BOWEL

OBSTRUCTION
Definition
■ Interruption in the normal forward flow of intestinal
contents along the intestinal trace.

■ A partial or complete block of the small or large

intestine that keeps food, liquid, gas, and stool from
moving through the intestines in a normal way.
Types
■Mechanical obstruction: is an mural obstruction
from pressure on the intestinal walls.
■Functional Obstruction: When the intestinal
musculature cannot propel the contents along the bowel.
Etiology/Causes
A. Mechanical obstruction:
1. Luminal obstruction
 Faecal impaction
 Gallstone ileus.
2. Intrinsic lesion of the intestinal wall
 Tumors of the large intestine.
 Diverticular disease
3. Extrinsic compression
 Hernias
 Volvulus (intestine twists around itself)
B. Functional Obstruction:
1. Paralytic ileus
 Peritonitis (inflammation of the peritoneum)
 Vascular (blockages in the vessels)
Pathophysiology
■ Due to etiological factor
■ Impairment of passage of material through bowel
■ Accumulation of flatus, feaceas and retention of fluid, reduce the fluid
absorption and stimulate more gastric secretion
■ Distension of proximal intestine with solid fluid and gas
■ With increasing distension, increase intestinal lumen pressure
■ Edema, congestion with decrease capillary pressure
■ Rapture of perforation of intestine
■ Peritonitis
Clinical features
■ Crampy, wavelike, and colicky pain
■ No feces and flatus, but may pass blood and mucus
■ Vomiting- fecal vomiting (for ileum obstruction)
■ Signs of dehydration (thirst, drowsy etc)
■ Abdominal distension
■ Signs of hypovolemic shock
■ Abdominal tenderness
■ Constipation
Investigations
■ Plain X-Ray abdomen A/P view in erect posture
shows multiple gas-fluid levels.
■ Ba-contrast study of upper GIT
■ Ba-enema (when large bowel obstruction is
suspected.)
Medical management
■ Insert NG tube for decompression
■ Fluid therapy
■ Surgical intervention in the case of possible
strangulation (bowel necrosis)
■ Colostomy
Nursing Diagnosis
■ Acute pain related to abdominal distension of the
obstructed bowel
■ Risk for deficient fluid volume related to vomiting,
NG suction, NPO stats and fluids shift in the GIT
■ Anxiety related to lack of knowledge
Nursing Intervention
■ Monitor pain and other abdominal signs indicating that the bowel obstruction is worsening
■ Provide pain relief measures, such as pain medication as prescribed, non-pharmacological
measures, such as distraction, relaxation, and other comfort measures.
■ Maintain patency and proper functioning of NG tube
■ Positon the patient in semi or high fowler position to relieve pressure in the abdomen and
facilitates ventilation
■ Encourage frequent position and ambulation once the condition is stabilized
■ Maintain accurate intake output record
■ Maintain fluid as prescribed
■ Monitor vital signs, gastric content (via NG tube)
■ Provide reassurance and comfort by spending tie with the patient and family
■ Listen attentively
■ Provide simple explanation of all tests and procedures
■ Encourage supportive involvement of the family
■ Set aside time to address family concerns