Intestinal Obstruction

An intestinal obstruction occurs when your small or large intestine is blocked. The blockage can be partial or total, and it prevents passage of fluids and digested food. If intestinal obstruction happens, food, fluids, gastric acids, and gas build up behind the site of the blockage.

1. Intestinal obstruction

2. Digestedfoodparticlesmusttravelthrough25feetormore
ofintestinesaspartofnormaldigestion.Thesedigested
wastesareconstantlyinmotion.However,intestinal
obstructioncanputastoptothis.Anintestinalobstruction
occurswhensmallorlargeintestineisblocked.The
blockagecanbepartialortotal,anditpreventspassageof
fluidsanddigestedfood.
Ifintestinalobstructionhappens,food,fluids,gastricacids,
andgasbuildupbehindthesiteoftheblockage.Ifenough
pressurebuildsup,intestinecanrupture,leakingharmful
intestinalcontentsandbacteriaintoabdominalcavity.Thisis
alife-threateningcomplication.

3. “Intestinalobstructioninvolvesapartialor
completeblockageofthebowelthatresults
inthefailureoftheintestinalcontentstopass
through”.
Intestinalobstructionisablockageofsmall
intestineorcolonthatpreventsfoodandfluid
frompassingthrough.

4. Manyconditionscancauseintestinal
obstruction.
"Mechanical"obstructionoccurswhen
something—suchasaherniaortumor—is
physicallyblocktheintestine.Blockageof
intestinecanbepartialorcomplete.
Paralyticileus(pseudo-obstruction),a
conditioninwhichtheintestinesdon't
functionproperly,mayhavethesamesigns
andsymptomsasmechanicalobstruction,
butnophysicalobstructionispresent.

5. Mechanicalobstruction:
Adhesions, which consist of fibrous tissue that can
develop after any abdominal or pelvic surgery or after
severe inflammation
Volvulus, or twisting of the intestines.
Intussusception, a “telescoping,” or pushing, of one
segment of intestine into the next section.
Malformations of the intestine, often in newborns, but
can also occur in children and teens.
tumors within small intestine.
Gallstones, although they rarely cause obstructions.
swallowed objects, especially in children.
hernias, which involve a portion of intestine protruding
outside of body or into another part of body.
Inflammatorybowel disease, such asCrohn’s disease.

7. Mechanicalobstruction:
Although less common, mechanical obstructions can
also block colon, or large intestine. This can be due to:
impacted stool
adhesions from pelvic infections or surgeries
ovarian cancer
colon cancer
meconium plug in newborns (meconium being the
stool babies first pass)
diverticulitis, the inflammation or infection of bulging
pouches of intestine.
stricture, a narrowing in the colon caused by scarring
or inflammation.

8. Paralyticileus
Paralyticileuscancausesignsandsymptomsofintestinal
obstruction.Inparalyticileus,althoughthereisnoblockage,
theintestinesdon'tfunctionproperly;movementofthe
intestinesisgreatlyreducedorabsent.Theintestinesare
unabletomovefoodandfluidsmoothlythroughthe
digestivesystem.
Paralyticileuscanaffectanypartoftheintestine.
Themostcommoncauseofparalyticileusisabdominal
surgery.

9. Abdominalorpelvicsurgery.
Crohn'sdisease—aninflammatoryconditionthat
cancausetheintestine'swallstothicken,
narrowingitspassageway.
Cancerwithinabdomen,especiallyifpatient’shad
surgerytoremoveanabdominaltumororradiation
therapy.
Ahistoryofconstipation.
Malrotation,aconditionpresentatbirth
(congenital)inwhichintestinedoesn'tdevelop
correctly.

11. Any of the cause
Accumulation of food, air, secretions
(gastric, biliary, pancreatic)
Bowel congestion followed by failure of
absorption, vomiting and decreased oral
intake

12. Volume depletion, electrolyte imbalance,
renal failure and shock
Bowel distention causes increased
intraluminalpressure, with decreased
vascular perfusion, lymphatic drainage
which increases permeability to bacteria
Bowel ischemia, necrosis, septicemia

13. Depending on the level of obstruction, bowel
obstruction can present with
Abdominal pain,
Abdominal distension,
Vomiting,
Fecalvomiting, and
Constipation.

14. Insmallbowelobstructionthepaintendstobe
colicky(crampingandintermittent)innature,with
spasmslastingafewminutes.Thepaintendsto
becentralandmid-abdominal.Vomitingoccurs
beforeconstipation.
Inlargebowelobstructionthepainisfeltlowerin
theabdomenandthespasmslastlonger.
Constipationoccursearlierandvomitingmaybe
lessprominent.Proximalobstructionofthelarge
bowelmaypresentassmallbowelobstruction.

15. Historytaking
AbdominalExamination
Themaindiagnostictoolsarebloodtests,X-
raysoftheabdomen,CTscanningand/or
ultrasound.Ifamassisidentified,biopsy
maydeterminethenatureofthemass.
Radiologicalsignsofbowelobstruction
includeboweldistensionandthepresenceof
multiplegas-fluidlevelsonsupineanderect
abdominalradiographs.

16. Nasogastricsuction.
IVfluids.
IVantibioticsifbowelischemiasuspected.
Patientswithpossibleintestinalobstructionshould
behospitalized.
Supportivecareissimilarforsmall-andlarge-
bowelobstruction:nasogastricsuction,IVfluids
(0.9%salineorlactatedRinger'ssolutionfor
intravascularvolumerepletion),andaurinary
cathetertomonitorfluidoutput.
Ifbowelischemiaissuspected,antibioticsshould
begiven(e.g.,a3rd-generationcephalosporin).

17. Patientmayneedsurgeryifnonsurgical
treatmentisnotabletoclearapartial
obstruction.Iftheboweliscompletely
blockedorthebloodsupplytothebowelis
cutoff(strangulation),surgerymaybethe
firsttreatment.
Duringsurgery,ageneralsurgeonoracolon
andrectalsurgeonremovestheblockageor
thesectionofblockedintestine.

18. Surgeryforbowelobstruction,including
obstructionsrelatedtotwistingofthe
intestine,andsomecancers,isoftendone
laparoscopically.Thismeansthat
surgeryisdonewithalightedscopeand
instrumentsinsertedthroughasmall
incision.

19. Inacaseofparalyticileus,treatmentmayinvolve
insertingaflexibletube(nasogastrictube)downthe
throattodrainfluidsfromthestomachaswellas
correctingfluidandelectrolyteimbalances.
Inmostcasesapartialblockagewillnotrequire
surgery,butacompleteblockagewill.Thetypeof
surgerywilldependonthetypeofblockageandits
location.
Alaparotomy,whereanincisionismadeintothe
abdomenwhileundergeneralanaesthesia,maybe
performedtosearchforthecauseofanobstruction
and/ortoremoveormanageit.

20. Laparoscopy,orkeyholesurgery,inwhichalaparoscope
(asmalltubewithalightandcameraontheend)isinserted
intoasmallincision,maybeanoptionfortreatingasmall
bowelobstructionorremovingadhesions.
Endoscopicstenting,whereaself-expandingstentis
insertedtohelpkeepthepassagewayopen,maybe
consideredintheelderlyandinpalliativecareofcancer
patients.
Asigmoidoscopyorcolonoscopyinvolvesinsertingathin
flexibletubewithasmallcameraandlightattachedonone
endthroughtherectumintothebowel,alongwithaflatus
tube(alongrubbertube),todecompressanduntwistthe
bowel.

21. Complicationsmayincludeormayleadto:
Electrolyte(bloodchemicalandmineral)imbalances
Dehydration
Hole(perforation)intheintestine
Infection
Jaundice(yellowingoftheskinandeyes).
Iftheobstructionblocksthebloodsupplytotheintestine,it
maycauseinfectionandtissuedeath(gangrene).Risksfor
tissuedeatharerelatedtothecauseoftheblockageand
howlongithasbeenpresent.Hernias,volvulus,and
intussusceptioncarryahighergangrenerisk.

22. Assessment
Subjective Data
Objective Data

23. Pre-operativeNursingDiagnosis
Fear&Anxietyrelatedtosurgicalcorrection.
Knowledgedeficitrelatedtodiseaseand
surgery.

24. Post-operativeNursingDiagnosis
Painrelatedtosurgicalincision.
Fluidvolumedeficitrelatedlossoffluiddue
tosurgicalcorrection.
Impairedskinintegrityrelatedtosurgical
incision.
Nutritionaldeficitrelatedtonauseaand
anorexia.
Knowledgedeficitrelatedtotreatmentplan
andfollowup.

25. Aprospectivedescriptivestudywasconductedindepartmentofsurgery
atatertiarycareteachinghospitalatSolapur(Mahrastra)fromJune2012
toJune2014.Alltheadultpatients,irrespectiveofgenderwithdiagnosis
ofdynamicintestinalobstructionundergoingexploratorylaparotomywere
includedinthestudy.Laparotomyfindingswererecordedandinthe
postoperativeperiodpatientswerefollowedupfordetectionof
complicationsandtreatment.
Results:50patientsweretreatedformechanicalintestinalobstruction.
Meanagewas49.5yearsandmaletofemaleratiowas1.7:1.External
hernia(50%)wasthecommonestcauseofintestinalobstructionfollowed
bypostoperativeadhesion(39%).Woundinfectionwasthecommonest
postoperativecomplication.Conclusions:Externalherniaistheleading
causesofmechanicalintestinalobstructioninourregion.Oldage,
delayedpresentation,associatedco-morbidities,increasesthemorbidity
andmortalityinthesepatients.