Intestinal Obstruction

Presented By:Sahar Bannani

Supervised By:Dr. Fatmah AlThubaity

ClassificationsIntestinal Obstruction

Dynamic/ Mechanical

Small Bowel

Large Bowel

Adynamic/ Ileus

- Paralytic- PseusoObs

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

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.

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.

Clinical picture

Partial vs. Complete Subacute, Acute, Chronic, Acute on

Chronic Small Bowel: high vs. low Strangulated Perforated

How to diagnose

History: Age Nausea, Vomiting, Obstipation, Pain,

Distention Past Surgical Hx Past Medical Hx Medications Systemic Review

Cont’ how to diagnose Physical Exam:

Vitals Abdomen Rectum

Labs: CBC: WBC, Hct, Hb U&E, creatinine ABG Amylase Urine Output

Cont’ how to diagnose

Radiology: Abdominal X-Ray: erect and supine.Erect CXR CT abdomen Upper GI series / small bowel series Contrast enema

How to manage

Resuscitation. NGT Conservative/Medical vs. Surgical

Paralytic ileus

LBO SBO

+ Late, ± feculent

Early, ± bilious Nausea, Vomiting

Minimal or absent

Colicky Colicky Pain

+ ++ + (proximal),++ (distal)

Distention

+ + + Con-/Ob-stipation

±visible peristalsis

± visible peristalsis

Others

or absent Or Or Bowel Sounds

Air throughout small bowel and colon

Air-fluid levels, picture-frame appearance, haustral markings, proximal distention

Air-fluid levels, Ladder pattern, valvulae conniventes, proximal distention + no colonic gas

AXR Findings

THANK YOU ALL