanical or non
mechanical cause which prevent descending
of intestinal content
Obstruction occurs resulting to accumulation
of the intestinal content (fluid or gas) above
the obstruction.
This result in abdominal distention and
retention of fluids which in turn reduces the
absorption of fluid and stimulates more
gastric secretion with increase distention.
CONT.
Pressure within the intestinal lumen increase causing
decrease venous and arterial capillary pressure.
This causes edema congestion necroses and
eventually rapture or perforation of the intestinal
wall with resultant peritonitis.
Reflux vomiting occurs due abdominal distention
which results in loss of hydrogen ion and potassium
from the stomach leading to reduction chloride and
potassium in blood and metabolic acidosis.
Dehydration and acidosis develop from loss of water
and Na
Hypo volamic shock occurs with chronic fluid loss.
CLINICAL
MANIFESTATION
The initial symptoms are usually:
Cramping pain that is wave in like colicky
Patient may pass blood or mucus but no fecal
material
Vomiting
Sign of dehydration become evidence e.g intense
thirst, drowsiness ,general malaise, and dry tongue
Distended abdomen ie the lower the obstruction the
more mark the abdominal distention.
If the obstruction continue uncorrected hypovalemic
shock from dehydration and loss of plasma volume.
DIAGNOSES
Through the presenting sign and
symptoms
Abdominal x ray
Ct scaning
Electrolyte studies
MRI reveal distended colon and side of
the obstructions
Complete blood cell count
MEDICAL MANAGEMENT
Decompression of the bowel through
NG tube
When the bowel is completely
obstructed the possibility of
strangulation warrant surgical
intervention but before the surgery Iv
fluid therapy is necessary to replace
the depleted H2O, Na, CL and K+.
SURGECAL
MANAGEMENT
Surgical management depends largely on
the cause of the obstruction.
If the cause is hernia or adhesion then the
surgical procedure involves repairing the
hernia or dividing the adhesion to which
the intestine attach.
In some instance the portion of the
affected intestine is being removed and
anastomoses is perform. However the
complexity of the procedure for intestinal
obstruction depends on the duration of
the obstruction and condition of the
NURSING MANAGEMENT
Maintain functioning of the NG tube
Assessing and measuring the NG tube output
Assessing for fluid and electrolyte imbalance
Monitoring nutritional status
Assessing the improvement of patient condition
(e.g. returning of the bowel sound, absent of
abdominal distention, subjective improvement of
abdominal pain tenderness and passage of flatus or
stool)
The nurse report the following:
i. Worsening of the abdominal pain or abdominal
distention
ii. Increase NG. Tube output.
iii. If the patient condition doesn’t improve the nurse
PATHOPHYSIOLOGY OF LARGE
BOWEL OBSTRUCTION
Same as lower colon obstruction
This result to severe abdominal
distention and perforation
Unless some gas and fluid can flow
back through iliac valve.
Dehydration occur more slowly in the
large bowel obstruction then in small
bowel obstruction.
CLINICAL
MANIFESTATION
L.B.O differ clinically from S.B.O in that
the symptoms develop and progress
relatively slowly
If the obstruction occurs in the sigmoid
colon and rectum constipation may be
the only symptom .
the shape of the stool is altered as its
passing the obstruction that is
gradually increasing in size
The patient may experience weakness loss
of weight and anorexia.
eventually the abdomen become markedly
distended
the loop of the large bowel become visibly
outline through the abdominal wall
the patient has cramping lower abdominal
pain
fecal vomiting develop
symptoms of shock may develop
DIAAGNOSES
Through the presenting sign and
symtoms
Abdominal X-ray
Abdominal CT
MRI reveal a distended colon and
pinpoint side of obstruction
MANAGEMENT OF L B O
MEDICAL MANAGEMENT
Same as S.B.O Management
SURGICAL MANAGEMENT
Colonoscopy.
NURSING MANAGEMENT
CONPLICATIONS OF INTESTINAL OBSTRUCTION
Severe dehydration
Perforation
Peritonitis
Shock
Intestinal gangrene
NURSING DIAGNOSES
Acute pain related to the condition/
intestinal obstruction
Deficient fluid volume related to vomiting
Imbalance nutrition related to the
obstruction to the flow of the intestinal
content
Anxiety related to the outcome of the
condition
Risk for complication
