1 Intestinal obstruction Halel Khaled Al-ward

DEFINITION:
it is blockage of the intestines

or blockage prevent the flow of intestinal contents through the

intestinal tract .

the obstruction can be : partial , complete

1) small bowel obstruction this is most bowel obstruction occur in

the small intestine .

2) result accumulate intestinal contents ,fluid, gas above l . o .

3) the most common cause are adhesions followed by hernias and

neoplasms.

Large obstruction:

This is Most obstruction in the large bowel occur in the sigmoid

colon .
Result accumulation intestinal contents fluid , gas , proximal to the
obstruction .
The most common causes are carcinomia , diverticulitis ,
inflammatory bowel disorder and benign tumors .

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 ANATOMY & PHYSIOLOGICAL
Parts of small intestine:
1) Duodenum.
2)Jejunum.
3) Ileum.

Parts of large intestine:

1) Cecum.
2) Ascending colon.
3) Transverse colon.
4) Descending colon.
5) Sigmoid colon.
6) Rectum.

FUNCTIONS OF SMALL & LARGE INTESTINE

Small intestine large intestine

 Complete digestion of  Absorbs H2O.
proteins &  Manufactures vitamins.
carbohydrates & feat.  Produces mucous.
(PCF).  Forms and expels feces.
 Absorb results of PCF
and transferred them to
the bloodstream.

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 CLASSIFICATION
1) According to cases:
a) simple obstruction due to mechanical occultation of
the gut lumen with out interference with is blood
supply .

b) strangulated :
occurs when there is interference with the intestinal
blood supply as when the bowel is trapped or twisted
e.g mesenteric vascular occlusion .

mixed : both lumen and vessels or vascular are blocked .

neurogenic: due to paralysis of peristaltic activity of the gut
paralytic ileus .

2) According to the level of obstruction .

a) High small bowel obstruction .
b) Low small bowel obstruction .
c) Large small bowel obstruction .

3) According to onset and causes of obstruction :

a) Acute obstruction the clinical course is rapid and the

symptoms early to develop .
b) Chronic obstruction slowly progressive symptoms
e.g colon cancer

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 CAUSES:
Causes of intestinal obstruction

Congenital intestinal obstruction

It is found as following conditions:
1. Intestinal atresia.
2. Malrotation.
3. Meconium plug syndrome.
4. Meconium ileus.
5. Annular pancrens.
6. Mickel's diverticulum.

Acquired intestinal obstruction

1. Intussusception.
2. Volvulus twisted loop.
3. Tumor or hematoma.
4. Hernia and strangulation.
5. Stricture or stenosis of the intestine.
6. Inflammatory diseases.
7. Foreign body ( e.g. coin)
8. Worm mass.
9. Paralytic iteus due to toxic

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 RISK FACTORS
Factors that may increase your chance of having a small bowel
obstruction include:
 Hernias
 Crohn’s disease —an inflammatory bowel condition
 Abdominal, joint, or spine surgery
 Swallowing a foreign body
 Decreased blood supply to the small bowel
 Abnormal growth of tissue in or next to the small intestine
 Tumors in the small intestine
 Cancer
 Infection in the lining of the small intestine
 Kidney disease
 Long-standing diabetes
 Rarely, gallstones

PREVENTION
modifying your diet and lifestyle.
 To help prevent colorectal cancer, eat a balanceddiet low in fat
with plenty of vegetables and fruits
 don't smoke
 To help prevent hernias avoid heavy lifting.
 If you develop an abnormal lump under the skin of your
abdomen ,contact your doctor.
 To help prevent diverticular disease should follow a high-fiber
diet and avoid foods that may become lodged in the
diverticula, such as seeds and popcorn.

CLINICAL FEATURES
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 Clinical features
Symptoms Signs
General Local
Abdominal pain Dehydration Absence of
( abdominal cramps ) . bowel sound .
Abdominal distension . Tachycardia or
hypotension .

Absolute constipation . Fever . Abdominal

distension .
Projectile vomiting . Oliguria .

Hypovolemic shock due to rapid Dry tongue.

collapse

COMPLICATION
1) Dehydration .
2) Peritonitis due to rupture .
3) Septicemia .
4) Shock ( hypovolemic shock, septic shock ).

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 DIAGNOSIS :
A.History
B. Physical examination
C. Investigation
 X-ray abdomen and chest.
 Proctoscopy
 simoidoscopy or USG.
 Barium enema .
 Complete blood count shows decrease Na , k and chloride
level and increase WBC count .

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 MANAGEMENT
Medical Management:

 Nothing by mouth ( keep n p o )

 Decompression by gastrointestinal drainage via nasogastric
tube (lavage ).
 I .v fluid and electrolytes.
 Antibiotics are given.
 Detect and treat the causes.
 Urgent surgery for hernia mechanical obstruction.

Surgical Management:

 Surgical Management is done to relieve the obstruction

Laparatomy followed by specific surgery to be done.

 Resection of bowel is done for obstructing lesion or

strangulated.
 In malrotation of gut, cutting of Ladd's band and lengthening
of the roots of the mesentry is done.
 Closed bowel procedure may be done to reduse volvulus and
intussusceptions .
 Enterotomy is performed for removal of foreign bodies in the
intestinal .

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 NURSING INTERVENTIONS
1) Providing rest and comfortable .
2) Relieving pain by analgesics .
3) Maintaining fluid and electrolyte balance by i.v fluid therapy
and recording of intake & out put .

4) Provide preoperative nursing care

 preparing the patient.
 Taking consent form relative with describe.
 Provide any test needed.
 Provide I.V Fluid for supplement during operation.
 Apply all instrument needed.

5) Reducing fear and anxiety by explanation reassurance and

answering questions .
6) Maintaining normal bowel elimination .

7) Provide Postoperative nursing care

 Bandaging and Surgical wound care.
 Check vital signs and take precaution for any problem
with them as needed (NGT ,IV Fluid).
 Management of pain.
 Assess for mobility.
 Assess bowel function.
8) [providing adequate respiration by relieving abdominal
distension through nasogastric tube aspiration .
9) Giving information and instructions for home based long term
care.
10) if patients condition does not improve, prepare him or her
for surgery .

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