Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Small bowel obstruction

6,517 views

Published on

You need a slideshow to present Schwart's Surgery content on small bowel obstruction? then it's a perfect choice!!!

Published in: Health & Medicine
  • Be the first to comment

Small bowel obstruction

  1. 1. Small Bowel Obstruction SCHWARTZ'S PRINCIPLES OF SURGERY; 9TH EDITION
  2. 2. Epidemiology  Most frequent surgical disorder of the small intestine  Etiologies according to their relationship to intestinal wall:  1. Intraluminal (e.g., foreign bodies, gallstones, or meconium)  2. Intramural (e.g., tumors, Crohn's disease–associated inflammatory strictures)  3. Extrinsic (e.g., adhesions, hernias, or carcinomatosis)
  3. 3. Continue  75% of cases is caused by intra-abdominal adhesions related to prior abdominal surgery  Less prevalent etiologies include:  hernias  malignant bowel obstruction  (extrinsic compression or invasion from neoplasms arising in organs other than the intestine)  and Crohn's disease
  4. 4. Continue  Congenital abnormalities  Usually become evident during childhood  intestinal malrotation and midgut volvulus should not be forgotten in adult patients  especially in those without history of prior abdominal surgery
  5. 5. Pathophysiology  In the onset, gas and fluid accumulate within the intestinal lumen proximal to the site of obstruction  Intestinal activity increases Colicky pain & Diahrrea  Where does the gas & fluid come from?  Bowel distends and intraluminal and intramural pressures rise  Impair of intestinal microvascular perfusion Ischemia Necrosis  strangulated bowel obstruction
  6. 6. Continues  partial small bowel obstruction  only a portion of the intestinal lumen is occluded  pathophysiologic events occur more slowly & strangulation is less likely  closed loop obstruction  accumulating gas and fluid cannot escape  Leading to a rapid rise in luminal pressure, and a rapid progression to strangulation
  7. 7. Clinical Presentation  colicky abdominal pain, nausea, vomiting, and obstipation  Vomiting is more seen with proximal obstructions than distal  In established obstructions you see vomitus more feculent  Continued passage beyond 6 to 12 hours after onset of symptoms is characteristic of partial obstruction  Abdominal Distention is another sign, esp. if the obstruction is in distal ileum, absent if in proximal small intestine  Bowel sounds
  8. 8. Continue  Laboratory findings intravascular volume depletion consist of:  hemoconcentration and electrolyte abnormalities  Mild leukocytosis is common  Features of strangulated obstruction include:  Odd abdominal pain, suggestive of intestinal ischemia  tachycardia, localized abdominal tenderness, fever, marked leukocytosis, and acidosis  Any of these findings must alert you to the possibility of strangulation Surgery
  9. 9. example  Chronic partial small bowel obstruction  several months' history of chronic abdominal pain, and intermittent vomiting  dilated segment shows evidence of fecalization
  10. 10. Diagnosis  Focus on the following goals: (a) distinguish mechanical obstruction from ileus (b) determine the etiology of the obstruction (c) discriminate partial from complete obstruction (d) discriminate simple from strangulating obstruction
  11. 11. Continue  Important elements to obtain on history:  prior abdominal operations (suggesting the presence of adhesions)  abdominal disorders (e.g., intra-abdominal cancer or inflammatory bowel disease)  hernias (esp. in inguinal & femoral regions)  Blood in Stool (Strangulation)
  12. 12. Radiographic Examination  Abdominal series in X-ray: (1) Abdomen Supine, (2) Abdomen Upright, (3) Chest Upright.  most specific triad for small bowel obstruction:  dilated small bowel loops (>3 cm in diameter)  air-fluid levels  a paucity of air in the colon  Specificity of plain Radiography is low (ileus and colonic obstruction)  False-negative (proximal of small intestine OR filled with fluid but no gas)
  13. 13. CT-Scan  a discrete transition zone with:  dilation of bowel proximally, decompression of bowel distally,  intraluminal contrast that does not pass beyond the transition zone,  and a colon containing little gas or fluid  Closed-loop obstruction  U-shaped or C-shaped dilated bowel loop  mesenteric vessels converging toward a torsion point  Strangulation (thickening of the bowel wall, pneumatosis intestinalis)
  14. 14. Therapy  marked depletion of intravascular volume decreased oral intake, vomiting, and sequestration of fluid in bowel lumen and wall  IV fluid and bladder catheter(urine output)  Broad-spectrum antibiotics  NG tube (decreases nausea, distention, and the risk of vomiting & aspiration)
  15. 15. The END

×