INTESTINAL OBSTRUCTION. .pptx

Intestinal obstruction

1. INTESTINAL OBSTRUCTION DR MALEMUNA G

2. OUTLINE introduction classification etiology pathophysiology diagnosis management

3. Introduction Intestinal Obstruction (IO)-Defined as the cessation in the propulsion of intestinal contents distally Commonest surgical emergency involving bowel 80% of IO cases are doe to small bowel obstruction can be fatal due to delay in diagnosis,treatment and complications associtated with surgery

4. Classification 1. Mechanical/dynamic vs Functional/Adynamic 2. Small bowel vs large bowel 3.Luminal/Intramural/Extramural 4.Acute/Subacte/Chronic

5. Etiology Adhesions-40% inflammatory-15% carcinoma-15% hernia-12% fecal impaction-8% pseudo-obstruction-5% Miscellaneous-5%

6. Causes of IO..

7. Causes of IO...

8. Causes of small bowel obstruction

9. Causes of large bowel obstruction

10. Pathophysiology Early in the course-Hyperperistalsis of bowel in an attempt to overcome the obstruction Later-bowel fatigue(flaccidity and paralysis) Accumulation of contents,gas,fluids in the lumen and intestinal wall=Bowel distension/third spacing/decreased reabsorption Bacterial proliferation in the lumen=gas production and more distension Intramural vessels compromised=ischaemia and necrosis

11. Pathophysiology..

12. Pathophysiology...

13. Diagnosis- Clinical features History-Abdominal pain-colicky in nature -vomitting -Abdominal distension -Absolute Constipation -features of dehydration

14. Clinical Feature Small bowel obstruction Large bowel obstruction Pain -colicky -periumbilical -frequent paroxysms -colicky -infraumbilical -less frquent paroxysms Nausea/vomitting -Severe nausea and vomitting -initially clear ,later bocomes dark,faeculent and foul-smelling -Delayed or absent -faeculent Distension -minimal distension in proximal obstructions, becomes greater the more distal the lesion -obvious,occurs later constipation Dehydration -Late -Common Early

15. Clinical features Features of dehydration-hypotension,tachycardia,dry skin and mucous membranes Abdominal distension-visible peristalsis in lean individuals Laparatomy scars Localised tenderness indicates ischaemia Peritonism indicates overt infarction or perforation Hyperesonant percussion note Increased bowel sounds-early. later-minimal or no bowel sounds

16. DRE-Performed to establish presence or absence of stool in rectum -to identify fecal impaction or presence of rectal mass -to identify gross or occult blood-tumour,ischaemia,inflammatory mucosal injury,intususception

17. Diagnosis-Investigations Laboratory investigations-Supportive FBC LFTs KFTs Lactic acid

18. X rays- Abdominal Xrays-Erect and supine,CXR Dilated bowel loops(>3cmSBO,>6cm LBO) multiple air-fluid levels(>3) step ladder pattern vulvulae conniventes absence of rectal gas special signs

19. CT Scan USG Barium studies MRI

20. Management Resuscitation-fluid and electrolyte replacement NGT insertion for decompression Analgesia/Antibiotics Surgical Tx-indicated for most cases but delayed until resuscitation is complete

21. ...End