intestinal obstruction

1. Intestinal obstruction
A clinical approach

2. Introduction
• General remarks
• The objective of the lecture

3. Definition of intestinal obstruction
• General description
• Technical descriptions commonly used-
mechanical or paralytic
partial or complete
high or low
simple or strangulated
specific etiology

4. Pathophysiology
• Mechanism of obstruction
-luminal
-mural
-extramural
• Effects of obstructive lesion
Early
Gas and fluid accumulation
distension, pain, vomiting
Late
strangulation, perforation, peritonitis, septic shock
and finally death

5. Symptoms
• Four cardinal symptoms
– Colicky pain which later may become continuous
– Vomiting
– Abdominal distension
– Failure to pass stool and flatus

6. Signs
• General
dehydration
toxicity
restless or lying still
vital signs
• Abdominal
inspection
palpation
percussion
auscultation
rectal examination

7. Diagnosis
• Overall clinical assessment includes consideration
of
– The cardinal symptoms
– Symptoms suggesting etiology or level of obstruction
– Symptoms suggesting gangrene or impending
gangrene
– Signs suggesting etiology and level of obstruction
– Signs suggesting impending gangrene or established
gangrene

8. Diagnosis
• Investigations
– To confirm clinical assessment
– To detect complications
– To prepare patient for surgery

11. An example in making a specific
diagnosis
• Sigmoid volvulus
– Overall clinical assessment
history, physical findings
-Investigations

12. Treatment
• Aims of treatment
– To relieve obstruction
– To correct dehydration
– To prevent recurrence
– To control peritonitis and to save life

13. Place of conservative treatment
• Conditions that can be dealt with non-
surgically
• Components of conservative treatment
• Contraindications of conservative treatment

14. Surgical treatment
• Preoperative treatment
• Elements of surgical intervention
• Post operative care

15. Conclusion
• Prompt diagnosis and treatment
• This has to be methodical