Obstruction occurs at two points (proximal and distal) Requires emergency surgery Occurs in incarcerated hernias, torsion, adhesions, volvulus Pathophysiology: Obstruction results in proximal air-fluid collection and distal decompression Increased intestinal activity (peristalsis) to overcome the obstruction (contracting against a blocked tube) results in colicky pain (early) Bowel wall edema and increased intraluminal contents and pressure Disruption of venous and then arterial circulation Ischemia (strangulation) and then necrosis occurs Perforation peritonitis, septicemia & shock & death Risk factors: Previous abdominal operations (MC RF) Hernia Inflammatory bowel disease (especially CD stricture SBO) Ingested foreign body Hx of cholecystitis/cholelithiasis (risk to develop gallstone ileus) Presentation: Symptoms: Colicky abdominal pain (diffuse/central) Abdominal distention N&V (proximal obstruction produce more vomiting; +/- bilious & feculent odor) Constipation: does not pass stools but may pass gas Obstipation: does not pass stool or gas (more likely to be complete) Signs: Unstable patient (patient appears unwell, altered mental status, dehydrated, tachycardic +/- fever, BP drop) Abdominal distention, visible peristalsis, previous operation scars Hyperactive bowel sounds on auscultation (high pitched tinkling sounds)
Obstruction occurs at two points (proximal and distal) Requires emergency surgery Occurs in incarcerated hernias, torsion, adhesions, volvulus Pathophysiology: Obstruction results in proximal air-fluid collection and distal decompression Increased intestinal activity (peristalsis) to overcome the obstruction (contracting against a blocked tube) results in colicky pain (early) Bowel wall edema and increased intraluminal contents and pressure Disruption of venous and then arterial circulation Ischemia (strangulation) and then necrosis occurs Perforation peritonitis, septicemia & shock & death Risk factors: Previous abdominal operations (MC RF) Hernia Inflammatory bowel disease (especially CD stricture SBO) Ingested foreign body Hx of cholecystitis/cholelithiasis (risk to develop gallstone ileus) Presentation: Symptoms: Colicky abdominal pain (diffuse/central) Abdominal distention N&V (proximal obstruction produce more vomiting; +/- bilious & feculent odor) Constipation: does not pass stools but may pass gas Obstipation: does not pass stool or gas (more likely to be complete) Signs: Unstable patient (patient appears unwell, altered mental status, dehydrated, tachycardic +/- fever, BP drop) Abdominal distention, visible peristalsis, previous operation scars Hyperactive bowel sounds on auscultation (high pitched tinkling sounds)
GS+notes.docx