University:
Texas Lutheran University
Course:
NURS 332 | Fundamental Nursing Concepts & Practice
Academic year:

2020
Views:

124

Pages:

12
Author:

TwoCyber

Intestinal obstruction Impairment, cessation or reversal of the physiological transit of intestinal content Secondary to ⊕ mechanical (obstruction) or ⊕ functional (paralytic ileus) Pathophysiology: obstruction --> gas and fluid accumulation (gas from swallowing & bacteria) --> distention --> ↑ luminal pressure --> venous & lymphatic obstruction --> wall edema --> compress artery --> ischemia and perforation --> strangulation with hypovolemic shock, tachycardia, fever, acidosis --> ↑ WBC, tenderness, rigidity, rebound Degree of Obstruction: Partial: only part of lumen occluded, allowing passage of content --> Constipation Complete: no passage of any luminal content --> Obstipation But some can have bowel sounds & flatus Closed loop: no exit for intra luminal content (obstruction at 2 points) --> Emergency! Seen with: incarcerated hernia, torsion, adhesion, volvulus Due to rapid progression to strangulation Site: Proximal --> early vomiting, late constipation, pain confined to periumbilicus, poss of gas distal to obstruction Distal --> early constipation, late vomiting Large bowel MC causes Adenocarcinoma Diverticulitis Volvulus Causes => MC Adhesion in non virgin abdomen Hernia in virgin abdomen Cancer large bowel Extrinsic | Intraluminal | Intramural Small bowel | Small bowel | Small bowel & adhesion *MC | * gallstone ileus * | * Crohn's Disease * hernia 2nd MC | * foreign body * | * lymphoma cancer | * intussusception | * radiation abscess | | * entritis Large bowel | Large bowel | Large bowel Volvulus | * Constipation | * adenocarcinoma * 60% adhesion * | * foreign body + | * Diverticulitis * 20% hernia | * bezoars | * IBD stricture intussusception | * Gall stone * | * Radiation stricture Hirschsprung | | oglivi Functional Causes → Paralytic Ileus Post operative Electrolyte abnormality → Hypokalemia Medications → opioids, anticholinergics Peritonitis Retroperitoneal hemorrhage / Hemoperitoneum Sepsis / Shock Inflammatory intra-abdominal process Spinal injury Risk factors: Previous abdominal surgery (Most imp) Hx of hernia Hx of cancer or FH of cancer Hx of diverticulitis Hx of IBD Cholelithiasis Ingestion of foreign body Constipation Old age (MC in large bowel obstruction) Complications: Bowel ischemia Perforation Sepsis Electrolyte disturbance Hypokalemia Hypochloremia Metabolic alkalosis Ischemia Metabolic acidosis Shock Signs & Symptoms Colicky abdominal pain Abdominal distention Vomiting & nausea 1st in proximal Constipation 1st in distal Hyperactive bowel (proximal) Blood in stool Strangulation Tenderness, tachycardia, fever, shock WBC Acidosis (due to lactic acid) Peritonitis signs Signs Rapid dehydration due to oral intake + vomiting and accumulation of fluid in bowel lumen (3rd spacing) Peritonitis signs Bowel sounds (↑ in mechanical, ↓ in functional) Hernial orifice PR examination Investigations CBC (for Wbc for perforation as well as anemia) U&E and ABG (hypokalemic, hypochloremic metabolic alkalosis or if late metabolic acidosis (skeletal)) BUN (Dehydration) , Hematocrit LFT, Coagulation profile -> Type and cross match (for OR) amylase, lipase (pancreatitis can cause ileus) Pregnancy test (rule out ectopic) Urine analysis (rule out UTI) Erect abdominal x-ray -> 3 or more air fluid level (Stepladder - Stair Step) Supine abdominal x-ray -> Dilated bowel loop (other specific signs: Omega or coffee bean sign) Upright chest x-ray to rule out free air under diaphragm (perforation) Abdominal CT scan with IV Contrast or oral Contrast *more sensitive & specific *findings: - Transitional Zone - Proximal Dilation - Distal collapse - No Contrast distally - Paucity of Gas and fluid in colon Signs of ischemia -> Gas in portal vein -> Pneumatosis intestinalis (air in the wall of intestine)

Intestinal Obstruction Course Materials

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