Clinical Manifestations of Intestinal Obstruction (Constipation)

1. CONSTIPATION
OBJECTIVES:
I. Describe the clinical manifestations of
intestinal obstruction.
II. List the major causes of intestinal
obstruction.
Updesh Kumar Yadav
Roll No : 5126
Magh 14, 2073

2. Definition
A blockage arising from a structural abnormality
that presents a physical barrier to the progression of
gut contents.
 Partial or Complete
 Simple or Strangulated
Factors affecting clinical manifestation:
 Location of obstruction
 Duration of obstruction
 Underlying pathology
 Presence or absence of intestinal ischemia

3. Major Clinical Manifestations of Intestinal
Obstruction:
1) Abdominal Pain
2) Vomiting
3) Distension
4) Constipation

4. Abdominal Pain
• First symptom, usually sudden
• Colicky in nature
• Centered on the umbilicus (small
bowel) or lower abdomen (large bowel)
• Coincides with increasing peristaltic
activity
• With increasing distension, the colicky
pain is replaced by a mild & more constant
diffuse pain
• Severe continuous pain indicates the
presence of strangulation

5. Vomiting
• Interval, frequency & nature of the vomitus depends
on the site of the obstruction.

6. Vomiting cont…
• More distal the obstruction, larger will be the interval
between the onset of symptom & the appearance of
nausea & vomiting.
• More proximal the obstruction, greater will be the
frequency of the vomitus.
• Large volume of vomitus & sometimes projectile
vomiting suggest upper intestinal obstruction.
• As obstruction progresses the character of vomitus
alters from digested food to faeculent material.
• Faeculent vomit suggests lower intestinal obstruction.

7. Distension
• Degree of distention depends on the
site of obstruction.
• More distal the obstruction, greater
& more delayed will be the distension.
• Central abdomen is distended in low
small bowel obstruction & distension
is much less in high SBO.
• Visible peristalsis may be present
(which can be provoked by gently flicking
the abdominal wall)

8. Few images of
visible peristalsis in
obstruction

9. Constipation
• A consensus definition used in research
(The Rome III Criteria) defines constipation as
having 2 or more of the following for at
least 12 weeks:
 infrequent passage of stool (<3/weeks),
 straining >25% of the time,
 passage of hard stools,
 incomplete evacuation & sensation of anorectal
blockage

10. Constipation cont…
• Types : 1) Absolute (neither feces nor flatus is passed)
2) Relative (where only flatus is passed)
 Absolute constipation (Obstipation) is the cardinal
features of the complete intestinal obstruction.

11. Other Manifestations:
• Dehydration
• Abdominal Tenderness
• Pyrexia
• Bowel Sound
• Hypokalemia
• Infrequent Urination
• Fatigue

12. Major Causes of Intestinal
Obstruction
 Hernia
 Intestinal Adhesions
 Volvulus
 Intussusception
 Tumors

13. Proximal small
bowel
Distal small bowel Large bowel
Severe vomiting Moderate vomiting Late vomiting
Less distension Central distension Early distension ,
pronounced
Colicky pain Central abdominal pain Less pain
Constipation late Varies in appearance Constipation is early
feature
Severe dehydration Moderate Less dehydration
Comparison of Clinical Manifestation
SUMMARY

14. References:
o Bailey & Love’s Short Practice of Surgery – 26e
o Harrison’s Principle of Internal Medicine – 18e
o Davidson’s Principles & Practice of Medicine – 22e
o Kumar & Clark’s Clinical Medicine – 7e
o Robbins & Cotran Pathologic Basis of Disease – 9e

15. THANK YOU !!!