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INTESTINAL
OBSTRUCTION
Amina Al-Qaysi1
DEFINITION
Interruption of
normal passage
of intestinal
contents.
CLASSIFICATION
1 –Mechanical ( dynamic) :
Bowel capable of contracting normally or
excessively proximal to a local site of...
CAUSES
4
 Dynamic:
1. Intraluminal:
Impaction
Foreign body
Bezoars
Gallstones
2. Intramural :
stricture
Malignancy
3. Ext...
Common causes of mechanical small bowel
obstruction:
1. Adhesions and bands following abdominal surgery
2. External hernia...
Common causes of mechanical large
bowel obstruction
1. Large bowel cancer.
2. Sigmoid diverticular disease.
3. Sigmoid vol...
7
8
9
Common causes of non-mechanical small-bowel
obstruction
1 – Paralytic ileus after abdominal surgery
2 – Localized intra ab...
Common cause of non-mechanical large
bowel obstruction:
1 – Retroperitoneal hematoma following lumber
fracture or lumber s...
COMMON CAUSES SBO
60%20%
10%
5%
5%
Adhesions
Neoplasms
Hernias
Crohns
Miscellaneous
PATHOPHYSIOLOGY
 Dilation proximal to obstruction (gas & fluid)
 Hyper-peristalsis
 Flaccidity & paralysis
 Dehydratio...
MECHANICAL OBSTRUCTION:
Three main types:
1 -Simple
2 – Closed-loop
3 - Strangulation
14
1 -SIMPLE OBSTRUCTION
 The bowel is usually occluded at one
level.
15
2 - CLOSED LOOP OBSTRUCTION
 Bowel obstructed at both proximal & distal
points
 There is rapid increase in the intra lum...
3 – STRANGULATION
 This is the end result a closed loop
obstruction when major arterial supply to the
affected bowel has ...
Mechanical obstruction
 Following questions must be answered:
1 – Is it obstruction and if so at what level ?
2 – Is stra...
1 – Is it obstruction, and if so, at what
level ?
 The question is answered by considering the
clinical features.
Symptom...
Symptoms
The cardinal
features of bowel
obstruction are,
1. Pain
2. Vomiting
3. Constipation
4. Distension 20
Pain
 Sudden, severe
 Colicky in nature
 Central , around umbilicus in small bowel
obstruction
 Lower abdomen in large...
Vomiting
 Early in high small bowel obstruction,
 Late in low small bowel obstruction ,
 Delayed or absent in large bow...
Constipation
 Early in large bowel obstruction
 Absolute in complete obstruction
23
Distension
 Epigastric or hypogastric in small bowel
obstruction
 Generalized in large bowel obstruction
24
Local signs in the abdomen are:
 Inspection:
 Scar
 Distension, central in small bowel obstruction and
peripheral in la...
 Palpation:
 Abdominal mass may suggest carcinoma or
strangulated bowel.
 Rigidity and rebound tenderness , indicates i...
 Percussion:
 Resonance because of gas filled bowel
 Tenderness on percussion indicates the presence of
peritonitis.
27
 Auscultation:
 Bowel sounds
 Tympani
 Metallic clicks as pressure is raised if much gas is
present in the bowel.
 Gu...
 On rectal examination:
 Impacted feces
 Rectal cancer
 Blood on finger which maybe present with mesenteric
artery occ...
2 – Is strangulation present ?
 Fever
 Tachycardia,
 Leukocytosis
 Constant pain
 Rebound Tenderness & rigidity
 Sho...
3 – Is Dehydration present ?
 Tachycardia
 Hypotension
 Dry skin
 Dry mouth
 Poor skin turgor
 Small volume concentr...
4 - What is the cause?
1 - Previous abdominal surgery and features of small
bowel obstructions suggest adhesions, The atta...
 Laboratory Examination
1. Complete blood count (WBC)
2. Serum electrolytes and amylase determination
3. Arterial blood g...
INVESTIGATIONS
 Radiologic Examination
1. Sigmoidoscopy (Carcinoma, Sigmoid Volvulus,
Inflammatory stricture)
2. Plain X-...
35
5 – Management
Non operative :
• Simple obstruction, No strangulation .
• Gastrointestinal decompression: NG tube
• IV fl...
Intestinal obstruction
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Intestinal obstruction

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Intestinal obstruction

  1. 1. INTESTINAL OBSTRUCTION Amina Al-Qaysi1
  2. 2. DEFINITION Interruption of normal passage of intestinal contents.
  3. 3. CLASSIFICATION 1 –Mechanical ( dynamic) : Bowel capable of contracting normally or excessively proximal to a local site of obstruction. 2 – Non-Mechanical (adynamic): Peristalsis maybe absent (paralytic ileus), OR present in non-propelsive form (mesenteric vascular occlusion, pseudo-obstruction). 3
  4. 4. CAUSES 4  Dynamic: 1. Intraluminal: Impaction Foreign body Bezoars Gallstones 2. Intramural : stricture Malignancy 3. Extramural: Bands/adhesions Hernia Volvulus Intessusception  Adynamic Paralytic ileus Mesenteric vascular occlusion Pseudo-obstruction
  5. 5. Common causes of mechanical small bowel obstruction: 1. Adhesions and bands following abdominal surgery 2. External hernia 3. Intussusceptions 4. Volvulus 5. Neoplasm (benign or malignant). 6. Obstruction : worms 7. Stricture: IBD 5
  6. 6. Common causes of mechanical large bowel obstruction 1. Large bowel cancer. 2. Sigmoid diverticular disease. 3. Sigmoid volvulus. 6
  7. 7. 7
  8. 8. 8
  9. 9. 9
  10. 10. Common causes of non-mechanical small-bowel obstruction 1 – Paralytic ileus after abdominal surgery 2 – Localized intra abdominal abscess or generalized peritonitis 3 – Mesenteric embolism or thrombosis with small bowel infarction 4 – Intestinal pseudo-obstruction 10
  11. 11. Common cause of non-mechanical large bowel obstruction: 1 – Retroperitoneal hematoma following lumber fracture or lumber surgery 2 – Idiopathic 11
  12. 12. COMMON CAUSES SBO 60%20% 10% 5% 5% Adhesions Neoplasms Hernias Crohns Miscellaneous
  13. 13. PATHOPHYSIOLOGY  Dilation proximal to obstruction (gas & fluid)  Hyper-peristalsis  Flaccidity & paralysis  Dehydration due to : 1. Reduced oral intake 2. Defective intestinal absorption 3. Vomiting 4. Sequestration in bowel lumen
  14. 14. MECHANICAL OBSTRUCTION: Three main types: 1 -Simple 2 – Closed-loop 3 - Strangulation 14
  15. 15. 1 -SIMPLE OBSTRUCTION  The bowel is usually occluded at one level. 15
  16. 16. 2 - CLOSED LOOP OBSTRUCTION  Bowel obstructed at both proximal & distal points  There is rapid increase in the intra luminal tension, Gangrene or perforation can occur more quickly, peritonitis.  Example: Colonic obstruction with competent ileocaecal valve
  17. 17. 3 – STRANGULATION  This is the end result a closed loop obstruction when major arterial supply to the affected bowel has been occluded , causing gangrene over a considerable area.
  18. 18. Mechanical obstruction  Following questions must be answered: 1 – Is it obstruction and if so at what level ? 2 – Is strangulation present ? 3 – Is dehydration present ? 4 – What is the cause ? 5 - What is the treatment for the individual case ? 18
  19. 19. 1 – Is it obstruction, and if so, at what level ?  The question is answered by considering the clinical features. Symptoms Signs 19
  20. 20. Symptoms The cardinal features of bowel obstruction are, 1. Pain 2. Vomiting 3. Constipation 4. Distension 20
  21. 21. Pain  Sudden, severe  Colicky in nature  Central , around umbilicus in small bowel obstruction  Lower abdomen in large bowel obstruction  Continuous if perforation or strangulation is present  Absent in paralytic ileus. 21
  22. 22. Vomiting  Early in high small bowel obstruction,  Late in low small bowel obstruction ,  Delayed or absent in large bowel obstruction.  Character : initially clear ,becomes discolored , and finally feculent (dark and foul smiling). 22
  23. 23. Constipation  Early in large bowel obstruction  Absolute in complete obstruction 23
  24. 24. Distension  Epigastric or hypogastric in small bowel obstruction  Generalized in large bowel obstruction 24
  25. 25. Local signs in the abdomen are:  Inspection:  Scar  Distension, central in small bowel obstruction and peripheral in large bowel obstruction  Visible peristalsis 25 SIGNS
  26. 26.  Palpation:  Abdominal mass may suggest carcinoma or strangulated bowel.  Rigidity and rebound tenderness , indicates ischemia & peritoneal irritation. 26
  27. 27.  Percussion:  Resonance because of gas filled bowel  Tenderness on percussion indicates the presence of peritonitis. 27
  28. 28.  Auscultation:  Bowel sounds  Tympani  Metallic clicks as pressure is raised if much gas is present in the bowel.  Gurgling borborygmi if gas and fluid are present in the bowel.  Silence if generalized peritonitis or paralytic ileus is present. 28
  29. 29.  On rectal examination:  Impacted feces  Rectal cancer  Blood on finger which maybe present with mesenteric artery occlusions, intussusception or Volvulus. 29
  30. 30. 2 – Is strangulation present ?  Fever  Tachycardia,  Leukocytosis  Constant pain  Rebound Tenderness & rigidity  Shock 30
  31. 31. 3 – Is Dehydration present ?  Tachycardia  Hypotension  Dry skin  Dry mouth  Poor skin turgor  Small volume concentrated urine. 31
  32. 32. 4 - What is the cause? 1 - Previous abdominal surgery and features of small bowel obstructions suggest adhesions, The attacks may have been recurrent 2 - Large bowel obstruction and history of constipation with intermittent mucous or bloody diarrhea suggest carcinoma of the colon 3 – No previous operations and symptoms of small bowel obstruction suggest obstructed hernia or an uncommon cause such as congenital band, internal hernia or mesenteric occlusion. 32
  33. 33.  Laboratory Examination 1. Complete blood count (WBC) 2. Serum electrolytes and amylase determination 3. Arterial blood gas analysis INVESTIGATIONS
  34. 34. INVESTIGATIONS  Radiologic Examination 1. Sigmoidoscopy (Carcinoma, Sigmoid Volvulus, Inflammatory stricture) 2. Plain X-ray of the abdomen, erect 3. Single- contrast water-soluble enema study 4. CT Scan 34
  35. 35. 35
  36. 36. 5 – Management Non operative : • Simple obstruction, No strangulation . • Gastrointestinal decompression: NG tube • IV fluid • Antibiotics  Operative: • Usually surgery • Replace fluid before surgery 36

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