Intestinal obstruction Flashcards
Types
Mechanical Functional (ileus)
Clinical presentation Mechanical
Colicky abdominal pain
Associated with vomiting (earlier with small bowel) and absolute constipation (earlier with large bowel)
Distension and tinkling bowel sounds
Subtypes of Mechanical intestinal obstruction
Small and large bowel obstructions depending on the location of the blockage
Mechanical pathophysiology
Depends on aetiology
A physical factor is preventing the movement of contents of the intestine through the tract.
This then causes backing up of the GI tract and an inability to empty -> vomiting and constipation
Small mechanical bowel obstruction aetiology
Adhesions, strangulated hernia or volvulus.
Possible malignancy.
Most commonly: intra-abdominal adhesions from large operations.
Intussusception
Large mechanical bowel obstruction aetiology
Most often colorectal malignancies
Is small or large mechanical more common
Small
Mechanical diagnosis
Abdominal X-ray
Mechanical treatment
Conservative = fluid replacement and intestinal decompression
Surgery = Resection possible, usually done in large bowel
If as a result of malignancy: Corticosteroids, opioids and anti-emetics
Complications of mechanical (large)
Carcinoma that causes obstruction is usually already advanced and metastatic
Clinical presentation of functional
Pain often not present and bowel sounds reduced
Constipation and vomiting
Pathophysiology of functional
*Bowel ceases to function and there is no peristalsis
This causes impaction since contents no longer move along the intestine.
*Aetiology of functional
Most often post-operative to peritonitis or any major abdominal surgery.
Associated with opiate treatment
Possible: nerves or muscles are damaged
Diagnosis of functional
X ray (gas seen throughout the bowel)
Treatment of functional
fluid replacement and intestinal decompression
