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Intestinal Obstruction

Intestinal Obstruction. Presented By: Sahar Bannani Supervised By: Dr. Fatmah AlThubaity. Classifications. Etiology. Small Bowel: Adhesions: 60-80 % Hernia: 15-20 % Neoplasms : 10-15 %, extramural > intramural Large Bowel: Malignancy: 60% Diverticulitis: 15%

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Intestinal Obstruction

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  1. Intestinal Obstruction Presented By:SaharBannani Supervised By: Dr. FatmahAlThubaity

  2. Classifications

  3. Etiology • Small Bowel: • Adhesions: 60-80 % • Hernia: 15-20 % • Neoplasms: 10-15 %, extramural > intramural • Large Bowel: • Malignancy: 60% • Diverticulitis: 15% • Volvulus “esp. elderly”: Sigmoid > Cecal

  4. Adynamic: • Metabolic:  K+, Mg++, Na+, Ketoacidosis, Uremia, Porphyria, Metal posioning. • Inflammation: Appendicitis, Abscess. • Drugs: Narcotics, Antipsychotics, Anticholinergics. • Neuropathy: DM, MS, SD, SLE, Hirschsprung’s. • Post-Op. • Ogilvie’s Syndrome.

  5. pathophysiology • Bowel distal to the obstruction: collapsed. • Bowel proximal to the obstruction: • Distends: • Gas • Fluids: • Intralumenal:  secretion,  absorption  net secretion • Intramural • Peritoneal cavity • Altered Motility. • Vomiting • Hypovolemia, Shock, Death. • Perforation, Sepsis, Shock, Death.

  6. Clinical picture • Partial vs. Complete • Subacute, Acute, Chronic, Acute on Chronic • Small Bowel: high vs. low • Strangulated • Perforated

  7. How to diagnose • History: • Age • Nausea, Vomiting, Obstipation, Pain, Distention • Past Surgical Hx • Past Medical Hx • Medications • Systemic Review

  8. Cont’ how to diagnose • Physical Exam: • Vitals • Abdomen • Rectum • Labs: • CBC: WBC, Hct, Hb • U&E, creatinine • ABG • Amylase • Urine Output

  9. Cont’ how to diagnose • Radiology: • Abdominal X-Ray: erect and supine. • Erect CXR • CT abdomen • Upper GI series / small bowel series • Contrast enema

  10. How to manage • Resuscitation. • NGT • Conservative/Medical vs. Surgical

  11. THANK YOU ALL

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