It’s the partial or complete blockage of the lumen of the small or large bowel.

it’s commonly a medical emergency.

Intestinal obstruction develops in three forms: • Simple: blockage prevents intestinal contents from passing, with no other complications. • Strangulated: blood supply to part or all of the obstructed section is cut off, in addition to blockage of the lumen. • Close-looped: both ends of a bowel section are occluded, isolating it from the rest of the intestine.

Intestinal obstruction results from mechanical or non mechanical ( Neurogenic ) blockage of the lumen. Adhesions & strangulated hernias ( usually associated with small bowl obstruction). Chronic, severe constipation or fecal impaction Carcinomas (usually associated with large bowel obstruction) Foreign bodies such as fruits pits, gallstones & worms Compression of the bowel wall from stenosis. Intussusception Volvulus of the sigmoid or cecum Tumors & atresia.

usually results from Paralytic ileus electrolyte imbalances toxicity such as that associated with uremia or generalized infection. Neurogenic abnormalities such as spinal cord lesions & thrombosis or embolism of mesenteric vessels.

several days after constipation begins . he may report vomiting of fecal contents. the hallmark of all types of mechanical obstruction auscultation may reveal bowel sounds Borborygmi. and constipation.He may describe his vomits as orange-brown and foul smelling which is characteristic of large-bowel obstruction . vomiting. Hypovolemic shock or septic shock. • Mechanical obstruction of the large bowel In patient with mechanical obstruction of the large bowel. Inspection may reveal a distended abdomen . Mechanical obstruction: The patient may complain of : • colicky pain. • The patient’s history may reveal constant hypogastric pain. • a history of constipation is common. nausea. Secondary infection . • If obstruction is complete .Perforation. vomiting. In the later stages . Septicaemia. And rushes (occasionally loud enough to heard without stethoscope ) • Palpation may be disclose abdominal tenderness. Rebound tenderness may be noted in patients with obstruction that result from strangulation with ischemia . Peritonitis. If untreated . Metabolic alkalosis or acidosis. the patient may report the sudden onset of colicky abdominal pain . nausea and..death . • .

The type of the surgery depends on the cause of blockage . • on inspection the abdomen is distended . Postoperative care involves: Careful patient monitoring and interventions geared to the type of surgery. • early in disease . he also reports frequent vomiting which may consist of gastric and bile contents but rarely fecal contents he may also complain of constipation and hiccups. • if obstruction result from vascular insufficiency or infraction the patient may complain of sever abdominal pain .taking as long as 6 to 8 hours . for example if a tumour is obstructing the intestine. the abdomen may appear dramatically distended . .it include: Correction of fluid & electrolyte imbalances .• on inspection . Surgical preparation is often lengthy. • Partial obstruction usually causes similar signs and symptoms. Leakage of liquid stools around the partial obstruction is common. with visible loops of large bowel auscultation may reveal loud . Non mechanical obstruction:The patient with a non mechanical obstruction usually describes: • diffuse abdominal discomfort instead of colicky pain . auscultation discloses decreased bowel sound these the sign disappears as the disorder progress • • • • • • • • • Surgery is usually the treatment of choice for complete obstruction. a colon resection with anastomosis is performed . high-patched broborygmi. In a milder form. if adhesions are obstructing the lumen. these are lysed . • typically. Decompression of the bowel to relieve vomiting and distension. Treatment of shock & peritonitis and administration of broad spectrum antibiotics.

Provide I. • To ease discomfort. continuous suction. Monitor drainage for color. dry cracked lips. Look for signs of dehydration (thick. blood urea nitrogen. Attach the tube to low-pressure. Remember. if necessary.• • • • • • • • • Total parenteral nutrition may be ordered if the patient has a protein defict from chronic obstruction. and amount. Non surgical treatment usually include : Decompression with an NG tube attached to low-pressure . a long nasointestinal tube is used for decompression. • Allow the patient nothing by mouth. swollen tongue. • Administer analgesics. • Insert an NG tube to decompress the bowel as order. • Because internal obstruction may be fatal and often causes overwhelming pain and distress. intermittent suction. • Maintain fluid and electrolyte balance by monitoring electrolyte. • If surgery won't be performed. tetany) or acidosis . as order. correction of fluids and electrolyte deficits. Non surgical treatment may be attempted in some patients with partial obstruction. slow shallow respirations. dry oral mucous membranes). postoperative or paralytic ileus or infection. but make sure to provide frequent mouth care to help keep mucous membranes moist.V fluids to keep levels within normal ranges. broad-spectrum antibiotics. hypertonic muscles. administration of broad-spectrum antibiotics. total parenteral nutrition. help the patient change positions frequently. Irrigate the tube. the patient may be allowed a few ice chips. consistency. • Watch for signs of metabolic alkalosis (changes in sensorium. and creatinine levels. colicky pain that suddenly becomes constant could signal perforation. Monitor the patient for desired effects and for adverse reactions. Avoid using lemoglycerin swabs. patients require skillful supportive care and keep observation. with normal saline solution to maintain patency. • Continually assess his pain. and other medications as order. Rarely. which can increase mouth dryness. occasionally.

. These positions pulmonary ventilation and ease respiratory distress from abdominal distention. and arrange for an enterostomal therapist to visit him. and signs and symptoms. teach him how to care for it. If surgery is scheduled. and monitor intake and output. Monitor urine output carefully to assess renal function. relieve pain and discomfort. focusing on his type of intestinal obstruction. review incisional care. Make sure the patient understands that these procedures are necessary to relieve the obstruction and reduce pain. Care for the surgical site. such as fever and chills. rapid breathing. weakness. if he has a colostomy or ileostomy. After surgery. • Demonstrate techniques for coughing and deep breathing. and malaise). and later. Provide preoperative teaching. After surgery. and watch for other signs of resuming peristalsis( passage of flatus and mucus through the rectum). • Prepare the patient and family members for the possibility of surgery. maintain respiratory status. provide all necessary postoperative care. • Explain necessary diagnostic tests and treatments. circulating blood volume. deep. Also. • Teach the patient about his disorder. Also measure abdominal girth frequently to detect progressive distention. Watch for signs and symptoms of secondary infection. and possible urine retention due to bladder compression by the distended intestine. its cause. catheterized the patient for residual urine immediately after he has voided. Listen for bowel sounds. maintain fluid and electrolyte balance. disorientation. • Tell the patient what to expect postoperatively. Keep the patient in semi-Fowler's or Fowler's position as much as possible. • Provide emotional support and positive reinforcement before and after surgery.• • • • • • (shortness of breath on exertion. and reinforce the physician's explanation of the surgery. and teach the patient how to use incentive spirometry. Listen to his questions and take time to answer them. If you suspect bladder compression. prepare the patient as required.

. and possible adverse reactions.• Discuss postoperative activity limitations and point out why these restrictions are necessary. desired effects. • Review the proper use of prescribed medications. • Encourage him to eat a high –fiber diet and to exercise daily. focusing on their correct administration.

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