Obstructive Mechanic
Transcript of Obstructive Mechanic
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OBSTRUKSI MEKANIKPembimbing : dr.Munthadar,Sp.B,Sp,BA
dr. Dian Adi Saputra, Sp B(K)
BA
Department Ilmu Bedah Divisi Bedah Anak
Fakultas Kedokteran Universitas Syiah Kuala
BLUD Rumah Sakit Umum Zainal Abidin
Banda Aceh
Oleh:Veliqa Nadhila
Nurul syakila
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INTRODUCTIONObstruction is the most common
disorder afflicting the small bowel.
the majority (75%) of small bowel
obstructions are attributed tointraabdominal adhesions from prior
operations.
At 10 years, recurrent obstruction
from adhesions is estimated to
occur 15 to 50% of the time. Amongs
patients with adhesive obstruction,
anywhere from 25 to 66% are
reported to require an operation
In the first three or so decades of
the 20th century, mortality from
small bowel obstruction was ashigh as 60%. Factors shown to
potentiate mortality risk include
older age and presence of
comorbiditiesDuron JJ,tezenas du Montcel S, Berger A et al: Prevalence and
risk factors of mortality and morbidity after operation for adhesive
postoperative small bowel obstruction. Am J Surg 2008;195:72673
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II. DEFINITION
MECHANICAL OBSTRUCTIONA mechanical bowel obstruction is a partial orcomplete blockage in the intestine, which is
also called the bowel. Blockages can occur at
any point along the small or large bowel.
They are more common in the small bowel.
When the bowel is blocked, food and liquid
cannot pass through. Over time, food, liquid,and gas build up in the area above the
blockage.
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Risk Factors
Risk factors for a bowel
obstruction include anything that is
likely to cause scar tissue or ablockage, such as:
-History of ulcers
-Previous gastrointestinal or
gynecologic surgery
-Diverticulitis
-Crohnsdisease-Hirschsprungsdisease
(in infants and children)
-Cancer of the gastrointestinal
tract
ETIOLOGY
Most small bowel blockages are due to
adhesions. An adhesion is a band of scar
tissue that causes the bowel to attach to
the abdominal wall or other organs. Most
largebowel obstructions are caused bytumors.
Specific causes of bowel obstructions
include:
-Hernia
-Tumors
-Bowel inflammation or swelling-Foreign matter in the intestines
-Gallstones
-Impacted feces
-Volvulus (twisting of the intestine)
-Intussusception
(telescoping of the intestine into itself)
-Scar tissue from a previous abdominal or
pelvic surgery, particularly gynecologic or
gastrointestinal operation Beers MH, Berkow R. The Merck Manual of
Diagnosis and Therapy. 17th ed. Whitehouse Station
NJ: Simon and Schuster; 1999.
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SymptomsSymptoms of a bowel obstruction include:
-Abdominal pain
-Abdominal distention-Abdominal cramps
-Nausea
-Vomiting
-Diarrhea
-Severe constipation; inability to pass gas or stool
-Bloating-Fever
-Rapid pulse
-Foul breath odor
Complications from an untreated obstruction can include strangulation, which is
cutting off of the blood supply to part of the intestine.
Beers MH, Berkow R. The Merck Manual of
Diagnosis and Therapy. 17th ed. Whitehouse
Station, NJ: Simon and Schuster; 1999.
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Diagnosis-Auscultation : absent bowel sound,
high pitched or tingling
-Blood tests
-Urine tests
-Abdominal x-rays, such as:
-Barium enema-Endoscopy
-CT scan of the abdomen
Terminology
-Simple obstruction (low grade)
bowel obstruction with an intact blood supply
-Strangulating obstruction (high grade,
complete)
bowel obstruction with resultant ischemia
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ABDOMINAL PLAIN FILM
3S rule:
- Lumen >3 cm
- Folds >3mm
- >3 air fluid levels
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ABDOMEN CT SCAN
Sign of obstruction
-Lumen >3 cm
-Transition point
Transition point
-Normal caliber post stenotic bowel
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DIFFERENTIAL DIAGNOSE
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TREATMENT
Possible treatments include the following:
a. Nasogastric tube
This involves the passage of a narrow tube through yournose and down into the stomach to suction out fluids that have become
trapped above the blockage.
b. IV fluidsVomiting and diarrhea can cause dehydrationand imbalances in
your body fluids; if you are dehydrated, you will be given fluids and
electrolytes.
c. Medications
antibiotics or pain medication through an IV or through thenasogastric tube.
d. Removal of fecal impactionIf fecal matter is causing the obstruction.
e. EndoscopyA thin, lighted tube is inserted through the rectum and into the
large intestine to straighten out the intestines.
f. Surgery
Depending on the cause of the obstruction, you may need surgery.Surgery can:
Remove scar tissue, tumors, gallstones, foreign matter, and other causes of the
blockages
Repair hernias
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