Transcript chronic inflammatory bowel disease

INTESTINAL OBSTRUCTION
Dr. Mohammad Jamil Alhashlamon
Intestinal Obstruction Causes
• Adhesions or Bands
– Resulting from previous surgery or intraperitonial
infection ( rarely congenital band)
• Strangulated external hernia
– Femoral or inguinal or umbilical
• Tumors
• Volvulus of small or large bowel
– A mobile or distended loop of bowel rotates causing
obstruction at its neck
• Inflammatory stricture
– e.g. diverticular disease , crohns disease ( obstruction
usually incomplete )
• Bolus obstruction
– e.g. impacted faeces , foreign body , gaalstone .
• Internal hernia
• Itussusception
– Usually initiated by a mass in the bowel
Pathophysiology
• Obstruction lead to dilation of bowel
proximally and disrupt peristalsis .
• Presentation depend on :
– Level of obstruction
– Completeness of obstruction
Symptoms of intestinal obstruction
• Vomiting
– The more proximal the obstruction the earlier it
develops .
– Nature of vomitus give important clues to the
level of obstruction .
– Change to faeculent vomiting usually take place
gradually after about 24 hours of complete
obstruction .
• Pain
– Fluid and swallowed air proximal to the
obstruction together with continuing peristalsis
cause the pain .
– Usually mild m colicky .
– Small intestine obstruction cause central
abdominal pain .
– Large intestine obstruction cause suprapupic
abdominal pain .
• Constipation
– Absolute constipation or obstipation
– The lower the obstruction the earlier the
obstipation develops .
• Symptoms develops more gradually in the
large bowel obstruction
• If the ileocecal valve remain competent , the
caecum will progressively distend and
eventually rupture .
• The ileocaecal valve become incompetent in
50% of the cases and this allow small intestine
distension and delay the onset of symptoms .
Incomplete obstruction
• If the bowel partially obstructed , the clinical
features are less clearly defined .
• The pain is often accompanied by visible
peristalsis ( this is the hallmark of partial
obstruction )
• The most common cause is slowly growing
cancer in the colon .
Physical signs of intestinal obstruction
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Dehydration
Abdominal distension
Visible peristalsis
Signs of primary cause .
Lack of tenderness “except in
strangulation “
• Mass “ if it is the cause “
• Bowel sounds will be “ loud , frequent , high
pitched and tinkling “
• Succession splash may be positive
Investigation of suspected obstruction
• Plane abdominal X-Ray
• Abdominal X-Ray with contrast
Adynamic intestinal obstruction
• Temporary disruption of normal peristaltic
activity without mechanical blockage .
• If happened in the small intestine called
“paralytic ileus “
• If happened in the large intestine called
“psudo-obstruction of the colon “
Paralytic ileus
• Most commonly post surgery .
• May also happened in :
– Hypokalemia
– Side effect of anti-parkinson medications
Psudo-obstruction of the colon
• Caused by :
– Retroperitonial inflammation or hemorrhage
– Neurological illnesses
– Anticholenergics
– Pregnancy
– Orthopedic injuries and surgery
• Physical signs : similar to those of the
mechanical obstruction except the absence of
bowel sounds
Management of intestinal obstruction
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Keep NPO
IV fluid and correct electrolytes
NG tube
Treat the underlying pathology
Bowel Strangulation
• Segment of the bowel trapped so that the
lumen becomes obstructed and its blood
supply compromised
• If unrelieved , this progress into infarction and
eventually perforation .
• This happened mostly in hernia and volvulus .
symptoms and signs of strangulation
• Signs and symptoms of obstruction
• Abdominal tenderness
• The patient more unwell and tachycardia and
lucocytosis
• Management :
– If it is diagnosed or even suspected immediate
surgery .
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