Exam 2: Chapter 47 - Intestinal Obsturction Flashcards
When does a intestinal obsturction exist?
When blockage prevents the normal flow of intestinal contents through the intestinal tract
Two types of processes that impede flow??
Mechanical Obsturction Functional or Paralytic Obstruction
What is a Mechicl Obstruction?
An intraluminal obsturction or a mural obstruction form pressure on the intestinal wall occurs
Blockage occurs within the intestine.
Examples include intussusception, polypoid tumors and neoplasms, stenosis, strictures, adhesions, hernias, abscesses, and bezoars (foreign objects created by ingesting unusual substances)
What is a Functional or Paralytic Obstruction?
The intestinal musculature cannot propel the content along the bowel.
Peristalsis is impaired, such as after surgery
Examples include amyloidosis, muscular dystrophy, endocrine disorders such as diebetes, or neurologic disease.
Most bowel obstructions occur in
the small intestine
Most common cause of small bowel obstruction?
Adhesions, followed by tumors, Crohns Disease, and Hernias
Other causes include intussusception, volvus (twisting of teh bowel) and paralytic ileus.)
Moswt obstructions in the large bowel occur in the
sigmoid colon
what are adhesions
Loops of intestine become adheent to areas that heal slowly or scar after abdominal surgery. Occurs most commonly in small intestine
what is a incarcerated hernia
bowel comes up through the abdominal wall
what does a tumor do
decreases lumen, where not as much can get through
Tumor exists within the wall of the intestine extends into the intestinal lumen or a tumor outside the intestine causes pressure on the wall of the intestine
what does intussusception cause
bowel went back into itself, causes a decrease in lumen
what does the vovulus do?
when the bowel becomes twisted and occludes the blood supply
Vomiting in this conndition causes?
Loss of hydrogen ions and potassium from the stomach, leading to reduction of chloride and potassium in the blood and to metabolic alkalosis
Signs and Symptoms?
Initial symptom is usually crampy pain that is wavelike. May pass blood and mucus but no fecal matter and no flatus. Peristaltic waves reverse directions.
Signs of dehydration become evident with intense thirst, drowsiness, generalized malaise, aching, and parched tongue. Abdomen becomes distended.
Increased bowel sounds before the blockage Parched tongues and mucous membranes due to dehydration
Labs and Diagnostics?
Abdominal X-Ray and CT Scan include abnormal quantities of gas, fluid, or both.
Lab studies include electrolyte studies and CBC. CBC determines if you’re losing blood and WBC level indicates if infection present.
Interventions
Letting bowel rest for three days while decompressing through NG tube.
Want to avoid surgery if possible. When bowel completely obstructed, the possibility of strandgulation and tissue necrosis warrants surgical intervention. Laparoscopy has become increasingly common.
How will you montior this?
Measuring NG output, assessing for fluid and electrolyte imbalance, monitoring nutritional status.
Large Bowel: Obstruction can lead to
severe distention and perforation unless some gas and fluid can flow back through the ileocecal valve
Large Bowel: How does dehydration compare here vs in the small bowel?
Dehydration occurs more slowly than in the small intestine becausue the colon can absorb its fluid contents and distend to a size considerably beyond its normal full capacity.
Large Bowel: What accounts for the majority of large bowel obstructions?
Adenocarcinoid tumors (tumor of the appendix)
Large Bowel: Sign and Symptoms here?
With obstruction in the sigmoid colon or the rectum, constipation may be the only symptoms for weeks.
Shape of stool is altered as it passes obstruction. Patient may experience weakness, weight loss, and anorexia.
Large Bowel: Diagnosis for Large Intestine obstruction?
Based on symptoms and imaging studies.
Abdominal x-ray and abdominal CT or MRI reveal a distended colon .
Large Bowel: What is attempted to be corrected?
Restoration of intravascular volume, correction of electrolyte abnormalities, and NG aspiration and decompression are instituted immediately
Large Bowel: Why would a colonoscopy be used?
May be performed to untwist and decompress the bowel
Large Bowel: Why would a cecostomy be used?
Surgical opening is made into the cecum, may be performed in patients who are poor surgical risk and urgently need relief from the obstruction.
Provides an outlet for releasing gas and a smal amount of drainage.
Large Bowel: Why would a rectal tube be used?
Decompress an area that is lower in the bowel .
Large Bowel: What is the usual treatment ?
Surgical resection to remove the obstructing lesion. Temporary or permanent colostomy may be necessary
