Intestinal obstruction is the mechanical impairment which is partial or complete blockage of the bowel that results in the failure of the passage of intestinal content through the intestine.

1. INTESTINAL
OBSTRUCTION
By
Miss Amanjot Kaur Sidhu
MSN (CCN)

2. INTESTINE OBSTRUCTION
Intestinal obstruction is the
mechanical impairment
which is partial or complete
blockage of the bowel that
results in the failure of the
passage of intestinal content
through the intestine.

3. CAUSES OF OBSTRUCTION
MECHANICAL
NON- MECHANICAL
OTHER CAUSES

4. PATHOPHYSIOLOGY
Due to etiological factors (Mechanical, non-
mechanical factors)
Gases and fluids accumulation in the Intestine
Increase contraction of proximal intestine, and
distention of intestine

5. Cessation of peristalsis
Increase intraluminal pressure
Increase secretions into the intestine
Compression of veins

6. Increase venous pressure
Decreased absorption
Edema of the intestine
Causes decrease arterial blood supply, and compression
of the terminal branches of mesenteric artery
Necrosis of the intestine
Gangrenous intestinal wall

7. COMMON
INTESTINAL
OBSTRUCTION

8. INTUSSUSCEPTION
• Invagination or
shortening of the
colon caused by
the movement of
one segment of
colon into another.

9. CONTII….
• This "telescoping" often blocks food or fluid
from passing through.
• Intussusception also cuts off the blood supply to
the part of the intestine that's affected, which can
lead to a tear in the bowel (perforation),
infection and death of bowel tissues.

10. VOLVULUS
• A twisting of the bowel upon itself
usually at least a full 180 ° ,
obstructing the intestinal lumen both
proximally or distally is called
‘volvulus’.
• The acute obstruction can quickly
result in bowel infarction and can be
life threatening as a result of
necrosis, perforation and peritonitis.

11. VOLVULUS

12. HERNIA
• A hernia is a protrusion
of an organ or structure
from its normal cavity
through a congenital or
acquired defect usually
in the muscles of
abdominal wall.

13. CONTII….
• Depending on its location hernia may contain peritoneal
uro-omentum, a loop of bowel or a section of bladder.
• Inguinal or umbilical hernias usually result from congenital
weakness of the muscles.
• Incisional hernia for usually complication of surgery.
• Hernia can result in bowel obstruction if the abdominal
wall defect through which the hernia protrudes becomes so
tight that the bowel segments become strangulated.

14. DIVERTICULITIS
• Diverticulitis is the
inflammation and infection of
small pouches called diverticula
that develop along the wall of
the intestine.
• The formation of the pouches
themselves is relatively benign
condition known as
diverticulosis.

15. DIVERTICULITIS

16. • CONTII…
• The diverticulitis involve small abscess in one or
more of the pouches to a massive infection or
perforation of the bowel.
• The pouches can develop anywhere in the digestive
tract, but they most commonly formed at the end of
the decending and sigmoid colons located on the
left side of the colon.

17. INTESTINAL STRICTURES
• Intestinal strictures
are narrowing of the
intestine which can
make it difficult for
food matter to pass
through.

18. CONTII…
• Strictures can be mild or severe and in the most severe
cases can lead to a complete blockage, meaning no food or
fluid can pass through that part of your intestine. If this
happens emergency surgery is needed to allow free passage
for food and drink again.
• Strictures tend to happen more commonly in Crohn’s
disease, although strictures can occasionally occur in
people who have ulcerative colitis.

19. HIRSCHPRUNG’S DISEASE
• Hirschsprung disease is
a developmental
disorder characterized
by the absence of
ganglia in the distal
colon, resulting in a
functional obstruction.

21. CONTII…
• Hirschsprung's disease is a condition that affects
the large intestine (colon) and causes problems
with passing stool.
• The condition is present at birth (congenital) as
a result of missing nerve cells in the muscles of
the baby's colon.

22. CONTII…
• A newborn who has Hirschsprung's disease
usually can't have a bowel movement in the days
after birth.
• In mild cases, the condition might not be detected
until later in childhood. Uncommonly,
Hirschsprung's disease is first diagnosed in
adults.

23. CLINICAL MANIFESTATIONS
Crampy pain- wavelike and colicky
The patient may pass blood and mucus but no
fecal matter and no flatus.
Nausea
Vomiting
Dehydration

24. CONTI…
Ileum obstruction: Fecal vomiting- First patient
vomit stomach content, then the bile stained content
of the duodenum and the jejunum and finally with
each paroxysm of pain, the darker, fecal like content
of the ileum.
Tachycardia
Drowsiness
Generalized malaise

25. CONTI….
Aching
Fever may be present secondary to an
inflammatory process or in response to bowel
ischemia
Parched tongue and mucous membrane
Distended abdomen
Hypovolemic shock

26. ASSESSMENT AND DIANOSTIC TEST
History
Inspection
Auscultation
Palpation
Percussion
BUN/creatinine levels: May be elevated in
dehydration due to vomiting

27. •CONTII…..
X-Ray
CT scan reveals abnormal quantity of fluid,
gas or both in the intestine
Laboratory studies : CBC, liver and kidney
function tests
Ultrasonography
Colonoscopy

28. CONTI….
Barium Enema: Barium enema is basically
enhanced imaging of the colon that may be done for
certain suspected causes of obstruction. During the
procedure, the doctor will insert air or liquid barium
into the colon through the rectum.

29. MEDICAL MANAGEMENT
Place intravenous line into a vein in the arm so that
fluids may be given to replace the depleted water,
sodium chloride and potassium.
Putting a nasogastric or NG tube through the nose
and into the stomach to suck out fluid as well as air
to release swelling in the abdomen.

30. CONTII…
Placing a flexible catheter into a bladder in order
to drain urine as well as collect it for testing.
A colonoscopy may be performed to untwist and
decompress the bowel
A rectal tube may be inserted to decompress an
area that is lower in the bowel.

31. CONTII…
Opioid and antiemetic can be administered
to relieve pain and nausea.
Administer antibiotic to treat bacterial
growth
Anticholinergic drugs are used to manage
colicky pain due to smooth muscle spasm
and bowel wall distention.

32. SURGICAL MANAGEMENT
• Lysis of adhesion: The process of removing
these bands of scar tissue is called lysis.
After the abdominal cavity has opened, the
surgeon locates the abdominal area and
delicately dissects the adhesion from the
intestine using surgical scissors and forceps.

34. •CONTII….
• Hernia repair: This procedure involves an
incision placed near the location of the
hernia through which the hernia sac is
opened. The herniated intestine is placed
back in the abdominal cavity and the muscle
wall is repaired.

36. CONTII….
• Resection with end to end anastomosis:
resection of small or large intestine involves the
removal of the obstructed or diseased section.
• Anastomosis is the connection of two cut ends
of a tubular structure to form a continuous
channel. The anastomosis of the intestine is
most often accomplished with sutures or
surgical staples.

37. END TO END ANASTOMOSIS

39. CONTII…
• Resection with ileostomy or colostomy: in some
patients anastomosis is not possible because the extent of
the disease tissue. After the obstruction and disease tissue
is removed, an ileostomy or colostomy is created.
• Ileostomy is a surgical procedure in which the small
intestine is attached to the abdominal wall, waste then exits
the body through an artificial opening called a stoma and
collect in a bag attached to the skin with adhesive.

40. CONTII…
• Colostomy is similar procedure with the
exception that the colon is the part of the
digestive tract is attached to the abdominal wall.
A temporary or permanent colostomy may be
necessary.

41. NURSING MANAGEMENT
ASSESSMENT:
• Inspection: Inspect the patient’s abdomen for
distension. Observe the patient’s abdomen for signs of
visible peristalsis or loops of large bowel. Measure the
patient’s abdominal girth every 4 hours to observe the
progress of an obstruction.

42. • CONTII….
•Auscultation: Auscultation the patient’s
abdomen for bowel sounds in all four quadrants, you
may hear rushes or borborygmus (rumbling noises in
the bowels). Always auscultate the abdomen for up
to 5 minutes for bowel sounds before palpation. Lack
of bowel sounds can indicate a paralytic ileus.

43. CONTII….
• Palpation: Palpate all four quadrants of the
abdomen to determine areas of localized
tenderness, guarding, and rebound tenderness.
• Ask the patient about vomiting fecal content,
wave like abdominal pain or abdominal
distension.

44. PRE-OPERATIVE NURSING CARE
Assess the patient’s level of anxiety and fear.
Assess the patient’s coping skills, support system
and the significant others response to the illness.
Administer perioperative antibiotics. Give him
chloramphenicol 500mg IV followed by an equal
dose 6 hourly and give him metronidazole 7.5
mg/kg 8 hourly.

45. • CONTII….
• Keep the patient in semi Folwer’s position as much as
possible. This position helps to promote pulmonary
ventilation and ease respiratory distress from abdominal
distension
• Prepare the patient by explaining surgical procedure, stoma
characteristics and ostomy management with pouching
system
• Prepare the patient and his family for the possibility of
surgery and provide emotional support and positive
reinforcement.

46. POST OPERATIVE NURSING MANAGEMENT:
•NURSING DIAGNOSIS:
Pain related to surgical incision
Fluid and electrolyte imbalance related to vomiting
Ineffective tissue perfusion related to intestinal
obstruction
Impaired skin integrity related to presence of
drains and bed rest

47. CONTII…
Altered nutrition less than the body requirement
related to avoidance of food
Risk for infection related to surgery
Knowledge deficient related to surgical procedure
and post-operative care
Disturbed body image related to surgery.

48. REFERENCES
• Sethi Deepak “Textbook of medical surgical nursing”
published by “The health science publisher”. Edition 1.
Page no:-713-716.
• Suddarth’s and Brunner “ A book of Medical Surgical
Nursing” Published by Lippinicot company Edition
seventh Page no 1096-1108.
• Priscilla lemone “Medical surgical nursing critical thinking
in client care” published by “ Dorling kindersely” . Edition
4the. Page no 812-816.

49. • https://www.healthline.com/health/intestinal-obstruction
• https://www.mayoclinic.org/diseases-conditions/intestinal-
obstruction/.../syc-2035146
• https://en.wikipedia.org/wiki/Bowel_obstruction
• https://www.medicinenet.com/script/main/art.asp?articleke
y=4003