Clinical features of intestinal obstruction

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1. CLINICAL FEATURES OF INTESTINAL OBSTRUCTION

2. Dynamic obstruction Pain Vomiting Distension Constipation Other manifestations

3. Pain 1 st symptom, usually sudden Colicky nature Centered on the umbilicus (small bowel) or lower abdomen (large bowel) Coincides with increased peristaltic activity Severe pain indicates presence of strangulation

4. V omiting The more distal the obstruction ,the longer the interval between the onset of symptoms and the appearance of nausea and vomiting. As obstruction progresses the character of vomitus alters from digested food to faeculent material.

5. Distension Degree of distension dependent on site The more distal the lesion greater is the distension

6. Constipation Absolute (neither faeces nor flatus is passed) cardinal feature of complete intestinal obstruction R elative (only flatus is passed)

7. Other manifestations Dehydration : in small bowel obstruction because of repeated vomiting Hypokalaemia Pyrexia : onset of ischemia intestinal perforation associated inflammation hypothermia indicates septicaemic shock Abdominal tenderness

8. Clinical features of strangulation Constant pain –pain never completely absent Tenderness with rigidity –indicates early laparotomy Shock –indicates underlying ischaemia

9. Clinical features of intussusception Classical presentation –episodes of screaming and drawing up of legs in previously well male infant Vomiting –conspicuous and bile stained ‘Redcurrant jelly’ stool

10. Lump which hardens on palpation in 60% Feeling of emptiness in the right iliac fossa (the sign of dance) On rectal examination blood stained mucus may be found on the finger Unrelieved, progressive dehydration and abdominal distension, followed by peritonitis secondary to gangrene. D/D : a/c gastroenteritis Henoch-Schoenlein purpura Rectal prolapse

11. Clinical features of volvulus Volvulus of the small intestine

12. Caecal volvulus : usually a clockwise twist in 25% ,a palpable tympanic swelling in midline or left side of abdomen

13. Sigmoid volvulus : large bowel obstruction abdominal distension vomiting absolute constipation