Intestinal Obstruction
Prepared by : A.A.A
Under supervision : Dr Mohemed Hazim
Objective
To understand:
The Pathophysiology of dynamic and Adynamic intestinal obstruction
The Cardinal features on history and examination
• The Causes of small and large bowel obstruction
• The Indications for surgery and other treatment options in bowel obstruction
CLASSIFICATION classified into two types:
Dynamic
Adynamic
PATHOPHYSIOLOGY
Gas
Fluid
STRANGULATION
Causes of strangulation
■ Direct pressure on the bowel wall Hernial orifices Adhesions/bands
■ Interrupted mesenteric blood flow Volvulus Intussusception
■ Increased intraluminal pressure Closed-loop obstruction
SPECIAL TYPES OF MECHANICAL INTESTINAL OBSTRUCTION
Internal hernia
Obstruction from enteric strictures
Bolus obstruction : Gallstones , food , Trychobezoars and phytobezoars , Stercolith and worms.
Obstruction by adhesions and bands
Acute intussusception
This occurs when one portion of the gut invaginates into an immediately adjacent segment; almost invariably, it is the proximal into the distal.
Volvulus
C/F OF INTESTINAL OBSTRUCTION
C/F of strangulation
C/F of Intussusception
‘Redcurrant Jelly’ Stool
Imaging
TREATMENT
ADYNAMIC OBSTRUCTION
Varieties of Paralytic Ileus :
• Postoperative
• Infection
• Reflex ileus
• Metabolic
Pseudo-Obstruction
Thank You
GEMC: Mesenteric Ischemia: Resident Training Open.Michigan
This is a lecture by Dr. Andrew Barnosky from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
in this presentation me & my colleagues discuss briefly the types of mesenteric ischemia ( acute , chronic , venous ) and its related syndromes (superior mesenteric artery syndrome , celiac trunk syndrome and supply it by good radiologic images ..
Abdominal xray - imaging and interpretation ArushiGupta119
everythng about abdominal radiograph is discussed from views to obstruction to foreign body.
definetly u r not going to get bored
read and share with your peers.
Rapid review of radiology text book, abdominal imaging, contrast imaging, CT , plain x ray, IVU , power point of abdominal pathological cases and description of diagnosis , differential diagnosis of diagnosis
acute abdomen conditions in radiology and their evaluation
acute pancreatitis, cholicystitis, pelvic pathology, mri evaluation , intra abdominal abcess, plain radiography evaluation of acute abdomen, vascular causes of acute abdomen, causes of acute abdomen.
In these slides we will go through the surgical anatomy of the gut,pathophysiology of intestinal obstruction, clinical presentation and management. Also we will discuss specific types of intestinal obstruction.
Abdominal pain is one of common problems
encountered by doctors, either in primary or
secondary health care (specialists). It may be
mild, but it may also a life-threatening sign. It
has been estimated that almost 50% adults have
experienced abdominal pain. In general, abdominal pain is categorized
based on the onset as acute or chronic pain.
Sudden onset of abdominal pain that lasts for less
than 24 hours is considered as acute abdominal
pain.
The problems of a surgeon
If 'I' operate 'and 'the' problem 'is' not 'surgical, Pt
exposed 'to' unnecessary 'risk ,'anesthetic,'etc.'
Risks 'greater' with 'concomitant 'illness,'older 'age'
If 'I' do 'not' operate 'and' problem 'is' surgical, 'patient 'at'
risk 'because' of 'wrong' therapy.'
Again 'the' older 'patient 'is' under 'greater' burden.'
2. 65 year old White male T: 98.9 P 110 R 16 BP 120/80
presents complaining of Gen: elderly male in NAD,
HEENT: PERRL, NCAT,
diffuse, crampy abdominal Oropharynx clear
pain. He began vomiting a CV: mildly tachycardic, No m/r/g
few hours ago and feels very Pulm: CTAB
Abd: active, high-pitched bowel
nauseated. His last bowel sounds; mild TTP diffusely, No
movement was yesterday. rebound/guarding; mild
He has a history of an open- distention
cholecystectomy and open - Ext: 2+ pulse, no c/c/e
appendectomy.
3.
4. 1. Air Fluid Levels
2. String of Pearls Sign
1. small, round air pockets
trapped in plicae circulares
(valvulae conniventes) of
small intestine
3. Dilated Bowel >3cm
1. Rule of 3,6,9
4. Coiled Spring Sign
5. Plicae Circulares
(Valvulae Conniventes)
1. Indicates Small Bowel
involved
6. No gas in colon
1. Indicates Small Bowel
involved
5. Most common causes: (1) surgical adhesions (2)
Hernia (3) Tumor (4) Inflammatory Bowel Disease
(5) Intussusception (6) Gallstone Ileus
Rule of 3,6,9:
suspect obstruction if small bowel dilated >3cm; large bowel >6cm,
cecum >9cm.
“Never Let the Sun Rise or Set on a Small Bowel
Obstruction”
6. IV & IVFs
NG Decompression
Analgesics and Antiemetics
Surgery Consult
Approximately one-quarter of patients admitted for small
bowel obstruction will require operation.
Patients suspected of having complete or closed-loop
obstruction with fever, leukocytosis, tachycardia, metabolic
acidosis, continuous pain or peritonitis warrant prompt
exploration
Antibiotics are suggested if surgery planned.
Admission to hospital
Medical service is reasonable disposition if patient does not
have significant risk factors for surgical managment
7. String of Pearls Sign = obstruction
Small Bowel: air pockets trapped in valvulae of small intestine, smaller,
rounder
Large Bowel: air pockets trapped in haustra; larger, and have flat
underside
Large Small
Bowel Bowel
8. • Coiled Spring Sign: • Slit sign:
•Dilated coils of small bowel • Caused by small amounts
that appear stacked of air caught in the valvulae
•Indicates SBO of fluid-filled bowel that
appear as “slits of air”
• Similar to string of pearls
sign
• Indicates SBO
