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Intestinal Obstruction. Presented By: Sahar Bannani Supervised By: Dr. Fatmah AlThubaity. Classifications. Etiology. Small Bowel: Adhesions: 60-80 % Hernia: 15-20 % Neoplasms : 10-15 %, extramural > intramural Large Bowel: Malignancy: 60% Diverticulitis: 15%

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intestinal obstruction

Intestinal Obstruction

Presented By:SaharBannani

Supervised By:

Dr. FatmahAlThubaity

etiology
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
slide4

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
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
Clinical picture
  • Partial vs. Complete
  • Subacute, Acute, Chronic, Acute on Chronic
  • Small Bowel: high vs. low
  • Strangulated
  • Perforated
how to diagnose
How to diagnose
  • History:
    • Age
    • Nausea, Vomiting, Obstipation, Pain, Distention
    • Past Surgical Hx
    • Past Medical Hx
    • Medications
    • Systemic Review
cont how to diagnose
Cont’ how to diagnose
  • Physical Exam:
    • Vitals
    • Abdomen
    • Rectum
  • Labs:
    • CBC: WBC, Hct, Hb
    • U&E, creatinine
    • ABG
    • Amylase
    • Urine Output
cont how to diagnose1
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
How to manage
  • Resuscitation.
  • NGT
  • Conservative/Medical vs. Surgical