Acute Intestinal Obstruction

Question 1

Definition

Answer 1

Complication of a disease characterized by complete impairment of the contents of the passage through the
intestine due to a mechanical obstacle of intestinal motor function disturbance manifesting as
stools & gas retention with further severe homeostasis impairments.

Intestinal obstruction is a complete or partial disturbance of intestinal evacuation and peristalsis resulting from various causes which manifests by specific clinical course and morphologic changes of involved part of the bowel

Question 2

Classification of Acute Intestinal Obstruction (AIO)

Answer 2

According to mechanism detiological factors.
1. Dynamic obstruction
Steady paresis/paralysis of whole intestine or its section
Steady intestinal spasm
causes
9) Paralytic : Inflammation in abdominal cavity , resulting in disseminated peritonitis
Inflammation in retroperitoneal space (pancreonecrosis, paranephritis
Inflammation of intestine (Crohn’s disease
Trauma of abdominal cavity
Metabolic Impairments
Thrombosis Eembolism and embolism of mesenterial blood vessels
b) Spastic : Intoxication by lead poisoning.Observed in porphyria, helminthic invasion
Hemostatic AlO

2) Mechanical obstruction
Can be
Strangulated or obturational
Strangulated - with pressing intestinal mesenterial vessels
Obturational- without pressing intestinal mesenteric vessels £

According to the course of pathological process.
1. Stage of acute disturbance of intestinal evacuation and peristalsis.
2. Stage of hemodynamic disorders of the bowel wall and its mesentery.
3. Stage of peritonitis.c

Question 3

Clinical picture of dynamic { paralytic }

Answer 3

Pain in the abdomen overpressing pain
Nausea recurrent vomiting
Non-passage of stools and gases
Tachycardia hypotension
Hyperthermia

Question 4

Clinical picture of mechanical

Answer 4

Obturational- abdominalpain/ nausea recurrent vomiting non-passage of stools and gases and pronounced weakness anemia.

Strangulation - intensive continuous abdominal pain recurrent vomiting non-passage of stools and gases pronouncedweakness tachycardia normothermia

Question 5

Diagnosis

Answer 5

USI
CT
Colonscopy
Laparoscopy

X-ray examination
1. Kloiber’s cups (air-fluid level)
2. Intestinal pneumatisation

Question 6

Surgical Treatment

Answer 6

Surgical treatment
is indicated only if no improvement during 3-4 hours of conservative treatment
•Wide laparotomy
•Procaine block of mesenteric root
•Revision of intestine and detecting of the level and cause of obstruction
•Decompression of intestine proximal to the obstruction
•Assessing of viability of the bowel (peristalsis, colour, vascular pulsation)
• Removal of the obstruction (division of adhesions, intestinal resection, collateral anastomosis)
•External drainage of intestine (nasogastrointestinal intubation, rectal tube)

If with peritonitis_- liquidation of the source OPP. Of sanction and drainage of abdominal cavity
If with crohn diseases - intestinal resection

Question 7

Causes of Acute intestinal obstruction (mechanical)

Answer 7

Adhesion
tumor
bile stone
inflammatory infiltrate
Defects of peritoneum
Long mesenteric of the bowel
Increase abdominal pressure
Internal hernia
Foreign bodies
Diverticulitis
Inflammatory bowel disease like Crohn disease

Question 8

Causes of Acute intestinal obstruction( obturation)

Answer 8

Medication
Electrolyte imbalance
Infection(appendicitis)
Neurological and muscular disorders
Ischemia

Question 9

Pathogenesis of acute intestinal obstruction

Answer 9

Intestinal block>accumulation q of intestinal content → distention ofintestinal wall → translation of intestinal juiceand vomitting

The accumulationOf intestinal contentalso lead to loss of electrolytesdehydration loss of potassium loss of proteins
Distention of intestinal wall → necrosis of the bower → peritonitis →intoxication hemodynamicdisturbances

Question 10

Peculiarities of strangulated intestinal obstruction

Answer 10

Transfusion of large quantity of proteins;
•Transfusion of erythrocytes and decreasing of volume of circulating blood;
•Severe dehydratation, caused by additional edema of the bowel wall;
•Rapid necrosis of intestinal wall with subsequent peritonitis and intoxication

Question 12

diagnostics of acute intestinal obstruction with acute pancreatitis

Answer 12

Periodic acute diffuse pain
•Constant vomiting and nausea without any relief
• Retention of stool and gases
•Abdominal distension
•On X-ray of the abdomen Kloiber’s cups (air-fluid levels)
•Splashing sound, increased peristalsis

Question 13

diagnostics of acute intestinal obstruction with mesenteric thrombosis

Answer 13

Periodic acute diffuse pain
•Constant vomiting and nausea without any relief
• Retention of stool and gases
•Abdominal distension
•On X-ray of the abdomen Kloiber’s cups (air-fluid levels)
•Splashing sound, increased peristalsis

Question 14

diagnostics of acute intestinal obstruction with acute cholecystitis

Answer 14

Periodic acute diffuse pain
•Constant vomiting and nausea without any relief
• Retention of stool and gases
•Abdominal distension
•On X-ray of the abdomen Kloiber’s cups (air-fluid levels)
•Splashing sound, increased peristalsis

Question 15

Conservative treatment

Answer 15

Conservative treatment is indicated only in:
1. Adhesive obstruction without signs of strangulation.
2. Initial stages of invagination.
3. Initial stages of low obturation
•Gastric decompression
•Siphon enema
•Paranephral procaine block
•Ganglio- and sympatholytics
•Correction of water-electrolyte balance

Question 16

Strangulation intestinal obstruction types and causes

Answer 16

Volvulus, (torsion).
2. Nodulus (knots).
3. Hernial strangulation (incarceration).
4.Invagination (refers to mixed forms of intestinal obstruction)
Causes
•Elongation of intestinal loop.
•Increasing of abdominal pressure.
•Long mesentery of the bowel.
•Cicatrical shortening of mesenteric root.
•Adhesions
•Extensive functional overload of the bowel.

Question 17

Volvulus (torsion)

Answer 17

Small intestine volvulus
Clinically manifests by high strangulation intestinal obstruction
Cecal volvulus, sigmoid volvulus
Clinically: low strangulation intestinal obstruction
asymmetric abdomen
by palpation enlarged and displaced colon (like balloon)
retracted right or left iliac region
Treatment: detorsion, division of adhesions, cecopexia, colon resection

Question 18

Nodulus

Answer 18

Nodulus
It is the most severe type of strangulation with manifestation of a high strangulated obstruction which rapidly results in shock, bowel necrosis and peritonitis
Treatment:
•very short preoperative period (less 1 hour)
•untie of the bowel node (till 4-5 hours from the onset)
•resection of the bowel

Question 19

Invagination

Answer 19

It is the insertion of one part of the bowel into the lumen of another
Treatment:
desinvagination or resection
Clinically:
•signs of obturation and in advanced cases the strangulation ileus
•elastic, painful, tumourlike formation in the abdomen
•blood in stool (or during rectal examination)