INTESTINAL OBSTRUCTION IN ENGLISH

                                                  

                              INTESTINAL  OBSTRUCTION  IN ENGLISH

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INTESTINAL  OBSTRUCTION-

Ø  Intestinal obstruction is defined as a blockage that prevents the normal flow of intestinal contents through the intestinal tract. There are two types of obstruction in the intestine:

Ø  Mechanical obstruction:

Ø  Functional obstruction:

Ø  Mechanical obstruction: This type of obstruction is caused by an intraluminal obstruction due pressure on the intestinal wall. Examples are intussusception, polypoid tumors and neoplasms, stenosis, strictures, adhesions, hernias, and abscesses.

Ø  Functional obstruction: In this type of obstruction the intestinal musculature cannot propel the contents along the bowel. Examples are amyloidosis, muscular dystrophy, endocrine disorders such as diabetes mellitus, or neurologic disorders such as Parkinson’s disease.  

CAUSES-

Ø  Adhesions are the most common cause of small bowel obstruction. These are scars made due to previous abdominal surgery and loops of intestine adhere to them.

Ø  Other causes includes hernias, neoplasms and intussusception. In intussusception one part of the intestine slips into another part located below.

Ø  Small intestine obstructions are also caused by paralytics ileus and volvulus. Volvulus is twisting of loop of small intestine on itself.

Ø  The most common causes of large intestine obstruction are carcinoma, diverticulitis, inflammatory bowel disorders, and benign tumors. A diverticulum is a saclike herniation of the lining of the bowel that extends through a defect in the muscle layer. Diverticula may occur anywhere in the small intestine or colon but most commonly occur in the sigmoid colon .

CLINICAL MANIFESTATIONS-

Clinical manifestations of intestinal obstruction include -

Ø  Crampy pain that is wavelike and colicky pain.

Ø  The patient may pass blood and mucus but no fecal matter and no flatus.

Ø  Vomiting occurs, If the obstruction is complete.

Ø  If the obstruction is in the ileum, fecal vomiting takes place. First, the patient vomits the stomach contents, then the bile stained contents of the duodenum and the jejunum, and finally, with each paroxysm of pain, the darker, fecal-like contents of the ileum.

Ø  The signs of dehydration appears such as intense thirst, drowsiness, generalized malaise and a dry tongue and mucous membranes.

Ø  The abdomen becomes distended.

Ø  Hypovolemic shock may occurs from dehydration

DIAGNOSTIC INVESTIGATIONS-

Ø  History and Physical examination. (presence of clinical manifestations of intestinal obstruction)

Ø  Abdominal x-ray

Ø  Abdominal CT scan

Ø   Serum electrolytes and

Ø  A complete blood cell count

TREATMENT-

Ø  Medical management includes-

Ø  Decompression of intestine by insertion of NG tube, hen intestine is decompressed obstruction may be relieved simultaneously.

Ø  IV fluids are necessary to replace the depleted water, sodium, chloride, and potassium etc.

Ø  In some cases surgical management may be needed. The surgical procedure of intestinal obstruction depends on the cause of the obstruction. If the underlying cause is hernia and adhesions, the surgical procedure involves repairing the hernia or dividing the adhesion to which the intestine is attached.

Ø  In severe cases where repair is not possible than the portion of affected bowel may be removed and an anastomosis performed. The complexity of the surgical procedure depends on the duration of the intestinal obstruction and the condition of the intestine.

NURSING MANAGEMENT-

Ø  Proper assessment is done by health history and physical examination and nursing care plan is prepared.

Ø  Nutritional assessment is very important in the assessment of patients with intestinal obstruction.

Ø  Patient is encouraged to discuss the problem and ask doubts and concerns to relieve anxiety related to diseases process and treatment.

Ø  NG tube may be inserted for decompression of intestine so proper NG tube drainage care should be provided.

Ø  Prescribed medicines are given on time to reduce pain and increase comfort.

Ø  The patient is continuously monitored for signs of dehydration.

Ø  The nurse assesses the patient for malnutrition and weight loss. After recovery from an acute phase of disease, the patient is advised about intake of proper diet and adequate nutrition.

Ø  The nurse monitors fluid and electrolyte balance and assesses the patient for localized infection or peritonitis

Ø  IV fluids are given as prescribed to maintain fluid and electrolyte balance postoperatively.

Ø  Patient may have colostomy as the part of surgical procedure than carefully colostomy care is provided with aseptic technique.

Ø  Patient is monitored for signs of infection at surgidcal site and surgical site and asepsis is maintained in care .

Ø  Health education is provided regarding colostomy care at home and follow up  during discharge planning.