| ID | 235 |
|---|---|
| Name | INTESTINAL OBSTRUCTION |
| Cause | |
| Signs Symptoms | |
| Diagnosis | |
| Investigations | |
| Management | Management: Conservative treatment: 1. Gastroduodenal suction to keep the stomach empty. 2. Intravenous fluid & electrolyte- potassium supplement is given (as in paralytic ileus). 3- Parenteral systemic antibiotics. 4. Parenteral systemic analgesic to relieve pain. Surgical treatment: 1. Relief of obstruction by operation. 2. Running i.v fluid to be given (3000 c.c daily or as required). |
| Introduction | Intestinal obstruction is a common surgical emergency and because of its serious nature it demands early diagnosis and immediately relief. It may be complete or incomplete, acute or chronic, intermittent or continuous. The most important issue to decide is whether the obstruction is simple or associated with strangulation. Urgent relief is required if gangrene, perforation and peritonitis are to be avoided. |
| History | |
| Etiology | Etiological classification: A. Mechanical obstruction 1. Luminal obstruction (obturation) a. Fecal impaction b. Gallstone ileus c. Worms e.g ascariasis 2. Intrinsic lesions of the bowel wall a. Tumours of the large intestine b. Strictures e.g Crohn’s disease c. Intussusception 3. Extrinsic compression a. Adhesions b. Hernias c. Volvulus B. Strangulation obstruction C. Pmnuytic ileus 1. Peritonitis 2. Postoperative 3. Vascular Ctiakal classification: A. Dynamic obst ruction 1. Acute obstruction (confined to the small gut). 2. Chronic obstruction (confined to the large gut). 3. Acute-on-chronic obstruction. B. Adynamic obstruction (or paralytic ileus) 1. Post-operative 2. Infective varity 3. Reflex type 4. Uremic paralytic ileus 5. Hypokalemic paralytic ileus |
| Clinical Features | Clinical features: 1. Sudden colicky pain in the abdomen. 2. Vomiting. 3. Distension of abdomen which is central in small gut but peripheral (flanks) in large gut obstruc-tion. 4. Absolute constipation. Om examination: I. Dehydration, rapid pulse, abdominal scars of previous operation, external hernia, visible peris-talsis and tenderness may be found. ‘1 Bowel sounds are accentuated high pitched & tinkling in character. Later sage- bowel sound absent due to formation of paralytic ileus. 3. X-oy shows gas shadows & fluid levels. |
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