Intestinal obstruction

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Nov. 6, 2020

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Intestinal obstruction

  2. INTRODUCTION •The incidence of bowel obstruction is 1.47 per 100,000 per year in the United States .The incidence of large bowel obstruction is approximately 0.15 - 0.29 per 100,000 in patients with colorectal cancer. •It should be noted that 770 per 100,000 of surgical emergencies with colorectal carcinoma are attributed to bowel obstruction. •The incidence of bowel obstruction in cases of Crohns disease may be as high as 250 per 100,000.
  3. DEFINITION Intestinal obstruction is a blockage that keeps food or liquid from passing through your small intestine or large intestine (colon).
  4. TYPES •functional — there is no physical blockage, however, the bowels are not moving food through the digestive tract. •mechanical — there is a blockage preventing the movement of food. A bowel obstruction may be a partial blockage or a complete blockage. You can also have what’s called a pseudo-obstruction. This is when you have symptoms of a bowel obstruction but nothing physically blocking it. It can happen because of problems with your gastrointestinal muscles or with the nerves that control them.
  5. CAUSES Causes of bowel obstruction include •Neoplasm / cancer •Diverticulitis /Diverticulosis •Constipation • Inflammatory bowel disease •Colonic volvulus(sigmoid, caecal, transverse colon) •Adhesions Foreign bodies (e.g. gallstones in gallstone ileus, swallowed objects such as expandable water toys)intestinal atresia •Faecal impaction c •Constipation • Faecaloma •Colon atresia •Intestinal pseudo obstruction • Endometriosis •Narcotic induced (especially with the large doses given to cancer or palliative care patients)
  7. SIGNS AND SYMPTOMS •Crampy abdominal pain that comes and goes •Loss of appetite •Constipation •Vomiting •Inability to have a bowel movement or pass gas •Swelling of the abdomen •Diarrhea •Bloating
  8. DIAGNOSIS •blood tests for blood counts, liver and kidney function, and levels of electrolytes, •X ray, •colonoscopy, flexible lighted tube that your doctor uses to look at your large intestine •enema with contrast
  9. TREATMENT •Medication. Opioids can lead to constipation. If this occurs, laxatives and stool softeners will help. •Observation. Ileus may need monitoring for a few days and often resolves with time. During this time, people should limit food and drink to stop further buildup. Doctors can provide fluid intravenously to keep people hydrated. •Nasogastric tube. This is a narrow tube that goes up the nose and into the stomach. It removes fluid and gas trapped in the stomach, relieving pressure. This eases pain and vomiting. •Surgery. Surgeons can remove blocked or damaged sections of the bowel. In cases of IBDs, a strictureplasty may be necessary. Here, a surgeon will widen a narrowed section of bowel by cutting and sewing. •Therapeutic enema. A nurse or doctor will push a medication or tap water into the bowel to try to relieve stool impaction, which can happen in severe constipation.
  10. SURGICAL MANAGEMENT Intestinal obstruction repair is surgery to relieve a bowel obstruction . A bowel obstruction occurs when the contents of the intestines cannot pass through and exit the body. A complete obstruction is a surgical emergency. Any damaged parts of your bowel will be repaired or removed. This procedure is called bowel resection. If a section is removed, the healthy ends will be reconnected with stitches or staples. Sometimes, when part of the intestine is removed, the ends cannot be reconnected. If this happens, the surgeon will bring one end out through an opening in the abdominal wall. This may be done using a colostomy or ileostomy. You had an injury or disease in your digestive system and needed an operation called an ileostomy. The operation changed the way your body gets rid of waste (feces). Now you have an opening called a stoma in your belly. Waste will pass through the stoma into a pouch that collects it. You will need to take care of the stoma and empty the pouch many times a day. stoma is made from the lining of your intestine. It will be pink or red, moist, and a little shiny. Stool that comes from your ileostomy is thin or thick liquid, or it may be pasty. It is not solid like the stool that comes from your colon. Foods you eat, medicines you take, and other things may change how thin or thick your stool is.
  11. PATIENT INSTRUCTION AFTER ILEOSTOMY Patient Instructions Eat bland diet Change pouch Eat low fibre diet See any infection Avoid smell foods like cabage etc Any swelling is their call doctor
  12. A bland diet can be used alongside lifestyle changes to help address the symptoms of ulcers, heartburn, GERD, nausea, and vomiting. You may also need a bland diet after stomach or intestinal surger A bland diet includes foods that are soft, not very spicy, and low in fiber. If you are on a bland diet, you should not eat spicy, fried, or raw foods. You should not drink alcohol or drinks with caffeine in them. •Your health care provider will tell you when you can start eating other foods again. It is still important to eat healthy foods when you add foods back in. Your provider can refer you to a dietitian or nutritionist to help you plan a healthy diet. Milk and other dairy products, low-fat or fat-free only •Cooked, canned, or frozen vegetables •Potatoes •Canned fruit as well as apple sauce, bananas, and melons •Fruit juices and vegetable juices (some people, such as those with GERD, may want to avoid citrus and tomato) •Breads, crackers, and pasta made with refined white flour •Refined, hot cereals, such as Cream of Wheat (farina cereal) •Lean, tender meats, such as poultry, whitefish, and shellfish that are steamed, baked, or grilled with no added fat •Creamy peanut butter •Pudding and custard
  13. Some foods you may want to avoid when you are on a bland diet are: •Fatty dairy foods, such as whipped cream or high-fat ice cream •Strong cheeses, such as bleu or Roquefort cheese •Raw vegetables and salads •Vegetables that make you gassy, such as broccoli, cabbage, cauliflower, cucumber, green peppers, and corn •Dried fruits •Whole-grain or bran cereals •Whole-grain breads, crackers, or pasta •Pickles, sauerkraut, and other fermented foods •Spices and strong seasonings, such as hot pepper and garlic •Foods with a lot of sugar in them •Seeds and nuts
  14. Doing these things will keep down the odor: •Eating parsley, yogurt, and buttermilk. •Keeping your ostomy devices clean. •Using special deodorants or adding vanilla oil or peppermint extract to your pouch before closing it. Ask your health care provider about this. Control gas, if it is a problem: •Eat on a regular schedule. •Eat slowly. •Try not to swallow any air with your food. •DO NOT chew gum or drink through a straw. Both will make you swallow air. •DO NOT eat cucumbers, radishes, sweets, or melons. •DO NOT drink beer or soda, or other carbonated drinks. Try eating 5 or 6 small meals a day. •This will help keep you from getting too hungry. •Eat some solid foods before you drink anything if your stomach is empty. This may help decrease gurgling sounds. •Drink 6 to 8 cups (1.5 to 2 liters) of fluids every day. You can get dehydrated more easily if you have an ileostomy, so talk to your provider about the right amount of fluid for you. •Chew your food well.
  15. It is OK to try new foods, but try only one at a time. That way, if you have any trouble, you will know which food caused the problem. Over-the-counter gas medicine can also help if you have too much gas. Try not to gain weight unless you are underweight because of your surgery or any other illness. Excess weight is not healthy for you, and it may change how your ostomy works or fits. When you feel sick to your stomach: •Take small sips of water or tea. •Eat a soda cracker or a saltine. Some red foods may make you think you are bleeding. •Tomato juice, cherry-flavored drinks, and cherry gelatin may make your stool reddish. •Red peppers, pimientos, and beets may show up as small red pieces in your stool or make your stool look red. •If you have eaten these, it is most likely OK if your stools look red. But, call your provider if the redness does not go away. When to Call the Doctor Call your provider if: •Your stoma is swollen and is more than a half inch (1 centimeter) larger than normal. •Your stoma is pulling in, below the skin level. •Your stoma is bleeding more than normal. •Your stoma has turned purple, black, or white. •Your stoma is leaking often.
  16. NURSING MANAGEMENT 1.Allow the patient nothing by mouth, as ordered. 2.Insert a nasogastric tube to decompress the bowel as ordered. 3.Begin and maintain I.V. therapy as ordered. 4.Administer analgesics, broad spectrum antibiotics, and other medication, as ordered. 5.Keep the patient in semi-Fowler’s or Fowler’s position as much as possible to promote pulmonary ventilation. 6.Look for signs of dehydration. 7.Monitor nasogastric tube drainage for color, consistency, and amount. 8.Monitor intake and output. 9.Monitor vital signs frequently. 10.When administering medication, monitor the patient for the desired effects and for adverse reactions. 11.Continually assess the patient’s pain. 12.Monitor urine output carefully to assess renal function, circulating blood volume, and possible urine retention due to bladder compression by the distended intestine. 13.Teach the patient about his disorder, focusing on his type of intestinal obstruction, its cause, and signs and symptoms. 14.Emphasize the importance of following a structured bowel regimen, particularly if the patient had