Clinical aspect of intestinal obstruction Ritasman Baisya Medical College kolkata

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Intestinal obstruction- clinical aspects Ritasman Baisya Roll no – 85 8 th semester

description

Ritasman Baisya Medical College kolkata

Transcript of Clinical aspect of intestinal obstruction Ritasman Baisya Medical College kolkata

Page 1: Clinical aspect of intestinal obstruction Ritasman Baisya Medical College kolkata

Intestinal obstruction- clinical aspects

Ritasman BaisyaRoll no – 85 8th semester

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Factors affecting clinical feature

• Location of obstruction

• Age of the obstruction

• Underlying pathology

• Presence or absence of intestinal ischemia

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Cardinal features

Abdominal pain

Distension Vomiting

Absolute constipation

Cardinal features of acute obstruction

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Pain

• First symptom

• Onset -- Occurs suddenly and usually severe

• Site - Around umbilicus or lower abdomen

• Nature-Colicky in nature ,with increased distension ,pain becomes mild, constant ,diffuse

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Contd. pain

• Special points –

• Very severe pain indicates strangulation

• Pain may not be significant in post operative simple mechanical obstruction

• Not present usually in paralytic ileus

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Vomiting

• Onset – timing depends on site

• Character— alters from digested food, bile stained food to faeculent matter

• Nature – projectile

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Distension

• Degree of distension depends on site of obstruction

• Visible peristalsis may be present

• Delayed in colonic obstruction & minimal /absent in mesenteric vascular occlusion

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Few images of visible peristalsis in obstruction

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Constipation

Types -- 1. absolute (neither feces nor flatus ) 2. relative (where only flatus is passed ) Absolute constipation is cardinal feature of

complete obstruction

Some patients pass feces or flatus due to distal bowel content

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Exceptions

• Richter hernia

• Gallstone obturation

• Mesenteric vascular occlusion

• Obstruction associated with a pelvic abscess

• Partial obstruction where diarrhea may often occurs

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Dehydration

• Mostly in small bowel obstruction due to repeated vomiting

• Dry tongue, dry skin , sunken eye , oliguria

• Secondary polycythemia…

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Abdominal tenderness

Initially localised , later diffuse

Rebound phenomenon & guarding will not be present in simple obstruction

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Temperature

• Fever signifies inflammation in bowel wall / ischemia / perforation

• Hypothermia -- when septicemia due to poor pyrogenic response

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Bowel sounds

• High pitched metallic to metallic tinkling sound of dilated bowel

• Once fatigue– silent abdomen peritonitis

• In paralytic ileus no return of bowel sound on auscultation

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Other features

• Pyrexia – onset of ischemia , intestinal perforation

• Hypokalemia

• Increase in serum amylase ,LDH

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Features of strangulation

• Continuous severe pain

• Shock indicates underlying ischemia

• Symptoms commence suddenly and recur regularly

• Local tenderness associated with rigidity and rebound tenderness ( Blumberg sign )

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Proximal small bowel

Distal small bowel Large bowel

Severe vomiting Moderate vomiting Late vomiting

Less distension Central distension Early distension , pronounced

Colicky pain Central abdominal pain Less pain

Constipation late Varies in appearance Constipation is early feature

Severe dehydration Moderate Less dehydration

Comparison of clinical aspects

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Complications • Peritonitis• Shock• Renal failure• ARDS• Intra abdominal abscess• Moribund status

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