Disease Condition Intestinal Obstruction,Causes, Sign and Symptoms, Pathophysiology, Types, Assessment and Dignostic Test, Management Gastrointestinal System By HIREN GEHLOTH For Nursing Students Medical Surgical Nursing EAT HEALTHY STAY HEALTHY

1. Subject: Medical Surgical Nursing - I
Topic: Intestinal Obstruction
By: Hiren K Gehloth
F.Y.M.Sc Nursing
Govt.College Of
Nursing,Abad(GINERA)

4. Stomach

6. Large Intestine

7. LIVER

8. GALL BLADDER

9. INTESTINAL OBSTRUCTION

10. INTRODUCTION
 Partial or complete obstruction of the forward flow of
intestinal contents is known as intestinal obstruction.
About 90% of bowel obstructions occur in the small bowel,
especially in the ileum, which is the narrowest segment.
 Obstructions of the small intestine are a common surgical
emergency. Large Bowel obstruction usually occur in the
sigmoid colon.
 The mortality rate for acute obstruction in the small bowel is
10% and in the large bowel 30%.
 Obstructions produces nausea, vomiting, dehydration, and
severe pain. Intestinal obstruction has a right mortality rate if
it is not diagnosed and treated within 24 hours.

11. DEFINITION
 “Intestinal obstruction is a partial or complete
blockage of the bowel that prevents the contents
of the intestine from passing through”

12. TYPESOF OBSTRUCTION:
 Simple → There is a obstruction but blood
supply to intestinal remains intact.
 Strangulated → In this
mesenteric blood vessels
are occluded beside the
usual mechanical
obstruction.

13.  Close loop obstruction → When there is a both
limbs afferent and efferent limbs are obstructed.
Close loop obstruction

14. CAUSES
 Mechanical obstruction: An intraluminal
obstruction or a mural obstruction from pressure n the
intestinal wall occurs.
 Intussusception,
 polypoid,
 tumours, and
 neoplasm,
 stenosis,
 strictures,
 adhesions,
 hernias,
 abscess,
 bezorars.

15.  Adhesions : Loops of intestine become adherent to
areas that heal slowly or scar after abdominal surgery:,
occurs most commonly in small intestine.
 Intussuception : One part of the intestine slips into
another part located below it. Occurs common in
infant than the adults.
 Volulus : Bowel twists and turns on itself and occludes
the blood supply.

16.  Hernia: Protrusion of intestine through a weakened area in
the abdominal muscle wall.
Tumor : A tumor that exists
within the wall of the intestine
extends into the intestinal lumen,
or a tumor outside the intestine
causes pressure on the wall of
the intestine. Most common
type is colorectal adenocarcinoma.

17.  Functional Obstruction: The intestinal
musculature cannot propel the contents along the
bowel,
 Examples are..
 amyloidosis,
 muscular dystrophy,
 Endocrine disorder
such as diabetes.
 The blockage also can be temporary and the result
of the manipulation of the bowel during surgery.

18.  Extrinsic bowel obstruction
◦ Begins outside the GI tract
◦ Adhesions, herniations, or masses

 Intrinsic bowel obstruction
◦ Lumen blockage
◦ Caused by acute or chronic bowel disease
inflammation, congenital defects, or tumors

 Intraluminal bowel obstruction
◦ Caused by the inability of material to pass
through the GI tract (meconium, foreign bodies, )

19. PATHOPHYSIOLOGY:

20. Symptoms of Hypovolemic Shock

21. CLINICALMANIFESTATION:
 Small Bowel Obstruction:
 Crampy abdominal pain that comes and goes
 Loss of appetite
 Constipation
 Vomiting
 Inability to have a bowel movement or pass gas
 Swelling of the abdomen
 Dehydration

22.  Large Bowel Obstruction :
 severe bloating
 abdominal pain
 decreased appetite
 nausea
 vomiting
 inability to pass gas or stool
 constipation
 diarrhea
 severe abdominal cramps
 Abdominal Distension
 abdominal swelling
 Hypovomemic shock may occur.
Abdominal Distension

23.  Physical exam:
 Complete blood count (CBC):
 Abdominal X-ray:
 Barium enema:
 CT scan:
 Colonoscopy:
DIAGNOSTICFINDINGS:

24. MANAGEMENT:
 There are different treatments depending on the type
of bowel obstruction you have, partial or complete.
 All obstructions will be treated with IV fluids and
electrolyte correction.
 Occasionally, a nasogastric tube is placed to
remove fluid and gas backing up in the upper
digestive tract.
 Medications are used to help with nausea and severe
pain. A complete obstruction may require surgery or
stenting. A partial obstruction may resolve on its
own.

25.  Fluid replacement therapy: A treatment to get the fluids in
the body back to normal amounts. Intravenous (IV) fluids
may be given and medicines may be prescribed.
 Electrolyte correction: A treatment to get the right amounts
of chemicals in the blood, such as sodium, potassium, and
chloride. Fluids with electrolytes may be given by infusion.
 Surgery: Surgery may be done if serious symptoms are not
relieved by other treatments.
 Stent: A metal tube inserted into the bowel to open the area
that is blocked.

26. MEDICATION
 Antibiotics
 Cefazolin
 Cefoxitin
 Cefotetan
 Cefuroxime
 Meropenem
•Antiemetic
• Promethazine
• Ondansetron

27. SURGICALMANAGEMENT:
 Surgical resection: Removal of the obstruction is
necessary when there is a mass, such as a tumor.
 Removal of adhesions: If scar tissue squeezing intestines
from the outside, this often requires careful incisions to
cut them away, although scar tissue can return again.

28.  Stent placement: A stent, which is a tube that holds the
intestine open, may be placed inside the intestine to
allow passage of food and stool and to prevent another
blockage. This may be necessary when a bowel
obstruction is recurrent or when the intestines are
severely damaged.

29.  Colostomy/ ileostomy: If intestines are damaged or
inflamed, a permanent or temporary ileostomy
or colostomy, which is an artificial opening in your
abdomen for waste or stool evacuation, may be needed.
 Sometimes, these are temporary structures needed to
prevent a severe gastrointestinal infection from
spreading throughout the body. However, it is possible
that the ends of the intestines cannot be reconnected, and
these openings may be needed for the long term.

30.  Revascularization: Ischemic colitis may require
revascularization, which is repair of the blocked blood
vessels that supply blood to the intestines.
Hemicolectomy: