TH4 - INTESTINAL OBSTRUCTION Flashcards
MECHANICAL OBSTRUCTION
Luminal content cannot pass through gut tube because lumen is blocked
> MECHANICAL BLOCK
FUNCTIONAL OBSTRUCTION
NEUROGENIC / FUNCTIONAL OBSTRUCTION
PROBLEM WITH FUNCTION > MOTILITY
Lumen content not able to pass through due to disturbance in motility and prevent peristalsis from one region to other gut region
SIMPLE OBSTRUCTION
INTESTINAL LUMEN PARTIALLY/ COMPLETELY OCCLUDED WITHOUT ANY CHANGES TO INTESTINAL BLOOD FLOW
NO PROBLEM WITH BLOOD FLOW
STRANGULATION OBSTRUCTION
BLOOD FLOW TO OBSTRUCTED SEGMENT IS COMPROMISED > TISSUE NECROSIS + GANGRENE
PROBLEM WITH BLOOD FLOW
OPEN LOOP OBSTRUCTION
INTESTINAL FLOW IS BLOCKED BUT PROXIMAL DECOMPRESSION POSSIBLE VIA VOMITING
PROXIMAL END OF LOOP = OPEN
CLOSED LOOP OBSTRUCTION
INFLOW + OUTFLOW OF LOOP BOTH END = BLOCKED
COMPLETE OBSTRUCTION WITH GAS + SECRETIONS TO ACCUMULATE IN LOOP WITHOUT ANY DECOMPRESSION PROXIMALLY/ DISTALLY
GENERAL SYMPS OF INTESTINAL OBSTRUCTION
ABDOMINAL PAIN - COLICKY NAUSEA VOMITING - SBO - BILE/FOOD VOMIT - LBO - FECAL VOMIT CONSTIPATION DEHYDRATION - DUE TO VOMIT
CHARACTER OF ABDOMINAL PAIN IN STRANGULATED OBSTRUCTION
> CRAMPY/ COLICKY PAIN = EARLY STAGE
progress to severe/ constant pain
strangulated loop in contact with inner aspect of abdominal wall > cause severe localised pain
CHARACTERISTIC OF X RAY FOR INTESTINAL OBSTRUCTION
DISTENDED GAS
FLUID FILLED LOOPS OF BOWL WITH FLUID LEVELS
STANDARD METHOD FOR IMAGE DX IN PX WITH INTESTINAL OBSTRUCTION
PLANE ABDOMINAL X RAY TAKEN IN ERECT + SUPINE POSITION
VOLVULUS
LOOP OF BOWEL TWISTED MORE THAN 180 deg. ABOUT AXIS OF ITS MESENTERY
> FORM OF CLOSED LOOP OBSTRUCTION
OBSTRUCTION + ISCHEMIA OF LOOP OCCURS
MOST COMMON SITE FOR VOLVULUS
SIGMOID COLON
65% OF CASES
HAPPENS MORE COMMON IN BED BOUND PX WITH NO MOBILITY + CHRONIC CONSTIPATION
COFFEE BEAN SHAPE SEEN ON X RAY
INTUSSUSCEPTION
ONE SEGMENT OF BOWEL TELESCOPES INTO ADJACENT SEGMENT
INTUSSESCEPTUM
SEGMENT WHICH INVAGINATE INTO INTUSSUSCIPIENS > RESULTS IN OBSTRUCTION + ISCHEMIC INJURY OF INTUSSUSCEPTING BOWEL
4 TYPES OF INTUSSUSCEPTION
1) ENTERIC
2) ILEOCOLIC
3) ILEOCECAL
4) COLONIC
CHILDREN ARE MOSTLY AFFECTED BY?
INTUSSUSCEPTION
WHO IS MOSTLY AFFECTED BY INTUSSUSCEPTION?
CHILDREN
PATHOLOGICAL CONDITION RELATED WITH INTUSSUSCEPTION
TUMORS
MAINLY > ADULTS
90% OF CASES
GALLSTONE ILEUS
INTENSE INFLAMMATION SURROUNDING GALL BLADDER WITH GALL STONES IN LUMEN
FISTULA MAY DEVELOP BETWEEN BILIARY TREE + SMALL/ LARGE INTESTINE
STONE PASS THROUGH FISTULA + CAUSE OBSTRUCTION OF SMALL/ LARGE BOWEL
WHAT IS ILEUS
TEMPORARY SLOWING OF DIGESTIVE TRACT MOTILITY > leading to blockage + build up of digestive tract
ACUTE MESENTERIC ISCHEMIA
constant + severe decrease of blood flow to small intestine due to obstruction in mesenteric artery
MESENTERIC ARTERY
ARTERY PROVIDING OXYGEN + NUTRIENTS TO INTESTINES
BRANCHE FROM ABDOMINAL AORTA
PHYSIOLOGICAL MECHANISMS LEADING TO ACUTE MESENTERIC ISCHEMIA
- ARTERIAL EMBOLUS
- ARTERIAL THROMBOSIS
- VASOSPASM
- VENOUS THROMBOSIS
MC CAUSE OF ACUTE MESENTERIC ISCHEMIA
EMBOLUS
50% OF CASES
