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.

intestinal obstruction

33,926 views

Published on

intestinal obstruction

Published in: Education
  • Login to see the comments

intestinal obstruction

  1. 1. OUTLINE INTRODUCTION DEFINITION CLASSIFICATION AETIOLOGY PATHOPHYSIOLOGY CLINICAL PRESENTATION MANAGEMENT COMPLICATION PROGNOSIS HOMOEOPATHIC THERAPEUTICS
  2. 2. Intestinal obstruction is a partial or complete blockage of the bowel that prevents the contents of the intestine from passing through.
  3. 3. Dynamic/ Adynamic Small bowel obstruction [ high or low ] Large bowel obstruction Acute Chronic Acute on chronic Subacute Simple Strangulated Closed loop obstruction
  4. 4. DYNAMIC : where peristalsis is working against a mechanical obstruction. A DYNAMIC: it may occur in two forms 1st where peristalsis may be absent (paralytic ileus,)occurring secondarily to neuromuscular failure in the mesentery. 2nd where peristalsis may be present in non-propulsive form.(pseudo-obstruction) IN BOTH FORMS MECHANICAL ELEMENT IS ABSENT.
  5. 5. ACUTE CHRONIC ACUTE ON CHRONIC SUBACUTE
  6. 6. IT USUALLY OCCUR IN SMALL BOWEL OBSTRUCTION WITH SUDDEN ONSET OF SEVERE COLICKY CENTRAL ABDOMINAL PAIN,DISTENTION AND EARLY VOMITINGAND CONSTIPATION.
  7. 7. USUALLY SEEN IN LARGE BOWEL OBSTRUCTION WITH LOWER ABDOMINAL COLIC AND ABSOLUTE CONSTIPATION,FOLLOWED BY DISTENTION.
  8. 8. IT SATRTS IN LARGE BOWEL BUT GRADUALLY INVOLVES THE SMALL INTESTINE. EARLY SYMPTOMS ARE PAIN AND CONSTIPATION BUT WHEN SMALL INTESTINE IS INVOLVED IT IS CHARACTERIZED BY VOMITING AND GENERAL DSTENTION.
  9. 9. SIMPLE MECHANICAL STARANGULATED CLOSED LOOP
  10. 10. IN WHICH THERE IS OBSTRUCTION BUT BLOOD SUPPLY TO INTESTINE REMAINS INTACT. IN THIS MESENTRIC BLOOD VESSEL ARE OCCLUDED BESIDES THE USUAL MECHANICAL OBSTRUCTION. IT IS A DANGEROUS CONDITION AND SHOULD BE OPERATED WITH OUT ANY DELAY . WHEN BOTH LIMBS (afferent& efferent limbs) OF THE LOOPS ARE OBSTRUCTED SO THAT THERE IS NEITHER PROGRESSION NOR REGURGITATION.
  11. 11. INTRALUMINAL(OBSTRUCTION IN THE LUMEN) BEZOARS :which may be trichobezoar(hair)or phytobezoar (fruit and vegetables) GALLSTONES POLYPLOID TUMOR OF THE BOWEL INTUSSUCEPTION IMPACTION OF BARIUM AND WORMS FOREIGN BODIES
  12. 12. GALLSTONES
  13. 13. INTUSSUCEPTION
  14. 14. (a)CONGENITAL: 1:ATERSIA AND STENOSIS 2: MEGA COLON {HIRSCHPRIUNG ‘S DISEASE} 3: MICKEL’S DIVERTICULUM 4:IMPERFORATE ANUS 5:DIVERTICULI
  15. 15. Duodenal Artesia
  16. 16. • (b)TRAUMATIC • (C)INFLAMATORY: • 1:CROHN’S DISAESE • 2:ULCERATIVE COLITIS (RARE) • 3:DIVERTICULITIS (RARE) • (d)NEOPLASIC:VARIOUS TUMORS OF SMALL AND LARGE INTESTINE ALSO CAUSE OBSTRUCTON. •(e)MISCELLANEOUS: •1:RADIATION THERAPY •2:IATROGENIC STRICTURE
  17. 17. Intestinal tumor
  18. 18. (a) ADHESIVE BAND CONSTRICTIONOR ANGULATION BY ADHESION.[LEADING CAUSE OF SMALL INTESTINE OBSTRUCTION] (b)EXTERNAL HERNIA [SECOND COMMON CAUSE] (c) VOLVULUS (d) EXTRINSIC MASSES [eg (i)haematomas and abscess may press the bowel and causes obstruction. (ii)Neoplasm outside the bowel (iii)Annular pancreas (iv)Abnormal vessels (rare).]
  19. 19. ADHESIVE BANDS AND CONSTRICTION
  20. 20. PARALYTIC ILEUS:IT IS OF TWO TYPES: 1ST ABDOMINAL CAUSES :IT INCLUDES (i)INTESTINAL DISTENTION (ii)PERITONITS (iii)RETROPERITONIAL LESIONS (e.g. retroperitoneal hemorrhage) 2ND SYSTMIC CAUSES:ELECTROLYTE IMBALANCE MAINLY HYPOKALEMIA AMD TOXAEMIA .
  21. 21. 40% 15% 15% 12% 8% 5% 5% percentage adhesions Inflamatory carcinoma obstructed hernia faecal impaction pseudo-obstruction miscellaneous
  22. 22. Narcotics. Antipsychotics. Anticholinergics. Ganglionic blockers. Agents used to treat Parkinson’s disease.
  23. 23. Diabetes. Multiple sclerosis. Scleroderma. Lupus erythromatosis. Hirshprung’s disease.
  24. 24.  In simple mechanical obstruction, blockage occurs without vascular compromise.  Ingested fluid and food, digestive secretions, and gas accumulate above the obstruction. The proximal bowel distends, and the distal segment collapses.
  25. 25. •The distention proximal to an obstruction is produced by two factors: •GAS:Regaradless of the level of obstruction, there is a significant overgrowth of both aerobic and anaerobic organisms, resulting in considerations gas production.
  26. 26. •Following the reabsorbtions of oxygen and carbon dioxide, the majority is made up of nitrogen(90 %) and hydrogen sulphide. •FLUID : this is made up of the various digestive juices.
  27. 27. •Following the obstruction, fluid accumulates within the bowel wall and any excess is secreted in to the lumen, •Whilst absorption from the gut is retarded. •Dehydration and electrolyte l0ss are therefore due to: •-Reduced oral Intake; •-Defective intestinal obstruction ; •-Losses due to vomiting; •-sequestration in the bowel lumen
  28. 28.  Strangulating obstruction is obstruction with compromised blood flow; it occurs in nearly 25% of patients with small-bowel obstruction.  It is usually associated with hernia, volvulus, and intussusceptions.  Strangulating obstruction can progress to infarction and gangrene in as little as 6 h. 
  29. 29. .  Venous obstruction occurs first, followed by arterial occlusion, resulting in rapid ischemia of the bowel wall.  The ischemic bowel becomes edematous and infarcts, leading to gangrene and perforation. In large- bowel obstruction, strangulation is rare (except with volvulus)
  30. 30.  Closed loop obstruction is a specific type of obstruction in which two points along the course of a bowel are obstructed at a single location thus forming a closed loop.  Usually this is due to adhesions, a twist of the mesentery or internal herniation.
  31. 31.  In the large bowel it is known as a volvulus.  In the small bowel it is simply known as small bowel closed loop obstruction.  Obstruction to the blood supply occur either from the same mechanism which caused obstruction or by the twist of the bowel on mesentery.
  32. 32.  Hernia  Intussusceptions  Volvulus  Peritoneal Adhesion & Band  Bolus obstruction: Gallstone  Food  Trichobezoars & phytobzoars  Worms
  33. 33.  An intussusceptions is a medical condition in which a part of the intestine has invaginated into another section of intestine.  Usually proximal loop invaginate in to the distal bowel.  Rarely distal loop may invaginate into the proximal loop this is called retrograde intussusceptions.
  34. 34.  Condition is more commonly seen in infants & young children.  More often in iliocaecal region.  Complication – Intestinal obstruction, gangrene, perforation and peritonitis.
  35. 35.  The first sign of Intussusception in an otherwise healthy infant may be sudden, loud crying caused by abdominal pain.  Infants who have abdominal pain may pull their knees to their chests when they cry.  The pain of Intussusception comes and goes, usually every 15 to 20 minutes at first.
  36. 36. i. Stool mixed with blood and mucus (also known as “redcurrant jelly" stool because of its appearance) ii. Vomiting iii. A "sausage-shaped" mass felt upon palpation of the abdomen, with concavity towards umbilicus iv. Lethargy
  37. 37. •REDUCING THE TERMINAL PART OF THE INTUSSUSCEPTION : •REDUCING IS ACHIEVED BY SQUEEZING THE MOST DISTAL PART OF THE MASS IN CEPHALAD DIRECTION
  38. 38.  Abnormal twisting of a portion of the gastrointestinal tract, usually the intestine, which can impair blood flow.  Volvulus can lead to gangrene and death of the involved segment of the gastrointestinal tract.
  39. 39.  More common in female in fourth and fifth decades and usually presents acutely with the classic feature of obstruction.  Rotation always occurs in clock wise direction.  Ischemia is common.
  40. 40.  Rare in Europe and USA but common in Eastern Europe and Africa.  Symptoms resembles that of large bowel obstruction.  Rotation is always occurs in anticlockwise direction.
  41. 41. Flexible sigmoidoscopy/ rigid sigmoidoscopy Laparotomy- untwisting
  42. 42. SIGMOID VOLVULUS
  43. 43. Intestinal obstruction Vomiting Distention constipation Pain
  44. 44.  Clinical obstruction of intestinal obstruction vary according to : a. The location of the obstruction; b. The age of the obstruction; c. The underlying pathology; d. The presence or the absence of the intestinal obstruction;
  45. 45.  Pain is the first symptom encountered, it occurs suddenly and is usually severe..  It is colicky in nature and usually centered on the umbilicus (small bowel) or lower abdomen (large bowel).  The pain coincides with the increasing peristaltic activity
  46. 46.  The more distal the obstruction ,the longer the interval between the onset of symptoms and the appearance of nausea and vomiting .  More proximal the obstruction, more the frequency.  The interval ,frequency & nature of vomitus depends on the site of obstruction
  47. 47.  In high bowel obstruction :  the interval is shorter  Bile stained vomitus  Vomiting is more frequent and copious ;  And is relieved by decompressing the obstructed bowel
  48. 48.  In low bowel obstruction :  the interval is longer may last for a day or two  Feculent vomitus  vomiting is less frequent and does not cause any relief. 
  49. 49.  Pyloric obstruction  Watery and acidic vomitus  Large bowel obstruction  Uncommon and late symptoms.
  50. 50.  Long standing low small bowel obstruction-  feculent material.  Strangulation- blood.
  51. 51.  In the small bowel, the degree of distention is dependent on the site of obstruction & is greater the more distal the lesion.  Central abdomen is distended in low small bowel obstruction.  Distention is much less in high small bowel obstruction.
  52. 52.  Failure to pass flatus or faeces through the rectum is important symptom of bowel obstruction.  It may be classified as 1. ABSOLUTE 2. RELATIVE
  53. 53.  Visible peristalsis may be present if the abdomen is examined carefully.  Mostly seen in proximal loops.  Borborygmi is quite loud ,does not require stethoscope to hear it .  In auscultation sound of hyper peristalsis coinciding with attack of colic characteristic feature f intestinal obstruction.
  54. 54.  The accumulation of chyme and gas gives rise to a feeling of fullness and causes bloating. This may also give rise to high-pitched gurgling sounds from the abdomen
  55. 55.  Obstruction and the resulting digestive inability hampers the absorption of vitamins and other nutrients from food, leading to weakness, headache and dizziness. Even regular activities may make the individual feel exhausted and drowsy
  56. 56.  Dehydration due to diarrhea and vomiting, results in the loss of body fluids and electrolytes. As a response to this, the body tries to retain water through lowered urine output.
  57. 57.  Dehydration  Hypokalamia  Pyrexia  Abdominal tenderness  Bowel sound
  58. 58.  Inspection  Palpation  Percussion  Auscultation  Rectal examination
  59. 59.  Shape of the abdomen  Movement of the abdomen wall  Umbilicus  Visible loop of bowel/visible peristalsis  Scar  Striae  Prominent veins  Pubic hair  Hernial orifices
  60. 60.  During colic there may be muscle guarding.  Slight tenderness may be present between attacks of pain.  Tenderness and rigidity at the sight of obstruction usually indicate strangulation.  All the hernial orifices should be palpated to exclude the presence of hernia.
  61. 61.  Percussion to hear any Dullness or Resonance related to site of obstruction.  Tympanic node will be present.  Tenderness on light percussion suggest strangulation.
  62. 62.  Bowel sounds are Initially Loud and frequent  Then as bowel distends the sounds become more resonant and high pitched  Eventually becoming amphoric.  In strangulation bowel sound is completely absent.
  63. 63.  Presence of mass on rectal examination within or outside the lumen will give a clue to diagnosis.  Presence or absence of feces in rectum should be noted. Absence means obstruction is higher up. If presence it should be studied for presence of occult blood which include mucosal lesion e.g.cancer,Intussuception or infraction
  64. 64.  BLOOD EXAMINATION  RADIOLOGICAL EXAMINATION
  65. 65.  CBC  Urea & electrolytes  Serum amylase level  Metabolic acidosis
  66. 66.  A rise white cell count will indicate an infection.  Normal or slight rise in W.B.C count: simple mechanical obstruction.  Moderate rise in W.B.C count(15000- 20000):strangulation.  Very high rise in W.B.C count(30000- 40000):primary mesenteric vascular occlusion.
  67. 67.  Derangement may be seen with vomiting & diarrhea.  Dehydration will be reflected in raised serum urea and creatinine.
  68. 68.  It is non specific test & may be raised in cases of small intestinal obstruction.
  69. 69.  It occurs due to combined effects of dehydration ketosis and loss of alkaline secretion.  Very common in distal intestinal obstruction.
  70. 70.  Gas fluid levels are the most important criteria of diagnosis of intestinal obstruction.  When obstruction occurs, both fluid and gas collect in the intestine.  They produce a characteristic pattern called "air-fluid levels". The air rises above the fluid and there is a flat surface at the "air-fluid" interface.
  71. 71. In most cases, the abdominal radiograph will have the following features: 1. ileated loops of small bowel proximal to the obstruction 2. predominantly central dilated loops 3. dilatation of loops over 3cm 4. valvulae conniventes are visible
  72. 72. The sigmoid colon is very dilated because it is twisted at the root of its mesentery in the left iliac fossa (LIF) The twisted loop of sigmoid colon is said to resemble a coffee bean
  73. 73.  Are recommended in patient with a history of recurring obstruction
  74. 74.  CT scan examination is particularly useful in patient with a history of abdominal malignancy, in postsurgical patients, and in patient who have no history of abdominal surgery and present with symptoms of bowel obstruction.
  75. 75. 1. An intestinal obstruction is a medical emergency that requires prompt medical treatment. Do not attempt to treat the problem at home. The appropriate treatment depends on the type of intestinal obstruction. 2. Initially, a flexible tube may be passed through your nose or mouth to remove fluid and gas. This will relieve the swelling of your belly. Most intestinal obstructions require surgery.
  76. 76. 3. You will be given fluids intravenously for as many as six to eight hours to relieve dehydration by restoring electrolyte levels in the body and to prevent shock during surgery. This therapy is typically administered in the hospital or at other certified health care facilities. . 4. If the affected part of your intestine has died, the surgeon will perform a resection, removing the dead tissue and joining the two healthy ends of the intestine.
  77. 77.  Electrolyte imbalance  Infection  Jaundice  Perforation of intestine  Necrosis and death of intestine
  78. 78.  Arsenic alb.  Aethusa.  Asafoetida  Alumina  Belladonna  Bryonia alb.  Bismuth  China  Cina  Carboveg  Colocynth  Cocculus ind.  Ipecac.
  79. 79.  Merc. Sol  Nux vomica  Opium  Pulsatilla  Phosphorus  Plumbum met  Ratanhia  Syzy jumb.  Veretrum alb  Zinc met

×