1. INTESTINAL OBSTRUCTION

2. Intestinal obstruction is a complete or partial disturbance of intestinal evacuation and peristalsis resulting from various causes which manifests by specific clinical course and morphologic changes of involved part of the bowel Intestinal obstruction occurs approximately in 9.4 % among urgent abdominal pathology, consisting 1.2 % of all surgical diseases.

3. Classification (by D.P.Chuhrienko) 1. Dynamic intestinal obstruction: a) paralytic; b) spastic. 2. Mechanical intestinal obstruction: a) strangulation; b) obturation; c) mixed (invagination). II. According to the course of pathological process. 1. Stage of acute disturbance of intestinal evacuation and peristalsis. 2. Stage of hemodynamic disorders of the bowel wall and its mesentery. 3. Stage of peritonitis.

5. Pathogenesis More higher the obstruction, more severe the pathologic changes Transudation of intestinal juice Vomiting Intestinal block Accumulation of intestinal contents Distention of intestinal wall Loss of electrolytes, dehydratation, loss of potassium, loss of proteins Necrosis of the bowel Peritonitis Intoxication, hemodynamic disturbances

6. Pathogenesis

8. Clinical manifestation It depends on the level of the block, type and degree of obstruction and its cause. 1. Acute onset of the disease. 2. Periodic acute diffuse pain of wavelike character which results in shock. 3. Constant vomiting and nausea without any relief. 4. Signs of dehydratation and intoxication (The patient looks anxious, with drawn features, hollowed-eyed, his lips and tongue are dry, with brown fur) . 5. Retention of stool and gases.

9. Objective examination 1. Signs of shock. 2. Distended and asymmetric abdomen. 3. Splashing sound (Sklyarov’s sign). 4. Increased peristalsis in early period with further absence. 5. Wahl’s sign - high tympanic sound over the distended bowel. 6. PR: empty and distended anus and rectal ampoule - (Grekov’s sign). 7. In intestinal strangulation and advanced cases of obstruction - peritoneal signs.

10. X-ray examination 1. Kloiber's cups (air-fluid level) 2. Intestinal pneumatisation

21. Volvulus (torsion) Small intestine volvulus Clinically manifests by high strangulation intestinal obstruction Cecal volvulus, sigmoid volvulus Clinically: low strangulation intestinal obstruction asymmetric abdomen by palpation enlarged and displaced colon (like balloon) retracted right or left iliac region Treatment: detorsion, division of adhesions, cecopexia, colon resection

28. Treatment of dynamic ileus 1. Cholynomymetics (Proserin, ubretid). 2. Intravenous infusion of hypertonic solution (10 % NaCl). 3. Hypertonic enema. 4. Oil enema. 5. Gastric decompression. 6. Paranephral novocaine block. 7. Ultrasound stimulation.