Exam 2: Chapter 47 - Intestinal Obsturction

Question 1

When does a intestinal obsturction exist?

Answer 1

When blockage prevents the normal flow of intestinal contents through the intestinal tract

Question 2

Two types of processes that impede flow??

Answer 2

Mechanical Obsturction Functional or Paralytic Obstruction

Question 3

What is a Mechicl Obstruction?

Answer 3

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)

Question 4

What is a Functional or Paralytic Obstruction?

Answer 4

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.

Question 5

Most bowel obstructions occur in

Answer 5

the small intestine

Question 6

Most common cause of small bowel obstruction?

Answer 6

Adhesions, followed by tumors, Crohns Disease, and Hernias

Other causes include intussusception, volvus (twisting of teh bowel) and paralytic ileus.)

Question 7

Moswt obstructions in the large bowel occur in the

Answer 7

sigmoid colon

Question 8

what are adhesions

Answer 8

Loops of intestine become adheent to areas that heal slowly or scar after abdominal surgery. Occurs most commonly in small intestine

Question 9

what is a incarcerated hernia

Answer 9

bowel comes up through the abdominal wall

Question 10

what does a tumor do

Answer 10

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

Question 11

what does intussusception cause

Answer 11

bowel went back into itself, causes a decrease in lumen

Question 12

what does the vovulus do?

Answer 12

when the bowel becomes twisted and occludes the blood supply

Question 13

Vomiting in this conndition causes?

Answer 13

Loss of hydrogen ions and potassium from the stomach, leading to reduction of chloride and potassium in the blood and to metabolic alkalosis

Question 14

Signs and Symptoms?

Answer 14

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

Question 15

Labs and Diagnostics?

Answer 15

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.

Question 16

Interventions

Answer 16

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.

Question 17

How will you montior this?

Answer 17

Measuring NG output, assessing for fluid and electrolyte imbalance, monitoring nutritional status.

Question 18

Large Bowel: Obstruction can lead to

Answer 18

severe distention and perforation unless some gas and fluid can flow back through the ileocecal valve

Question 19

Large Bowel: How does dehydration compare here vs in the small bowel?

Answer 19

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.

Question 20

Large Bowel: What accounts for the majority of large bowel obstructions?

Answer 20

Adenocarcinoid tumors (tumor of the appendix)

Question 21

Large Bowel: Sign and Symptoms here?

Answer 21

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.

Question 22

Large Bowel: Diagnosis for Large Intestine obstruction?

Answer 22

Based on symptoms and imaging studies.

Abdominal x-ray and abdominal CT or MRI reveal a distended colon .

Question 23

Large Bowel: What is attempted to be corrected?

Answer 23

Restoration of intravascular volume, correction of electrolyte abnormalities, and NG aspiration and decompression are instituted immediately

Question 24

Large Bowel: Why would a colonoscopy be used?

Answer 24

May be performed to untwist and decompress the bowel

Question 25

Large Bowel: Why would a cecostomy be used?

Answer 25

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.

Question 26

Large Bowel: Why would a rectal tube be used?

Answer 26

Decompress an area that is lower in the bowel .

Question 27

Large Bowel: What is the usual treatment ?

Answer 27

Surgical resection to remove the obstructing lesion. Temporary or permanent colostomy may be necessary