General management of intestinal obstruction Arindam Roy Medical College Kolkat

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Arindam Roy Medical College Kolkat

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General management of intestinal obstruction Arindam Roy Medical College Kolkat

  1. 1. GENERAL MANAGEMENTOF INTESTINAL OBSTRUCTION - by ARINDAM ROY 8th semester
  2. 2. ALGORITHM FOR MANAGEMENT OFA CASE OF INTESTINAL OBSTRUCTION
  3. 3. LABORATORY INVESTIGATION• COMPLETE BLOOD COUNT -1. TLC2. HAEMATOCRIT VALUE• SERUM UREA AND CREATININE• SERUM ELECTROLYTES• LIVER FUNCTION TEST• SERUM AMYLASE
  4. 4. SUPPORTIVE TREATMENT 1. Nasogastric AspirationS• Non-vented Ryle’s tube• Vented Salem tube
  5. 5. Role of nasogastric aspiration• Reduce bowel distension• Improve pulmonary ventilation• Reduce risk of subsequent aspiration during induction of anesthesia and post extubation
  6. 6. 2. Fluid and electrolyte replacement• I.V. fluid - to correct the fluid loss• Electrolyte solution - to make up electrolyte deficiency mainly sodium loss• Hartmann’s solution or normal saline used• Volume required to be determined by clinical hematological and biochemical criteria
  7. 7. 3. Parenteral antibiotics• Broad spectrum antibiotics- Ampicillin, Gentamycin, Metronidazole, Cephalosporins• To correct bacterial infection• Mandatory for all patients undergoing small or large bowel resection
  8. 8. 4. Blood Transfusion• FFP or platelet transfusions• Often needed in critical patients
  9. 9. 5. ICU Critical Care• For systemic management of complications like ARDS, DIC, SIRS• If hypotension- Dopamine/Dobutamine
  10. 10. 6. Indwelling Catheter• Perurethral• To collect and measure 24 hours urine output• Intake and output chart is made
  11. 11. 7. CVP For Fluid And Monitoring• PCWP (pulmonary capillary wedge pressure) monitoring• Needed in haemodynamically unstable patients
  12. 12. 8. Clinical Follow UpIMPROVEMENT DETERIORATION• Conservative treatment • Surgery indicated if no is carried on. improvement occurs with in 24-48 hours

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