General management of intestinal obstruction Arindam Roy Medical College Kolkat
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Transcript of General management of intestinal obstruction Arindam Roy Medical College Kolkat
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GENERAL MANAGEMENTOF INTESTINAL OBSTRUCTION
- by ARINDAM ROY 8th semester
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ALGORITHM FOR MANAGEMENT OF A CASE OF INTESTINAL OBSTRUCTION
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LABORATORY INVESTIGATION
• COMPLETE BLOOD COUNT - 1. TLC2. HAEMATOCRIT VALUE • SERUM UREA AND CREATININE• SERUM ELECTROLYTES• LIVER FUNCTION TEST• SERUM AMYLASE
SUPPORTIVE TREATMENT
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SUPPORTIVE TREATMENT
1. Nasogastric AspirationS
• Non-vented Ryle’s tube• Vented Salem tube
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Role of nasogastric aspiration
• Reduce bowel distension• Improve pulmonary ventilation• Reduce risk of subsequent aspiration during
induction of anesthesia and post extubation
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2. Fluid and electrolyte replacement
• I.V. fluid - to correct the fluid loss• Electrolyte solution - to make up electrolyte
deficiency mainly sodium loss• Hartmann’s solution or normal saline used• Volume required to be determined by clinical
hematological and biochemical criteria
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3. Parenteral antibiotics
• Broad spectrum antibiotics- Ampicillin, Gentamycin, Metronidazole, Cephalosporins
• To correct bacterial infection• Mandatory for all patients undergoing small
or large bowel resection
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4. Blood Transfusion• FFP or platelet transfusions• Often needed in critical patients
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5. ICU Critical Care• For systemic management of complications
like ARDS, DIC, SIRS• If hypotension- Dopamine/Dobutamine
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6. Indwelling Catheter
• Perurethral• To collect and measure 24 hours urine output• Intake and output chart is made
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7. CVP For Fluid And Monitoring
• PCWP (pulmonary capillary wedge pressure) monitoring
• Needed in haemodynamically unstable patients
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8. Clinical Follow UpIMPROVEMENT• Conservative treatment
is carried on.
DETERIORATION• Surgery indicated if no
improvement occurs with in 24-48 hours