intestinal obstruction

 Intestinal Obstruction

Bowel obstruction; intestinal obstruction is mechanical or functional obstruction of intestine interruption of normal passage of intestinal content.

Classification of Intestinal Obstruction

1. Open or closed bowel obstruction

2. Complete or incomplete bowel obstruction

3. Extrinsic, intrinsic/ Intramural or intra luminal bowel obstruction

4. Small and large bowel obstruction

5. True or pseudo-obstruction

1. Open or closed bowel obstruction

Open bowel obstruction 

Obstructions at single location where rest of bowel is patent (open).

Closed bowel obstruction

Closed bowel obstruction occurring at two locations, no proximal or distal outlets.

2. Complete or incomplete obstruction

Complete bowel obstruction

Complete obstruction is completely occlude lumen of bowel.

Incomplete bowel obstruction 

Incomplete obstruction is partially or incompletely occlude the bowel.

3. Extrinsic, intrinsic/ Intramural or intra luminal obstruction

Extrinsic bowel Obstruction 

Obstruction due to external causes, for example; tumor.

Intrinsic bowel Obstruction

Obstruction due to internal causes.

4. Small and large bowel obstruction

Small bowel Obstruction

Small bowel obstruction include obstruction that occur along duodenum.

Large bowel obstruction 

Obstruction beyond duodenum junction is large bowel obstruction.

5. True or pseudo-obstruction 

True bowel obstruction result of mechanical causes (such as colorectal cancer).

Pseudo obstruction are not true mechanical obstruction as bowel dilated due to sepsis but intestinal content are not able to pass.

Pathophysiology

Blockage in intestine

Distension of proximal intestine

Nacrosis and perforation of bowel

Bacteria growth and obstruction

Allowing bacteria pass into peritoneum and then into blood stream, leading to septicemia.

Intestinal absorption and lymphatic drainage decreases.

Etiology

1. Twisting of intestine (Volvulus)

2. Telescoping of Intestine (intussusception)

3. Narrowing of colon

4. Impacted feces

5. Trauma

6. Abdominal or pelvic surgery; causes adhesion

7. Cancer within abdomen

8. Crohn's disease (ileitis)

(Inflammatory bowel disease;IBD causes swollen and irritated digestive tract).

Clinical manifestation

1. Abdominal fullness

2. Abdominal pain/ cramping

3. Constipation

4. Abdominal distension

5. Vomiting (biliary or fecal)

6. Dehydration

7. Electrolyte disturbance due to vomiting

8. Absence of flatus

9. Diarrhea; due to infection

10. Bowel ischemia

11. Colicky pain central and mid abdominal; small bowel obstruction

12. Large bowel obstruction; pain in lower abdomen

Diagnostic Evaluation

1. History taking and physical examination

2. Abdominal X rays or CT scan; identifies abscess, tumors

3. Complete blood count (CBC)

4. Serum electrolyte level

5. BUN (blood urea nitrogen)

6. Creatinine level

7. Glucose level

8. Barium enema and contrast enemas; determine location of obstruction (extrinsic or intrinsic)

9. Colonoscopy

10. Urinalysis

11. Stool for occult blood

12. Ultrasonography

Reveals intestinal abnormalities, tumors, mesenteric cyst, intussusceptions.

Management

1. NG tube insertion

2. Analgesic administration

Opioid pain reliever; severe pain

3. Antiemetics 

4. IV infusion

5. Colon decompression with nasogastric tube

(Decrease chance of abdominal distension, vomitus and aspiration).

6. Broad spectrum antibiotics

For Necrosis or perforation

Surgical Management

1. If constricting bands or adhesions are found, they are cut and resected.

2. End to end anastomosis of remaining segments.

3. Temporary colostomy done and later when patient is in better physical condition a resection and anastomosis of bowel performed.

Nursing Diagnose 

1. Acute pain related to bowel obstruction as evidence by facial expression

2. Constipation related to bowel obstruction as evidence by abdominal distension

3. Imbalance nutrition less than body requirement related to bowel obstruction as evidence by body weight