INTESTINAL
OBSTRUCTION
Definition_
• Intestinal obstruction isn't a disease on it's own but occurs due to
some other factors. Intestinal obstruction is a partial or complete
blockage of the bowel that result in d failure of d intestinal contents
to pass through
Types of intestinal obstruction_
Mechanical Obstruction :
• May be caused by an occlusion of d lumen of intestinal tract from pressure on d intestinal
wall. Example includes : Intussusception, polypoid , hernias, volvulus, and abscess.
Functional Obstruction:
• The intestinal muscles cannot propel d contents along d bowel. Examples includes:
muscular dystrophy, amyloidosis, endocrine disorders such as Diabetes, neurologic
disorders such as Parkinson's disease
Vascular obstruction:
• When blood supply to a segment of bowel is cut off 2° to strangulated hernia or
atheromatous changes in blood vessels, ischemia is followed by infarction and gangrene.
Causes/ Risk factors
• Adhesions (2° to abdominal or pelvic surgeries)
• Crohn's disease
• Paralytic ileus( partial or complete loss of peristaltic activity)
• Volvulus (twisting of d intestine).
• Intussusception (Invagination or telescoping of d intestine)
• Diverticulitis
• Hernia(protrusion of an organ or part of an organ through a weak
aperture in d surrounding structures)
• Narrowing of d colon
Pathophysiology
• Blockage in d intestine secondary to mechanical, vascular or
neurological causes impairment of the passage of materials through
the bowel
• Blockage results in distention of d proximal intestine
• Necrosis and perforation of the bowel follows
• Activation of local and systemic inflammatory responses and
translocation of bacteria through the wall of the intestine.
Clinical features_
• Abdominal fullness (gas)
• Abdominal pain, cramping
• Breath odor
• Constipation
• Diarrhea
• Vomiting
• Absence of flatus
• Failure to pass stool in d case of paralytic ileus
• Fatigue
• Fever
Diagnostic Evaluations_
• A thorough history and physical examination.
• Abdominal X-rays or CT scan.
• Complete blood counts
• Serum electrolyte amylase
• Blood urea Nitrogen
• Barium enema
• Sigmoidoscopy/ Colonoscopy
• Ultrasonography
Medical Management_
• Treatment involve placing a naso gastric tube into d stomach to help
relieve abdominal distention.
• Before surgery, I.V infusions that contain normal saline and potassium shld
be given to maintain fluid and electrolyte imbalance.
• Sigmoidoscopy may reduce a sigmoid volvulus
• Colon decompression catheters may be passed through partially
obstructed areas via colonoscope to decompress the bowel before surgery.
• Analgesic and sedatives re prescribed. Opiates re avoided due to G.I
mobility inhibition.
• Antibiotics re prescribed to treat infections.
Nursing management
• History taking: Take a careful history to obtain info about current symptoms and
previous diseases.
• Observation: Look for signs of dehydration and monitor patient's vital signs and level
of responsiveness.
• Fluid and electrolyte monitoring: Maintain fluid and electrolyte by administering
prescribed I.V fluids and monitoring electrolyte, intake and output and Blood urea
Nitrogen
• NG tube placement: insert and NG tube to decompress d bowel as prescribed, attach
tube to low pressure intermittent suction
• Administration of Prescribed drugs: Administer prescribed analgesic and antibiotics.
• Physical care: Assist patient with oral care, so as to make d oral mucous membrane
moist
Cont…
• Physiological care: maintain nil per oral as prescribed, and prepare
patient for surgery if indicated.
• Psychological care: Reassure d patient and allay patient anxiety.
• Health teachings on discharge:
• Advice patient to avoid carbonated beverages
• Increase dietary fiber
• Decrease emotional stress
• Demonstrate Ostomy care ,including cleaning if colostomy is done.
• High standard of personal hygiene at home and environmental sanitation.
