Intestinal obstruction- clinical            aspects         Ritasman Baisya           Roll no – 85           8th semester
Factors affecting clinical feature• Location of obstruction• Age of the obstruction• Underlying pathology• Presence or abs...
Cardinal features of acute obstruction           Abdominal painVomiting        Cardinal features   Distension           Ab...
Pain• First symptom• Onset -- Occurs suddenly and usually severe• Site - Around umbilicus or lower abdomen• Nature-Colicky...
Contd. pain• Special points –• Very severe pain indicates strangulation• Pain may not be significant in post operative  si...
Vomiting• Onset – timing depends on site• Character— alters from digested food, bile  stained food to faeculent matter• Na...
Distension• Degree of distension depends on site of  obstruction• Visible peristalsis may be present• Delayed in colonic o...
Few images ofvisible peristalsis inobstruction
ConstipationTypes -- 1. absolute (neither feces nor flatus )         2. relative (where only flatus is passed ) Absolute ...
Exceptions• Richter hernia• Gallstone obturation• Mesenteric vascular occlusion• Obstruction associated with a pelvic absc...
Dehydration• Mostly in small bowel obstruction due to  repeated vomiting• Dry tongue, dry skin , sunken eye , oliguria• Se...
Abdominal tenderness Initially localised , later diffuse Rebound phenomenon & guarding will not be present in simple obs...
Temperature• Fever signifies inflammation in bowel wall /  ischemia / perforation• Hypothermia -- when septicemia due to p...
Bowel sounds• High pitched metallic to metallic tinkling  sound of dilated bowel• Once fatigue– silent abdomen peritonitis...
Other features• Pyrexia – onset of ischemia , intestinal  perforation• Hypokalemia• Increase in serum amylase ,LDH
Features of strangulation• Continuous severe pain• Shock indicates underlying ischemia• Symptoms commence suddenly and rec...
Comparison of clinical aspectsProximal small Distal small bowel             Large bowelbowelSevere vomiting      Moderate ...
Complications•   Peritonitis•   Shock•   Renal failure•   ARDS•   Intra abdominal abscess•   Moribund status
Clinical aspect of intestinal obstruction Ritasman Baisya Medical College kolkata
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Clinical aspect of intestinal obstruction Ritasman Baisya Medical College kolkata

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Clinical aspect of intestinal obstruction Ritasman Baisya Medical College kolkata

  1. 1. Intestinal obstruction- clinical aspects Ritasman Baisya Roll no – 85 8th semester
  2. 2. Factors affecting clinical feature• Location of obstruction• Age of the obstruction• Underlying pathology• Presence or absence of intestinal ischemia
  3. 3. Cardinal features of acute obstruction Abdominal painVomiting Cardinal features Distension Absolute constipation
  4. 4. Pain• First symptom• Onset -- Occurs suddenly and usually severe• Site - Around umbilicus or lower abdomen• Nature-Colicky in nature ,with increased distension ,pain becomes mild, constant ,diffuse
  5. 5. Contd. pain• Special points –• Very severe pain indicates strangulation• Pain may not be significant in post operative simple mechanical obstruction• Not present usually in paralytic ileus
  6. 6. Vomiting• Onset – timing depends on site• Character— alters from digested food, bile stained food to faeculent matter• Nature – projectile
  7. 7. Distension• Degree of distension depends on site of obstruction• Visible peristalsis may be present• Delayed in colonic obstruction & minimal /absent in mesenteric vascular occlusion
  8. 8. Few images ofvisible peristalsis inobstruction
  9. 9. ConstipationTypes -- 1. absolute (neither feces nor flatus ) 2. relative (where only flatus is passed ) Absolute constipation is cardinal feature of complete obstruction Some patients pass feces orflatus due to distal bowel content
  10. 10. Exceptions• Richter hernia• Gallstone obturation• Mesenteric vascular occlusion• Obstruction associated with a pelvic abscess• Partial obstruction where diarrhea may often occurs
  11. 11. Dehydration• Mostly in small bowel obstruction due to repeated vomiting• Dry tongue, dry skin , sunken eye , oliguria• Secondary polycythemia…
  12. 12. Abdominal tenderness Initially localised , later diffuse Rebound phenomenon & guarding will not be present in simple obstruction
  13. 13. Temperature• Fever signifies inflammation in bowel wall / ischemia / perforation• Hypothermia -- when septicemia due to poor pyrogenic response
  14. 14. Bowel sounds• High pitched metallic to metallic tinkling sound of dilated bowel• Once fatigue– silent abdomen peritonitis• In paralytic ileus no return of bowel sound on auscultation
  15. 15. Other features• Pyrexia – onset of ischemia , intestinal perforation• Hypokalemia• Increase in serum amylase ,LDH
  16. 16. Features of strangulation• Continuous severe pain• Shock indicates underlying ischemia• Symptoms commence suddenly and recur regularly• Local tenderness associated with rigidity and rebound tenderness ( Blumberg sign )
  17. 17. Comparison of clinical aspectsProximal small Distal small bowel Large bowelbowelSevere vomiting Moderate vomiting Late vomitingLess distension Central distension Early distension , pronouncedColicky pain Central abdominal pain Less painConstipation late Varies in appearance Constipation is early featureSevere dehydration Moderate Less dehydration
  18. 18. Complications• Peritonitis• Shock• Renal failure• ARDS• Intra abdominal abscess• Moribund status

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