Intestinal Obstruction

Intestinal obstruction involves a partial or complete blockage of the bowel that

results in the failure of the intestinal contents to pass through.Two processes that can impede the flow of intestinal contents:

Mechanical Obstruction: Complete arrest or serious impairment of the passage of intestinal contents caused by a mechanical blockage.

Examples:

1. Adhesions2. Hernias3. Tumors4. Foreign bodies (including gallstones)5. Inflammatory bowel disease (crohn’s disease)6. Hirschsprung’s disease7. Fecal impaction8. volvulus

Functional Obstruction: The intestinal musculature cannot propel the contents along the bowel.

Examples:

1. Muscular dystrophy2. Neurologic disorders such as Parkinson’s disease3. Endocrine disorders such as diabetes mellitus4. amyloids

Pathophysiology

In simple mechanical obstruction, blockage occurs without vascular or neurologic compromise. Ingested fluid and food, digestive secretions, and gas accumulate in excessive amounts if obstruction is complete. The proximal bowel distends, and the distal segment collapses. The normal secretory and absorptive functions of the mucous membrane are depressed, and the bowel wall becomes edematous and congested. Severe intestinal distention is self-perpetuating and progressive, intensifying the peristaltic and secretory derangements and increasing the risks of dehydration, ischemia, necrosis, perforation, peritonitis, and death.

Small Bowel Obstruction

Small-bowel obstruction is commonly caused by incarceration in hernias or by adhesions and is less commonly caused by tumors (primary or metastatic), obturation by foreign bodies, a Meckel's diverticulum, or Crohn's disease.

Clinical Manifestations:

Symptoms:

1. Abdominal x-ray in both the supine and upright positions usually confirms diagnosis.

2. Vomiting starts early with small-bowel and late with large-bowel obstruction.3. Obstipation occurs with complete obstruction, but diarrhea may be present

with partial obstruction.

Signs: 1. Dehydration2. Intense thirst3. Drowsiness4. Generalized malaise5. Aching6. Parched tongue and mucous membrane7. Breath odor

Diagnostic Findings:

1. Abdominal x-ray in both the supine and upright positions usually confirms diagnosis.

2. Ct Findings include abnormal quantities of gas, fluid or both in the intestines.3. Laboratory studies (CBC, electrolyte study) reveal a picture of dehydration,

los of plasma volume, and possible infection.

Medical Management:

1. Nasogastric suction2. IV fluids3. Laparotomy4. Obstructing gallstones are removed by lithotomy.5. Treatment of obstruction of the duodenum in adults consists of resection or,

if the lesion cannot be removed, palliative gastrojejunostomy.

Nursing Management:

1. distention) Maintain the function of the nasogastric tube2. Assess and measure nasogastric output3. Assess for fluid and electrolyte imbalance4. Monitor nutritional status5. Assess for improvement (return of normal bowel sounds, decreased

abdominal

Large Bowel Obstruction

Results in an accumulation of intestinal contents, fluid, and gas proximal to the obstruction which can lead to severe distention and perforation unless some gas and fluid can flow back through the ileal valve.

Clinical Manifestations:

Symptoms:

1. Constipation2. abdominal distention3. Vomiting but not rare4. Lower abdominal cramps unproductive of feces

Large bowel obstruction differs clinically from small bowel obstruction in that the symptoms develop and progress relatively slowly.

Signs:1. Weakness2. Weight loss3. anorexia

Diagnostic Findings:

1. Abdominal x-ray shows distention of the colon proximal to the obstruction.2. CT findings3. MRI findings4. Barium enema

Medical Management:

1. Nasogastric suction2. IV fluids and electrolytes3. Urinary catheter are needed before emergency operation.4. Obstructing cancers of the colon can often be treated by a single-stage

resection and anastomosis.

Nursing Management:

1. Monitor for worsening of symptoms2. Provide emotional support and comfort