Intestinal Obstruction

Intestinal obstruction involves a partial or complete blockage of the bowel that

results in the failure of the intestinal contents to pass through.
Two processes that can impede the flow of intestinal contents:

➢ Mechanical Obstruction: Complete arrest or serious impairment of the

passage of intestinal contents caused by a mechanical blockage.
Examples:
1. Adhesions
2. Hernias
3. Tumors
4. Foreign bodies (including gallstones)
5. Inflammatory bowel disease (crohn’s disease)
6. Hirschsprung’s disease
7. Fecal impaction
8. volvulus
➢ Functional Obstruction: The intestinal musculature cannot propel the
contents along the bowel.
Examples:
1. Muscular dystrophy
2. Neurologic disorders such as Parkinson’s disease
3. Endocrine disorders such as diabetes mellitus
4. amyloids

Pathophysiology
In simple mechanical obstruction, blockage occurs without vascular or neurologic
compromise. Ingested fluid and food, digestive secretions, and gas accumulate in
excessive amounts if obstruction is complete. The proximal bowel distends, and the
distal segment collapses. The normal secretory and absorptive functions of the
mucous membrane are depressed, and the bowel wall becomes edematous and
congested. Severe intestinal distention is self-perpetuating and progressive,
intensifying the peristaltic and secretory derangements and increasing the risks of
dehydration, ischemia, necrosis, perforation, peritonitis, and death.

Small Bowel Obstruction

Small-bowel obstruction is commonly caused by incarceration in hernias or by
adhesions and is less commonly caused by tumors (primary or metastatic),
obturation by foreign bodies, a Meckel's diverticulum, or Crohn's disease.
Clinical Manifestations:
Symptoms:
1. Abdominal x-ray in both the supine and upright positions usually confirms
diagnosis.
2. Vomiting starts early with small-bowel and late with large-bowel obstruction.
3. Obstipation occurs with complete obstruction, but diarrhea may be present
with partial obstruction.
Signs:
1. Dehydration
2. Intense thirst
3. Drowsiness
4. Generalized malaise
5. Aching
6. Parched tongue and mucous membrane
7. Breath odor

Diagnostic Findings:

1. Abdominal x-ray in both the supine and upright positions usually confirms
diagnosis.
2. Ct Findings include abnormal quantities of gas, fluid or both in the intestines.
3. Laboratory studies (CBC, electrolyte study) reveal a picture of dehydration,
los of plasma volume, and possible infection.

Medical Management:

1. Nasogastric suction
2. IV fluids
3. Laparotomy
4. Obstructing gallstones are removed by lithotomy.
5. Treatment of obstruction of the duodenum in adults consists of resection or,
if the lesion cannot be removed, palliative gastrojejunostomy.

Nursing Management:

1. distention) Maintain the function of the nasogastric tube

2. Assess and measure nasogastric output
3. Assess for fluid and electrolyte imbalance
4. Monitor nutritional status
5. Assess for improvement (return of normal bowel sounds, decreased
abdominal

Large Bowel Obstruction

Results in an accumulation of intestinal contents, fluid, and gas proximal to the
obstruction which can lead to severe distention and perforation unless some gas
and fluid can flow back through the ileal valve.

Clinical Manifestations:

Symptoms:

1. Constipation
2. abdominal distention
3. Vomiting but not rare
4. Lower abdominal cramps unproductive of feces

➢ Large bowel obstruction differs clinically from small bowel obstruction in that
the symptoms develop and progress relatively slowly.

Signs:
1. Weakness
2. Weight loss
3. anorexia

Diagnostic Findings:

1. Abdominal x–ray shows distention of the colon proximal to the obstruction.

2. CT findings
3. MRI findings
4. Barium enema

Medical Management:

1. Nasogastric suction
2. IV fluids and electrolytes
3. Urinary catheter are needed before emergency operation.
4. Obstructing cancers of the colon can often be treated by a single-stage
resection and anastomosis.

Nursing Management:

1. Monitor for worsening of symptoms

2. Provide emotional support and comfort