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Intestinal Obstruction: Fadi J. Zaben RN MSN
Intestinal Obstruction: Fadi J. Zaben RN MSN
The small intestine and colon are components of digestive tract, which
processes the foods what we eat.
The small intestine and colon extract nutrients from the foods. What isn't
absorbed by the small intestine and colon continues along the digestive
tract and is expelled as stool during a bowel movement.
Definition:
Intestinal obstruction occurs when the passage of
intestinal contents through the lumen is impaired.
Intestinal obstruction is an interruption in the
normal flow of intestinal contents along the
intestinal tract.
The block may occur in the small or large intestine,
may be complete or incomplete, may be mechanical
or paralytic, and may or may not compromise the
vascular supply.
Obstruction most frequently occurs in the young and
the old.
Bowel obstruction can occur in both the small and
large bowel.
The small bowel is most commonly affected, with
the ileum as the most common site of obstruction.
Large bowel obstruction accounts for only 15% of
cases of bowel obstruction and the sigmoid colon
is the most common site of obstruction.
The location of the obstruction, the degree of
obstruction, and the presence of ischemia are
important distinctions because treatment varies.
Types of Intestinal Obstruction:
1. Mechanical obstruction.
3. Strangulation obstruction.
Mechanical obstruction:
• It is a physical block to passage of intestinal
contents without disturbing blood supply of
bowel.
• High small-bowel (jejunal) or low small-bowel
(ileal) obstruction occurs four times more
frequently than colonic.
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• Caused by:
1. Extrinsic adhesions: from surgery, hernia, wound
dehiscence, masses, volvulus (twisted loop of intestine).
Up to 70% of small bowel obstructions are caused by
adhesions.
2. Intrinsic: hematoma, tumor, intussusception
(telescoping of intestinal wall into itself), stricture or
stenosis, congenital (atresia, imperforate anus), trauma,
inflammatory diseases (Crohn's, diverticulitis, ulcerative
colitis)
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• Causes include:
Spinal cord injuries; vertebral fractures.
Postoperatively after any abdominal surgery.
Peritonitis, pneumonia.
Wound dehiscence (breakdown).
GI tract surgery.
Strangulation Obstruction:
• Contrast Studies:
Barium enema may diagnose colon obstruction or
intussusception.
Ileus may be identified by oral barium or Gastrografin.
• Laboratory Tests:
May show decreased sodium, potassium, and chloride levels
due to vomiting.
Elevated WBC counts due to inflammation; marked increase
with necrosis, strangulation, or peritonitis.
Serum amylase may be elevated from irritation of the pancreas
by the bowel loop.
• Flexible sigmoidoscopy or colonoscopy may identify the
source of the obstruction such as tumor or stricture.
Treatment:
1. Nonsurgical Management.
2. Surgery.
Nonsurgical Management:
1) Correction of fluid and electrolyte imbalances with
normal saline or Ringer's solution with potassium as
required.
2) NG suction to decompress bowel.
3) TPN may be necessary to correct protein deficiency
from chronic obstruction, paralytic ileus, or infection.
4) Analgesics and sedatives, avoiding opiates due to GI
motility inhibition.
5) Antibiotics to prevent or treat infection.
6) Ambulation for patients with paralytic ileus to
encourage return of peristalsis.
Surgery:
• Consists of relieving obstruction. Options
include:
Closed bowel procedures: lysis of adhesions,
reduction of volvulus, intussusception, or
incarcerated hernia
Enterotomy for removal of foreign bodies.
Resection of bowel for obstructing lesions, or
strangulated bowel with end-to-end anastomosis
Intestinal bypass around obstruction
Temporary ostomy may be indicated.
Complications:
Dehydration due to loss of water, sodium, and
chloride.
Peritonitis.