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small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
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small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
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small intestine diseases 2
small intestine diseases 2
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small intestine diseases 2
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small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
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small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
small intestine diseases 2
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small intestine diseases 2

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  • 1. Intestinal Obstruction 肠梗阻
  • 2. Defination <ul><li>A blockade of the flow of intestinal content. </li></ul>
  • 3. Etiology and classification 1. According to its basic causes: mechanical obstruction dynamic obstruction obstruction of vascular supply origin
  • 4. 2. According to whether the vascular supply to intestinal wall is compromised, Simple and strangulation obstruction .
  • 5. 3. According to obstruction level or site . high and low obstruction 4. According to the extent of obstruction Incomplete and complete obstruction, 5. According to mode of onset and progression of obstruction. Acute and chronic obstruction
  • 6. <ul><li>6. Open-loop Obstruction: </li></ul><ul><li>Closed-loop Obstruction: </li></ul>
  • 7. Pathophysiology A.Local Effects <ul><li>Intestinal gas increases </li></ul><ul><li>Intestinal fluid accumulates </li></ul><ul><li>Intestinal flora is abnormal </li></ul><ul><li>Intestinal motility (peristalsis) is abnormal </li></ul>
  • 8. B. Systemic Effects <ul><li>Water and electrolyte losing </li></ul><ul><li>Gut original endotoxemia </li></ul><ul><li>Cardiopumonary dysfunction </li></ul><ul><li>Shock and other organs insufficiency </li></ul>
  • 9. Clinical manifestations Abdominal pain Nausea and vomiting Obstipation Abdominal distention.
  • 10. Physical Examination the signs of dehydration: Vital Signs:
  • 11. <ul><li>a.Inspection: </li></ul><ul><li>visible peristalsis </li></ul><ul><li>distending gut </li></ul><ul><li>incisions of previous surgery </li></ul>
  • 12. <ul><li>b.Palpation: </li></ul><ul><ul><li>Localized tenderness </li></ul></ul><ul><ul><li>Signs of localized or generalized peritonitis: referred tenderness </li></ul></ul><ul><ul><li>muscle spasm </li></ul></ul><ul><ul><li>the mass in abdominal cavity </li></ul></ul>
  • 13. <ul><li>c.Percussion: </li></ul><ul><ul><li>Tympanic resonance </li></ul></ul><ul><ul><li>Shifting dullness demonstrates ascites. </li></ul></ul>
  • 14. <ul><li>d.Auscultation: </li></ul><ul><li>Bowel sounds increased </li></ul><ul><li>Intestinal sound is absent </li></ul>
  • 15. Laboratory Study <ul><li>Hemoconcentration </li></ul><ul><li>Leukocyte counts </li></ul><ul><li>Water and electrolyte imbalance </li></ul><ul><li>Acid-base imbalance </li></ul>
  • 16. Radiological Examination <ul><li>A plain abdominal film </li></ul><ul><ul><li>dilated loops of small intestine </li></ul></ul><ul><ul><li>multiple air-fluid level </li></ul></ul><ul><li>Computed tomography </li></ul>
  • 17. &nbsp;
  • 18. Endoscopy <ul><li>Early ileal carcinoma demonstrating submucosal invasion </li></ul>
  • 19. <ul><li>disposable capsule: 30 x 11 mm </li></ul>Capsule endoscopy
  • 20. Capsule endoscopy <ul><li>provide more than five hours of real-color images </li></ul><ul><li>The data is later downloaded to a computer workstation and processed to produce a 20-minute video clip of the images transmitted by the capsule </li></ul>
  • 21. Capsule endoscocpy : normal findings
  • 22. Capsule endoscopy angiodysplasia, jejunum bleeding angiodysplasia, ileum
  • 23. Diagnosis must make clear the following questions: 1. Whether intestinal obstruction exists: Through symptoms and signs, the diagnosis can be made without difficulty. Abdominal Radiology is much helpful in diagnosis.
  • 24. 2. Whether the obstruction is mechanical or dynamic : mechanical obstruction, typical symptoms and signs. paralytic obstruction, cramping abdominal pain is absent, distention is prominent
  • 25. 3. Whether the obstruction is simple or strangulation obstruction: Indications for strangulation: a. Developing continuous violently rather than intermittent pain b. Crisis rapidly and presence of toxemia (elevated temperature and leukocyte count), shock and rapid pulse c. Obvious peritoneal irritation d. A palpable tender abdominal mass with asymmetric distention
  • 26. <ul><li>e. Bloody gastrointestinal contents </li></ul><ul><li>f. Single distending gut loop or pseudo-neoplasm sign on plain abdominal film </li></ul><ul><li>g. A large amount of bloody ascites </li></ul><ul><li>h. No relieving evidence to intensive nonoperative treatment </li></ul>
  • 27. 4. Whether the obstruction is high or low: Vomiting, in proximal intestinal obstruction. Distention in low obstruction Abdominal radiography is helpful. 5. Whether the obstruction is complete or incomplete: frequency of vomiting, extent of distention, and radiography.
  • 28. 6.Which causes leads to obstruction : According to the age, history, symptoms and signs, radiography. Postoperative adhesions, Postinflammatory origin Henias Congenital malformations Intestinal intussusception Obstruction of parasite origin Carcinomas and dry feces.
  • 29. Treatment <ul><li>Principles: </li></ul><ul><ul><li>Correcting of fluid and electrolytes imbalance and acid-base disturbance </li></ul></ul><ul><ul><li>Relief of intestinal distention, and removing the cause of obstruction </li></ul></ul>
  • 30. A. Basic Treatment <ul><li>Fluid and electrolytes replacement </li></ul><ul><ul><li>Volume restoration: colloid liquid </li></ul></ul><ul><ul><li>Acidosis correction: sodium bicarbonate or sodium lactate </li></ul></ul><ul><ul><li>Potassium deficit </li></ul></ul>
  • 31. <ul><li>Gastrointestinal decompression </li></ul><ul><ul><li>Intubation with gastrointestinal tube (gastrointestinal tube suction) is the important step in the management of obstruction. </li></ul></ul>
  • 32. <ul><li>Antibiotics </li></ul><ul><ul><li>Antibiotic treatment plays an important role in the management of obstruction. </li></ul></ul><ul><ul><li>Antibiotic would be given in any type of obstruction </li></ul></ul><ul><ul><li>The principle is giving the broad spectrum (aerobic and anaerobic) with large dose and short course and taking the less cost </li></ul></ul>
  • 33. <ul><li>Symptomatic treatment </li></ul><ul><ul><li>giving tranquilizer </li></ul></ul><ul><ul><li>Antispasmodic </li></ul></ul><ul><ul><li>Sedative </li></ul></ul>
  • 34. &nbsp;
  • 35. B.Nonoperative Treatment <ul><li>Indications: </li></ul><ul><ul><li>Nonstrangulated adhesive obstruction </li></ul></ul><ul><ul><li>Obturative obstruction resulting of ascariasis and constipation </li></ul></ul><ul><ul><li>Incomplete obstruction </li></ul></ul><ul><ul><li>Intussusception in child </li></ul></ul><ul><ul><li>Inguinal hernia </li></ul></ul>
  • 36. <ul><li>Methods: </li></ul><ul><ul><li>a. Emollient: paraffin oil </li></ul></ul><ul><ul><li>b. Enema: suds </li></ul></ul><ul><ul><li>c. Traditional Chinese Herb intake </li></ul></ul><ul><ul><li>d. Acupuncture </li></ul></ul><ul><ul><li>e. Physical treatment </li></ul></ul>
  • 37. <ul><li>close observation is very important. </li></ul><ul><li>worsed, transferred to surgical intervention. </li></ul>
  • 38. C. Surgical Treatment <ul><li>Indication: </li></ul><ul><ul><li>strangulated obstruction </li></ul></ul><ul><ul><li>closed-loop obstruction </li></ul></ul><ul><ul><li>simple obstruction without respond to nonoperation more than 96 hours </li></ul></ul>
  • 39. <ul><li>The surgical procedures includes: 1)Lysis of adhesion, reduction of intussusception, torsion. 2)Enterectomy and anastomosis. 3)Bypass procedure for nonresectable lesions. 4)Enterostomy </li></ul><ul><li>Treatment of obstructing carcinoma colon </li></ul>
  • 40. 1). Lysis of adhesion
  • 41. reduction of torsion
  • 42. 2)Enterectomy and 3)Bypass procedure for anastomosis. nonresectable lesions.
  • 43. 4)Enterostomy
  • 44. <ul><li>Postoperative care: </li></ul><ul><ul><li>Gastrointestinal decompression </li></ul></ul><ul><ul><li>Electrolyte management </li></ul></ul><ul><ul><li>Nutrition support </li></ul></ul><ul><ul><li>Antibiotics </li></ul></ul>
  • 45. &nbsp;
  • 46. The Common Types Of Intestinal Obstruction
  • 47. Peritoneal Adhesions and Bands----Adhesive Obstruction
  • 48. Etiology <ul><li>Previous laparotomy </li></ul><ul><li>Abdominal inflammatory </li></ul><ul><li>Trauma </li></ul><ul><li>Congenital diseases </li></ul>
  • 49. Pathology <ul><li>strangulated easily by band formation </li></ul>
  • 50. Classification <ul><li>diffuse adhesion </li></ul><ul><li>adhesion angulation </li></ul><ul><li>band compression </li></ul><ul><li>internal hernia </li></ul>
  • 51. 1. band compression 2. adhesion angulation
  • 52. Diagnosis <ul><li>intestinal obstruction </li></ul><ul><li>previous laparotomy </li></ul><ul><li>abdominal infection </li></ul><ul><li>trauma </li></ul>
  • 53. Prophylaxis <ul><li>avoiding any unnecessary trauma, strangulation of tissue, contamination, and foreign body such as excessive suture. modifying the propensity of patient </li></ul>
  • 54. Treatment <ul><li>nonoperative: </li></ul><ul><ul><li>nasogastric intubation </li></ul></ul><ul><ul><li>emollient filling stomach </li></ul></ul><ul><ul><li>enema with traditional Chinese herb </li></ul></ul>
  • 55. <ul><li>operative: </li></ul><ul><ul><li>lysis of adhesions or bands </li></ul></ul><ul><ul><li>enterectomy for strangulated intestinal loop or adhesive loop mass </li></ul></ul><ul><ul><li>bypass anastomosis for difficult situation or critical case </li></ul></ul><ul><ul><li>placation for recurrent case </li></ul></ul>
  • 56. Placation for recurrent case
  • 57. &nbsp;
  • 58. Volvulus <ul><li>Definition: It is a twisting or rotation of the bowel upon its mesentery and induces strangulation when it twist more than 180°with a high mortality. </li></ul>
  • 59. Etiology <ul><li>too long mesentery </li></ul><ul><li>too heavy intestinal contents </li></ul><ul><li>Malrotation </li></ul><ul><li>adhesion </li></ul>
  • 60. Pathology <ul><li>Rotation around the mesenteric axis closed-loop obstruction </li></ul>
  • 61. Classification <ul><li>sigmoid colon volvulus in the elder with constipation </li></ul><ul><li>small bowel volvulus in the younger with strenuous exercises after full dinner </li></ul>
  • 62. small bowel volvulus sigmoid colon volvulus
  • 63. Clinical Features <ul><li>sudden severe abdominal pain </li></ul><ul><li>Others like SBO </li></ul>
  • 64. Diagnosis <ul><li>sigmoid colon volvulus: indentation (bird beak sign) while enema </li></ul><ul><li>small bowel volvulus: shock in early stage and difficulty to differentiate from other types until laparotomy </li></ul>
  • 65. Volvulus of sigmoid colon <ul><li>The coffee bean sign . </li></ul><ul><li>The greatly dilated sigmoid almost fills the entire abdomen. </li></ul>
  • 66. Volvulus of sigmoid colon <ul><li>The bird sign </li></ul>
  • 67. Treatment <ul><li>fiber colonoscopic reduction for the early stage of the sigmoid vulvulus and then rectal tube fixed in place for 2-3 days </li></ul><ul><li>surgical intervention immediately in small bowel volvulus and most of sigmoid vulvulus: </li></ul><ul><ul><li>reduction for nonstrangulation situation </li></ul></ul><ul><ul><li>Resection the gangrenous bowel (short bowel syndrome, sigmoid colostomy) </li></ul></ul>
  • 68. &nbsp;
  • 69. Intussusception <ul><li>Definition: It is the invagination of a part of the intestinal tract into the lumen of the adjacent intestine. </li></ul>
  • 70. &nbsp;
  • 71. Etiology <ul><li>Irregular peristalsis in child less than 2 years old </li></ul><ul><li>Intestinal neoplasm and abdominal inflammatory causing chronic recurrent intussusceptions </li></ul>
  • 72. Classification <ul><li>small intestine to small intestine </li></ul><ul><li>colon to colon </li></ul><ul><li>ileocecal intussusception (Dance sign: empty in right low quadrant) </li></ul>
  • 73. small intestine to small intestine ileocecal intussusception Ileum, cecum to colon colon to colon
  • 74. Clinical Features <ul><li>abdominal pain </li></ul><ul><li>abdominal mass </li></ul><ul><li>melena (currant jelly stool) </li></ul>
  • 75. Diagnosis <ul><li>colonic intussesception shows the glass sign while the enema </li></ul>
  • 76. barium enema Intussusception
  • 77. <ul><li>A 47-year-old man presenting with features of small-bowel obstruction. </li></ul><ul><li>Image shows a coiled-spring appearance in the region of the cecum suggestive of an intussusception. </li></ul><ul><li>At laparotomy, an ileocecal intussusception was found in association with a carcinoid tumor of the terminal ileum. </li></ul>
  • 78. <ul><li>A complex mass of concentric rings of alternating low- and high-attenuating layers surrounding a very high attenuation center due to intraluminal Gastrografin. </li></ul><ul><li>At laparotomy, a chronic jejunojejunal intussusception was found. </li></ul>
  • 79. Computed tomography <ul><li>Anatomic segment involved </li></ul><ul><li>Tumor mass as lead point </li></ul><ul><li>Three concentric circles indicating segment of bowel invaginated into another </li></ul>
  • 80. Treatment <ul><li>enema reduction for children and some early stage cases: </li></ul><ul><ul><li>barium enema with hydrostatic pressure </li></ul></ul><ul><ul><li>or air enema with high-pressure </li></ul></ul>
  • 81. <ul><li>surgical intervention for adult patients, the failure of enema reduction, and the case with peritonitis: </li></ul><ul><ul><li>reduction for nonstrangulation situation </li></ul></ul><ul><ul><li>resection the gangrenous bowel (short bowel syndrome, colostomy) </li></ul></ul><ul><ul><li>remove the cause in adult </li></ul></ul>
  • 82. &nbsp;
  • 83. &nbsp;
  • 84. Obturation <ul><li>Definition: It refers to intestinal lumen blockage by an intraluminal foreign body. </li></ul>
  • 85. Etiology <ul><li>impacted feces </li></ul><ul><li>Gallstone </li></ul><ul><li>Gutstone </li></ul><ul><li>Group of ascarids </li></ul><ul><li>foreign body </li></ul>
  • 86. Pathology <ul><li>simple mechanical obstruction </li></ul>
  • 87. Clinical Features <ul><li>severe abdominal pain and abdominal tender mass </li></ul>
  • 88. Diagnosis <ul><li>the differentiation between symptom and sign by different causes </li></ul>
  • 89. <ul><li>A case of ascariasis in the small intestine found by barium meal examination </li></ul>
  • 90. Ascarids in small intestine
  • 91. obstruction caused by ascarids
  • 92. Treatment <ul><li>symptomatic management </li></ul><ul><li>oxygen filling to stomach (100 ml/years old, total &lt;1500 ml) for ascarids </li></ul><ul><li>paraffin filling to stomach or enema for bezoar (stone in stomach) </li></ul><ul><li>laparotomy for broken of obstructive mass, enterotomy for obstructive body </li></ul>
  • 93. &nbsp;
  • 94. Other disese in small intestine
  • 95. tumor in small intestine
  • 96. trauma of small intestine
  • 97. &nbsp;
  • 98. &nbsp;
  • 99. small intestine diverticulum
  • 100. small intestine diverticulum and perforation
  • 101. Aneurysm type B-cell lymphoma of the jejunum with remarkable wall thickening
  • 102. A case of a metastatic jejunal tumor originating from pulmonary giant cell carcinoma in a patient whose chief complaint was melena.
  • 103. Discussion
  • 104. CASE HISTORY <ul><li>A 47-year-old male is admitted to the emergency room with a 36- hour history of lower abdominal pain, nausea, and vomiting. The patient describes the pain as crampy in nature and notes that his abdomen has become distended over the last 12 hours. His last bowel movement was three days prior to presentation. </li></ul>
  • 105. <ul><li>His past medical history is remarkable in that he underwent an appendectomy for acute appendicitis eight months ago. He is otherwise healthy and takes no medications. </li></ul>
  • 106. <ul><li>Physical exam reveals a temperature of 38℃. His abdomen is distended. </li></ul><ul><li>There is mild tenderness periumbilically but no guarding or rebound. High-pitched bowel sounds are present and rectal exam reveals no stool in the rectum. </li></ul>
  • 107. Admitting laboratory date <ul><li>A hemoglobin of 16, hematocrit 48, white blood cell count 12,200 with 74 polys. </li></ul><ul><li>Serum electrolytes are normal </li></ul><ul><li>An abdominal X-RAY reveals multiple dilated loops of small bowel with numerous air fluid levels. There is no gas or stool visible in the colon </li></ul>
  • 108. Symptoms of the patients <ul><li>Pain </li></ul><ul><li>Vomiting </li></ul><ul><li>Obstipation </li></ul><ul><li>Abdominal distention </li></ul>
  • 109. Signs of the patients <ul><li>Vital Signs: </li></ul><ul><ul><li>temperature of 38℃ </li></ul></ul><ul><li>His abdomen is distended. </li></ul><ul><li>Mild tenderness periumbilically but no guarding or rebound. </li></ul><ul><li>High-pitched bowel sounds </li></ul><ul><li>Rectal exam reveals no stool in the rectum </li></ul>
  • 110. Laboratory Study <ul><li>A hemoglobin of 16, hematocrit 48, show hemoconcentration </li></ul><ul><li>White blood cell count 12,200 with 74 polys and 5 bands, show inflammation. </li></ul><ul><li>Serum electrolytes are normal </li></ul>
  • 111. Radiography exam <ul><li>An abdominal X-RAY reveals multiple dilated loops of small bowel with numerous air fluid levels. There is no gas or stool visible in the colon </li></ul><ul><li>To confirm the diagnosis </li></ul>
  • 112. Diagnosis <ul><li>Intestinal obstuction </li></ul>
  • 113. Whether the obstruction is mechanical or dynamic : the crampy abdominal pain and high-pitched bowel sounds
  • 114. Whether the obstruction is simple or strangulation obstruction: Indications for strangulation: a. Developing continuous violently rather than intermittent pain b. Crisis rapidly and presence of toxemia (elevated temperature and leukocyte count), shock and rapid pulse c. Obvious peritoneal irritation d. A palpable tender abdominal mass with asymmetric distention
  • 115. <ul><li>e. Bloody gastrointestinal contents </li></ul><ul><li>f. Single distending gut loop or pseudo-neoplasm sign on plain abdominal film </li></ul><ul><li>g. A large amount of bloody ascites </li></ul><ul><li>h. No relieving evidence to intensive nonoperative treatment </li></ul>
  • 116. Whether the obstruction is complete or incomplete: complete
  • 117. Postoperative adhesions, Postinflammatory origin Henias Congenital malformations Intestinal intussusception Obstruction of parasite origin Carcinomas and dry feces. Which causes leads to obstruction : His past medical history is remarkable in that he underwent an appendectomy for acute appendicitis eight months ago.
  • 118. <ul><li>Adhesive obstruction: diagnosis based on not finding any other cause of obstruction </li></ul><ul><li>Obstruction due to carcinomatosis: mass or bowel wall thickening along serosa of bowel at the transition zone </li></ul><ul><li>Crohn&apos;s disease: inflammatory mesenteric mass or discrete loculated fluid collection </li></ul><ul><li>Sigmoid volvulus: whirl sign </li></ul>
  • 119. <ul><li>Acute cholecystitis: enlarged thick walled gallbladder </li></ul><ul><li>Pancreatitis: swelling and fluid around pancreas </li></ul><ul><li>Mesenteric ischemia: thickened bowel wall, focal dilatation, pneumatosis </li></ul><ul><li>Acute appendicitis: inflammatory changes in fat around appendix </li></ul>
  • 120. Treatment <ul><li>Nonoperative Treatment </li></ul><ul><ul><li>Correcting of fluid and electrolytes imbalance and acid-base disturbance </li></ul></ul><ul><ul><li>Gastrointestinal decompression </li></ul></ul><ul><ul><li>Antibiotics </li></ul></ul><ul><ul><li>Symptomatic treatment </li></ul></ul>
  • 121. <ul><li>By close observation </li></ul><ul><li>Exacerbated, transferred to surgical intervention. </li></ul>
  • 122. <ul><li>Surgical treatment: if doubt strangulated obstruction </li></ul><ul><ul><li>Lysis of adhesion </li></ul></ul><ul><ul><li>Enterectomy and anastomosis </li></ul></ul>
  • 123. Conclusion
  • 124. Diagnosis must make clear the following questions: 1. Whether intestinal obstruction exists 2. Whether the obstruction is mechanical or dynamic
  • 125. 3. Whether the obstruction is simple or strangulation obstruction: Indications for strangulation: a. Developing continuous violently rather than intermittent pain b. Crisis rapidly and presence of toxemia (elevated temperature and leukocyte count), shock and rapid pulse c. Obvious peritoneal irritation d. A palpable tender abdominal mass with asymmetric distention
  • 126. <ul><li>e. Bloody gastrointestinal contents </li></ul><ul><li>f. Single distending gut loop or pseudo-neoplasm sign on plain abdominal film </li></ul><ul><li>g. A large amount of bloody ascites </li></ul><ul><li>h. No relieving evidence to intensive nonoperative treatment </li></ul>
  • 127. 4. Whether the obstruction is high or low 5. Whether the obstruction is complete or incomplete 6. Which causes leads to obstruction
  • 128. Treatment Basic Treatment <ul><li>Fluid and electrolytes replacement </li></ul><ul><li>Gastrointestinal decompression </li></ul><ul><li>Antibiotics </li></ul><ul><li>Symptomatic treatment </li></ul>
  • 129. Surgical Treatment <ul><li>Indication: </li></ul><ul><ul><li>strangulated obstruction </li></ul></ul><ul><ul><li>closed-loop obstruction </li></ul></ul><ul><ul><li>simple obstruction without respond to nonoperation more than 96 hours </li></ul></ul>
  • 130. <ul><li>The surgical procedures includes: 1)Lysis of adhesion, reduction of intussusception, torsion. 2)Enterectomy and anastomosis. 3)Bypass procedure for nonresectable lesions. 4)Enterostomy and exteriorization of intestine. Treatment of obstructing carcinoma colon </li></ul>
  • 131. The Common Types Of Intestinal Obstruction
  • 132. Adhesive Obstruction
  • 133. Diagnosis <ul><li>intestinal obstruction </li></ul><ul><li>previous laparotomy </li></ul><ul><li>abdominal infection </li></ul><ul><li>trauma </li></ul>
  • 134. Treatment <ul><li>nonoperative: </li></ul><ul><li>operative: </li></ul>
  • 135. Volvulus <ul><li>Definition: It is a twisting or rotation of the bowel upon its mesentery and induces strangulation when it twist more than 180°with a high mortality. </li></ul>
  • 136. Classification <ul><li>sigmoid colon volvulus in the elder with constipation </li></ul><ul><li>small bowel volvulus in the younger with strenuous exercises after full dinner </li></ul>
  • 137. Intussusception <ul><li>Definition: It is the invagination of a part of the intestinal tract into the lumen of the adjacent intestine. </li></ul>
  • 138. Etiology <ul><li>Irregular peristalsis in child less than 2 years old </li></ul><ul><li>Intestinal neoplasm and abdominal inflammatory causing chronic recurrent intussusceptions </li></ul>
  • 139. Clinical Features <ul><li>abdominal pain </li></ul><ul><li>abdominal mass </li></ul><ul><li>melena (currant jelly stool) </li></ul>
  • 140. Obturation Etiology <ul><li>impacted feces </li></ul><ul><li>Gallstone </li></ul><ul><li>Gutstone </li></ul><ul><li>Group of ascarids </li></ul><ul><li>foreign body </li></ul>
  • 141. &nbsp;

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