Path Notes: Intestinal Obstruction*****

Question 1

What are the major locations where intestinal obstructions can occur (in general terms)?

Answer 1

1. Within the lumen
2. Within the wall
3. Outside the wall

Question 2

What are examples of intestinal obstructions arising from within the lumen?

Answer 2

Tumours
Strictures
Atresias
Bands
Faecaliths**
Foreign Bodies
Gallstones

Question 3

What are examples of intestinal obstructions arising from within the wall of the intestine?

Answer 3

**Intussusception (where one section of the intestine invaginates into an adjacent section, like the expanding portion of a telescope)

Inflammatory strictures

Tumours

Question 4

What are examples of intestinal obstructions arising from outside of the intestinal wall?

Answer 4

**Adhesions (post-surgical, due to peritonitis, endometriosis - where lining of uterus grows outside of uterine cavity)

**Hernias (weaknesses in the wall that allos a protrusion of the perinoneal sac (called a hernial sac) that intestinal contents can squeeze into - can be femoral, inguinal, umbilical, associated with surgical scars)

**Volvulus (complete twisting of a section of intestine, around its mesenteric attachment site)

Question 5

What is a pseudo-obstruction?

Answer 5

Medical condition where there is severe impairment of the intestines to push through, without the presence of an actual intra-luminal, within-the-wall or outside-the-wall obstruction.

Question 6

What are some causes of pseudo-obstruction?

Answer 6

Paralytic Ileus (disruption of normal propulsive action of the SI)

Vascular-bowel infarction (due to restricted blood supply)

Myopathies

Hirschsprungs Disease (condition where a section of the GIT has no nerves and thus cannot function properly - congenital)

Question 7

Describe the clinical presentation of someone with bowel obstruction

Answer 7

1. Abdominal Pain
2. Abdominal Distension
3. Vomiting
4. Constipation - constipation of faeces AND flatus occurs in the obstruction is complete*