INTESTINAL OBSTRUCTION

This is an interference with normal passage

of intestinal contents
 Сlassified as:

• mechanical and functional

• adynamic and dynamic

• mechanical and dynamic

 Mechanical
Mechanical obstruction can be:

• obturation (without squeezing of the

mesanteric vessel),

• strangulation obstruction (with squeezing of the

mesanteric vessel)

• combined.
 Dynamic

• Spastic

• Paralytic
Classification according to level
of obstruction
• High small bowel obstruction

• Low small bowel obstruction

• Large bowel obstruction

 OBSTRUCTION
• Complete and partial

• Acute and chronic

 Mechanical obstruction is most
frequently caused by
• adhesive bands (result from a previous surgical
exploration)

• strangulated hernia (segment of intestine

migrates through a defect in the abdominal wall
and becomes blocked by the narrow ring )

• neoplasm
 Fluid and Electrolyte Losses
• Large quantities of fluid accumulate above the
obstruction.

• As bowel becomes progressively distended, its

circulation is impaired, resulting in wall edema and
even necrosis.

• This edema and accompanying fluid exudation from

bowel wall exacerbates losses of fluid.
+
• Peritonitis, vomiting adds to dehydration.
 Strangulated Bowel Obstruction
• This is mechanical obstruction with occlusion of
the mesenteric blood supply

• Venous outflow blockage leads to bloody fluid

accumulation within the bowel and bowel wall

• Gangrenous bowel leaks bacterial toxins into

peritoneal cavity, leading to septic shock.
 Colonic Obstruction

Strangulation is rare except with volvulus

Obturation as a result of growth of a
tumour
Fluid and electrolyte sequestration
progresses more slowly
 Clinical Manifestations (Clinical
features)
• abdominal pain
• vomiting
• obstipation
• abdominal distention
• severe colicky pain with hyperperistalsis,
quiescent periods, then diffuse pain
• vomiting occurs immediately (reflex) and at a
variable time later depending on the level of
obstruction
 Physical Examination
• Tongue is dry

• Tachycardia

• Auscultation shows loud, metallic sounds

• Abdominal distension
 Laboratory Findings
• dehydration with increased HCT(hematocrit)
• BUN(blood urea nitrogen мочевина) and
oliguria
• metabolic acidosis and CO2 retention from
abdominal distention
• мarked leukocytosis suggests strangulation or
ischemia
• аmylase elevation can occur.
 . Viability of intestin
• -pulsation of vessels
• - peristalsis
• - brightness of serosal cover
• - color.
Viability of intestin
 X-Ray examination
• X-Ray examination show Kloiber's cups
X-Ray examination