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Intestinal Obstruction

Intestinal Obstruction. Tintinalli Chapter 79. Intestinal Obstruction. Inability of the intestinal tract to allow for regular passage of food and bowel contents Mechanical obstruction Intrinsic Extrinsic Adynamic ileus. Duodenum Stenosis Foreign body Bezoars Stricture SMA syndrome.

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Intestinal Obstruction

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  1. Intestinal Obstruction Tintinalli Chapter 79

  2. Intestinal Obstruction • Inability of the intestinal tract to allow for regular passage of food and bowel contents • Mechanical obstruction • Intrinsic • Extrinsic • Adynamic ileus

  3. Duodenum Stenosis Foreign body Bezoars Stricture SMA syndrome Intestinal Obstruction

  4. Small Bowel Adhesions Most common cause Hernia Inguinal most common Umbilicus Femoral – elderly female Primary lesion Polyp, lymphoma, adenocarcinoma Intussusception Stricture Radiation enteritis Inflammatory bowel disease Intestinal Obstruction

  5. Colon Neoplasm – most common Diverticulitis (stricture , abscess) Volvulus Sigmoid Cecal volvulus more common in gravid Fecal impaction Ulcerative colitis Intussusception Pseudo-obstruction Intestinal Obstruction

  6. Abdominal pain Cramping Intermittent Vomiting Especially with proximal Bilious Distal Feculent Lack of BM / flatus in complete obstruction Clinical

  7. Abdominal distension Tympani Tenderness Bowel sounds Mechanical obstruction Active high pitched with rushes early Absent late Adynamic ileus Hypoactive or absent Clinical

  8. Rectal exam Fecal impaction Mass Blood Presence of stool or air Pelvic examination Compressive pathology Pessary? Clinical

  9. Flat and upright abdominal film Upright chest or lateral decubitus Barium films CT CBC BMP Amylase / lipase Lactic acid Urine analysis Labs / Radiology

  10. True mechanical obstruction NG tube IV fluid replacement Broad spectrum antibiotics preoperatively Surgical intervention Rectal tube for volvulus of sigmoid Treatment

  11. Adynamic ileus NPO IV fluids NG? Observation Repeat films / CT Review medications Treatment

  12. Ogilvie syndrome Low colonic most common Review meds Anticholinergics TCA Treatment Neostigmine infusion Colonoscopy Pseudo-Obstruction

  13. Questions?

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