INTESTINAL OBSTRUCTION and its management .ppt

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1. INTESTINAL
OBSTRUCTION

2. Introduction
Bowel obstruction (or intestinal obstruction) is a
mechanical or functional obstruction of the intestines,
preventing the normal transit of the products of digestion.
It can occur at any level distal to the duodenum of the
small intestine and is a medical emergency.

4. Definition
Partial or complete impairment of the
forward flow of intestinal contents
known as intestinal obstruction.

5. Etiology
1.Obstruction due to narrowing caused by:
Inflammation
Neoplasm's
 Adhesions
 Hernia
 Volvolus
 Intussuception
 Food blockage
 Compression
 Paralytic ileus

6. Contd..
2. Infections of abdomen and
sometimes thoracic cavity, such
as peritonitis or pancreatitis.
3. Cancer account for 80% of
obstruction of large intestine
with most occurring in sigmoid
colon.
4. Diverticulus and ulcerative
colitis.

7. Risk Factors
MECHANICAL FACTORS:
1.ADHESIONS:
Most common cause of obstruction in
small and large intestines combined.
Adhesions form after abdominal
surgery.
Loops of intestine become adherent to
areas that heal slowly or scar after
abdominal surgery.

8. Contd..
2. HERNIA: Protrusion of
intestine through a weakened
area in the abdominal muscle
or wall.
•A strangulated hernia is
always obstructed, because
the bowel cannot function
when its own blood supply is
cut off.

9. 3. VOLVULUS: It is the twisting of the bowel .
•It can cause infarction of bowel and can occur in
either the small or large bowel.
•Volvulus can sometimes be corrected without
surgical intervention.

11. Contd..
4. INTUSSUSCEPTION: It is
telescoping of bowel in itself.
One part of intestine slips into
another part located below it.
The intestinal lumen
becomes narrowed.

13. Contd..
5. TUMORS: In large bowel, tumors
are the chief cause of obstruction.
Process develops slowly.
In small bowel, A tumor outside
the lumen causes pressure on
the wall of the intestine.

14. Neurogenic Factors
A dynamic or functional obstruction, sometimes called
“paralytic ileus”.
Caused by a lack of peristaltic activity. Paralytic ileus
commonly occurs after abdominal surgery particularly if the
bowel has been extensively handled.

15. Vascular Factors
When blood supply to any part of the body is interrupted, the
part ceases to function and pain occurs. Obstruction of blood
flow can arise as a result of:-
Complete occlusion
Partial occlusion

16. Contd..
Complete occlusion (Mesenteric infarction): Any
occlusion of arterial blood supply to the bowel, as in
mesenteric thrombosis, effectively stops bowel function.

Acute occlusion cause ischemia, may lead to intense
pain.
As process advances fever, leukocytosis, shock, bowel
gangrene develops.

17. 2. Partial Occlusion(abdominal
Angina):
This condition results from atherosclerosis of
mesenteric arteries. Symptoms arise only when
interruption of blood supply is sufficient to
compromise bowel function.

Then pain occurs
Change in bowel habits
Nausea vomiting
Wt. loss

18. Pathophysiology
Due to bowel obstruction
Fluids & air collect proximal to the site
Distension
Increase in peristalsis
Bowel become flaccid
Continuous Increase in pressure within lumen

19. Greater pressure reduces its absorptive ability
Fluid retention still further
Increasing venous pressure, congestion & vessel fragility
In turn raises capillary permeability
Allow plasma to extravasate into bowel lumen & peritoneal
cavity

20. Contd..
Bowel wall become permeable to bacteria
Bowel organisms enter the peritoneal cavity
Rising pressure in bowel wall soon slows arterial blood flow
Causing necrosis & in some cases toxemia & peritonitis

21. PATHOPHYSIOLOGY
intestinal obstruction
sequestration of gas and fluid proximal to
obstruction

DISTENTION

Dehydration
dec. k+ , Cl-
Pressure on
diaphragm
dec.
Respiratory
volume
atelectasis
pnemonia
Prolonged
inc. in
intraluminal
wall tension
dec. venous return
Intestinal wall edema
abd. pain
Nausea &
vomiting
Dec. plasma volume
hemoconcetration
Dec. CVP
tachycardia
LOSS OF WATER
& ELECTROLYTE

22. inc. capillary permeability HYPOVOLEMIA
SHOCK
Release of toxins
Feve
r
peritonitis

23. Clinical Manifestations
Manifestations Depend On The:
Level and length of bowel involved
Extent to which the obstruction interfere with blood supply
The type of lesion producing the obstruction

24. Symptoms are:
Crampy pain (wavelike & colicky)
Inability to pass fecal matter & flatus
Vomiting
Fecal vomiting may takes place
Dehydration
Intense thirst

25. Drowsiness
Generalized malaise
Distended abdomen
If obstruction continues uncorrected, hypovolemic shock

26. Diagnostic Findings
X- ray
Barium or radiopaque studies
Complete blood count
Increased hemoglobin & hematocrit values may indicate
dehydration
Stool for occult blood

27. Medical Management
Decompress The Bowel:
Major treatment is the insertion of an intestinal tube. An
intestinal tube both decompress the bowel and breaks
up the obstruction .

29. Contd..
In paralytic ileus:
Best intervention is bowel rest.
Prevention of distention by gastric suction.
Medications are not effective in stimulating bowel
activity.

30. Contd..
Nasogastric tube—This involves the passage of a
narrow tube through nose and down into the stomach to
suction out fluids that have become trapped above the
blockage
Medications— Give antibiotics or pain medication
through an IV
Removal of fecal impaction—If fecal matter is causing
the obstruction, it can be removed; doctor will insert a
gloved finger into patient’s rectum to loosen and remove
the feces.

31. Surgical Management
Depends largely on:
Cause of the obstruction
Location of obstruction
oSurgical procedures involves:
Repairing the hernia & adhesions.
Bowel resection & anastomosis.
colostomy

32. Hernias cannot be fixed with medications. Most
require surgery (herniorrhaphy).
During hernia repair surgery, a surgeon:
Pushes the bulging tissue back into place
Repairs the weakened connective tissue and
muscle, called the hernia defect
May use a supportive mesh material to
strengthen the weakened area and help tissues
stay in place

34. Treatment of
adhesions.
Adhesions can be
treated either
with
 open or
laparoscopic
(keyhole) surgery,
known as
adhesiolysis.

35. VOLVULUS
Surgical options for sigmoid volvulus include
bowel resection and bowel conservative
surgery.
Bowel resection is recommended over
conservative surgery (sigmoidopexy or
mesenteric plication)
 Endoscopic decompression

36. Intussusception
Non surgical-A barium saline or pneumatic
pressure enema may be sufficient for treating
intussusception. This procedure starts with
the injection of air into the intestine. The
pressure from the air may push the affected
tissue back into its original position.
 Laproscopic reduction and resection of lead
point intususception.mp4

37. Nursing Management
Assessment
1.Complete history of the onset of manifestations, eating
pattern, food tolerance, vomiting episodes, stools (no.
per day & appearance)
2.Physical examination:
•Abdominal distention
•Quality of bowel sounds
•Presence & extent of dehydration
•Manifestations of abdominal pain

38. Nursing Diagnosis
Fluid volume deficit r/t vomiting, decreased intestinal
reabsorption, decreased intestinal secretions
Altered gastro-intestinal tissue perfusion r/t intestinal
obstruction, tumor, volvulus
High risk of infection r/t contamination of bowel after
surgery
High risk of injury r/t post operative complication,
infection, hemorrhage.

39. Fluid volume deficit r/t vomiting, decreased
intestinal reabsorption, decreased
intestinal secretions
•Assess the fluid intake and output.
•Replacing fluids and electrolyte
•Administer parenteral fluids with sodium chloride,
bicarbonate, and potassium as ordered
•Maintain the intestinal tube attach to suction to relieve
the vomiting and distention
•Note the amount and type of discharge and relief of
distention and nausea, vomiting
•Assess emesis and drainage from intestinal tube .
Document color and odor, consistency and volume.

40. Altered gastro-intestinal tissue perfusion r/t
intestinal obstruction.
•Immediately report to physician symptoms such as
emesis, increasing distention and pain as sign bowl
strangulation.
•Assess for temp. elevation as sign of bowl strangulation.
•If blood supply is impaired then client will require
emergency surgery
•Nurses must prepare the client for surgery
•Require emergency bowel resection if bowel obstruction
is with impaired tissue perfusion

41. High risk of infection r/t contamination of
bowel after surgery
•Assess for peristalsis and passage of flatus and return of
bowel sounds
•Patient should be kept on gastric suction until peristalsis
returns.
•Dressing should be change maintaining sterility
•If colostomy is done, stoma care is necessary
•Nurse should asses the color, odor, volume of drainage
from the site.

42. High risk of injury r/t post operative
complication, infection, hemorrhage.
•Assess for peristalsis and passage of flatus and return of
bowel sounds
•Patient should be kept on gastric suction until peristalsis
returns.
•Dressing should be change maintaining sterility
•If colostomy is done, stoma care is necessary
•Nurse should assess the color, odor, volume of drainage
from the site.