Intestinal obstruction occurs when the intestine is blocked, preventing normal movement of its contents. It can be caused by mechanical blockages such as tumors or hernias, or functional issues like neuromuscular problems. Symptoms include abdominal pain, vomiting, distension and constipation. Treatment involves fluid resuscitation, antibiotics, pain management, and sometimes surgery to remove the obstruction. Proper diagnosis and timely treatment are important to prevent complications like perforation and sepsis.

1. INTESTINAL
OBSTRUCTION
PRESENTED BY
PANKAJ SINGH RANA
NURSE PRACTITIONER IN
CRITICAL CARE

2. INTRODUCTTION
▪ Intestinal obstruction means blockage of intestinal pathway
that prevents the normal flow of products of intestine.
▪ It is also known as bowel obstruction.

3. DEFINITION
▪ Intestinal obstruction is a significant or mechanical
blockage of intestine that occurs when food or stool
can not move through the intestine.
▪ These obstruction may be complete or partial.

4. CAUSES
MECHANICAL CAUSES:
An intraluminal obstruction or a mural obstruction from
pressure on the intestinal wall occurs e.g.. Tumour &
neoplasm, stenosis, hernia, abscess.

5. FUNCTIONAL OBSTRUCTION:
The intestinal mass culture can’t propel the contents the bowel.
e.g.. Amyloidosis (It is a group of disease in which abnormal
protein known as amyloid fibrils builds up in tissue, it cause &
change in shape, work & also called organ failure.)
-Muscular dystrophy
-Endocrine disorder such as diabetes
-Neurological disorders

6. CLASSIFICATON
ONTHE BASIS OF CHANGES & MOVEMENTS
Dynamic a dynamic
ONTHE BASIS OF DURATION
Subacute & acute chronic
ONTHE BASIS OF LOCATION
Small bowel obstruction & large bowel obstruction

7. ONTHE BASIS OF CHANGES & MOVEMENTS
DYNAMIC: It occurs when peristalsis is working against a mechanical
obstruction.

8. ADYNAMIC: It may occur in two forms:
1.Where peristalsis may be absent. Occurring secondarily to
neuromuscular failure in the mesentery.
2.Where peristalsis may be present in non-propulsive form (pseudo-
obstruction).
* In both form mechanical elements is absent.

9. ON THE BASIS OF NATURE IT IS
CALSSIFIED INTO
SUBACUTE & ACUTE: It usually occurs in small bowel
obstruction with sudden onset of severe colicky central
abdominal pain distension & early vomiting & constipation.
CHRONIC OBSTRUCTION : Usually seen in large bowel
obstruction with lower abdominal colic and absolute
constipation, followed by distension.

10. ON THE BASIS OF LOCATION
▪ Small bowel obstruction: duodenum, jejunum, and ilium are
the part of the small intestine, when the obstruction occur in
this part of intestine.
▪ High bowel wash: ascending colon, transverse colon,
descending colon, cecum, rectum when the obstruction occur
in this part of intestine.

11. SMALL BOWEL OBSTRUCTION
▪ duodenum, jejunum, and ilium are the part of the small
intestine, when the obstruction occur in this part of
intestine.

12. CAUSES
Adhesion 60%
Hernia 20%
Neoplasm 5%
Volvulus 5%.
Others: IBD - gall stone - foreign body – intussusception
Atresia
Stenosis

13. ADHESION

14. ▪ Superior mesenteric artery syndrome: compression of duodenum
by superior mesenteric artery in abdominal aorta

15. INTUSSUSCEPTION

16. VOLVLUS

17. LARGE BOWEL OBSTRUCTION
▪ Descending colon, sigmoid colon rectum and anal canal
is part of large intestine
▪ Large bowel obstruction occur when if obstruction in
these part of intestine

18. CAUSES
Cancer 60%.
Diverticular disease 15%.
Volvulus 15%.
Others: hernia – fecal impaction - IBD.
Inflammatory bowel disease
Constipation
Adhesion
Faecaloma extreme form of faecal immobilization
Colon atresia- narrowing of colon

20. PATHOPHYSIOLOGY
Due to etiological factor
Impairment of passage of material through bowel
Accumulation of flatus,feaceas and retention of fluid,
reduce the fluid absorption and stimulate more gastric
secretion

21. PATHOPHYSIOLOGY
Distension of proximal intestine with solid fluid and gas
With increasing distension, increase intestinal lumen pressure
Decrease in venous in increase in capillary pressure

22. Oedema, congestion with decrease capillary
pressure
Rapture of perforation of intestine
Peritonitis

23. CLINICAL MANIFESTATION
▪ Initial symptoms is usually crampy pain that is wave like and colicky.
▪ Classical symptoms is nausea vomiting and constipation
▪ Without treatment abdominal pain may increase as a result of
perforation
▪ Ischemia
▪ Absence of passage of flatus abdominal distension
▪ Fever
▪ Tachycardia

24. Difference between High & Low
intestinal obstruction
HIGH LOW
BEGINNING Acute Slow, insidious
GENERAL CONDITION Early compromission preserved
PAIN Crampy pain in paroxism Less intensity
VOMITING Early, profuse, biliary Late, feculent may
be absent
ABDOMINAL
DISTENTION
Moderate, upper
quadrant Early, intense
CONSTIPATION + +++
ELECTOLYTES Cl, K, Na rapid loss Late hydro electrolytic
imbalance

25. COMPLICATION
▪ Intestinal perforation
▪ Peritonitis due to perforation
▪ Sepsis- mostly in which delay in diagnosis or treatment.
▪ Intraabdominal abscess.
▪ Dehydration
▪ Electrolyte disturbance
▪ Multiple organ failure(rarely)
▪ Death

26. DIAGNOSTIC EVALUATION
HISTORY COLLECTION
present medical and surgical history
past medical and surgical history
PHYSICAL EXAMINATION
LABORATORYTEST
 RADIOLOGICALTEST

27. PHYSICAL EXAMINATION
INSPECTION
Abdominal Distention, scar, visible peristalsis,
PERCUSION
Tympani, dullness
AUSCULTATION
Bowel sounds
PALPATION
Mass, tenderness, gaurding

28. LABORATORY FINDINGS
• CBC:
–Increase PCV (dehydration ) and increase in WBC.
• KFT:
–Increase in BUN and creatinine .
• Lactate concentration-amylase-lactic dehydrogenase useful but
not sensitive
–Torule out necrosis
• ABG:
–metabolic alkalosis and respiratory acidosis.

29. RADIOLOGICAL EVALUATION

31. SIGMOIDOSCOPY (FLEXIBLE)
▪ it is a minimal invasive endoscopic procedure for large
intestine from the rectum through the last part of the colon

32. COLONOSCOPY
▪ it is the endoscopic procedure for large intestine and
digital part of the small with fibber optic camera on a
flexible tube passed through the anus and it provide
the visual diagnosis show location of obstruction

34. CT SCAN

35. MEDICAL MANAGEMENT
 Fluid replacement with aggressive intravenous resuscitation using
isotonic saline or ringer lactate is indicate.
 Antibiotic therapy for gram negative bacteria such as cefazolin and
cefotaxime and meropenem
 Antiemetic for symptomatic relief of nausea and vomiting such as
ondansetron
 Analgesic to relief pain such as morphine, fentanyl and diclofenac.

36. ▪ Diuretics to reduce the fluid retention such as
furosemide.
▪ Stool softener such as duphalac for relief
constipation

37. SURGICAL MANAGEMENT
▪ Bowel resection (enterotomy) - it is a surgical procedure in
which a part of bowel is removed, from either small
intestine or large intestine.
▪ Colostomy
▪ Bypass surgery

41. DIETARY MANAGEMENT
Clear liquid diet- a Clear liquid diet starting with soups and
advancing to half cup to one cup portions.
Food allowed on clear liquid diet, fruit juice after 1 to 2 weeks.
Low fibber diet- temporarily limiting the amount of fibber for
bowel healing

42. Low fibber rich diet such as white bread with outs nuts and seeds
White rice, plain white pasta
Well cooked vegetables and fruits without skin and seeds
Avoid hot spicy and cholesterol rich diet
Avoid alcohol
Avoid smoking

44. Acute pain related to intestinal obstruction as
evidence by patient verbalization.
Goal- resolved the pain
Intervention-
▪ assess level, frequently and type of pain.
▪ Provide comfortable position
▪ Administer the prescribed medication provide diversional
therapy
▪ Provide calm environment

45. Imbalance nutrition less than body requirement related to
altered nutritional absorption as evidence by aversion to
eating
Goal: Enhance the nutritional status
Intervention:
▪ Recommend bed rest before meal
▪ Provide oral hygiene
▪ Avoid food that cause abdominal cramping
▪ Record intake and output
▪ Promote patient participation in dietary planning as possible

46. Risk for deficit fluid volume related to vomiting as
evidence by skin turgidity
Goal: maintain adequate fluid and volume level
Intervention:
▪ Monitor intake and output
▪ Note possible condition that may lead to deficient fluid loss.
▪ Monitor vital sign
▪ Observe the skin condition
▪ Administration preantral fluid

47. Anxiety related to changes in health status as
evidence by somatic complaints
Goal: Patient feel relaxed
Intervention
▪ Review physiological factor such as active medical condition
▪ Observe and note behaviour
▪ Encourage verbalization of feeling

48. A clinical study of intestinal obstruction and its surgical Management in
rural population
Naveen N, Avijeet Mukherjee, Nataraj Y. S, LingeGowda S. N.
The study revealed that Intestinal obstruction is more common in the
age group of 30-60 years. Small bowel obstruction is more common
than large bowel obstruction. Four cardinal features of intestinal
obstruction are pain abdomen, vomiting, distension and constipation.
Most common etiological factor is postoperative adhesions followed
by abdominal hernia. Malignancy as a cause for obstruction is more
common in large bowel than small bowel. Intravenous fluids and
electrolytes, gastrointestinal aspiration, antibiotics and timed
appropriate surgery are still the mainstay of treatment.

49. CONCLUSION
▪ At last in this topic I would like to say intestinal
obstruction is a digestive system disorder that may
affect the intestinal which are responsible for
movement of digestive food particles, faeces, gases.
▪ if they are not passed it will strangulate in intestine and
cause many problem. It may also cause intestinal
perforation that is life threatening condition and if not
treated it will cause death.