Intestinal obstruction 2

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Intestinal obstruction- clinical aspects:

Intestinal obstruction- clinical aspects Ritasman Baisya Roll no – 85 8 th semester

Factors affecting clinical feature:

Factors affecting clinical feature Location of obstruction Age of the obstruction Underlying pathology Presence or absence of intestinal ischemia

PowerPoint Presentation:

Cardinal features Abdominal pain D istension Vomiting Absolute constipation Cardinal features of acute obstruction


P ain First symptom Onset -- Occurs suddenly and usually severe Site - Around umbilicus or lower abdomen Nature -Colicky in nature ,with increased distension ,pain becomes mild, constant ,diffuse

Contd. pain:

Contd. pain Special points – Very severe pain indicates strangulation Pain may not be significant in post operative simple mechanical obstruction Not present usually in paralytic ileus


V omiting Onset – timing depends on site Character — alters from digested food, bile stained food to faeculent matter Nature – projectile

Distension :

Distension Degree of distension depends on site of obstruction Visible peristalsis may be present D elayed in colonic obstruction & minimal /absent in mesenteric vascular occlusion

PowerPoint Presentation:

Few images of visible peristalsis in obstruction

Constipation :

Constipation Types -- 1. absolute (neither feces nor flatus ) 2. relative (where only flatus is passed ) Absolute constipation is cardinal feature of complete obstruction Some patients pass feces or flatus due to distal bowel content

Exceptions :

Exceptions Richter hernia Gallstone obturation Mesenteric vascular occlusion Obstruction associated with a pelvic abscess Partial obstruction where diarrhea may often occurs


Dehydration Mostly in small bowel obstruction due to repeated vomiting Dry tongue, dry skin , sunken eye , oliguria Secondary polycythemia …

Abdominal tenderness:

Abdominal tenderness Initially localised , later diffuse Rebound phenomenon & guarding will not be present in simple obstruction

Temperature :

Temperature Fever signifies inflammation in bowel wall / ischemia / perforation Hypothermia -- when septicemia due to poor pyrogenic response

Bowel sounds:

Bowel sounds High pitched metallic to metallic tinkling sound of dilated bowel O nce fatigue– silent abdomen peritonitis In paralytic ileus no return of bowel sound on auscultation

Other features:

Other features Pyrexia – onset of ischemia , intestinal perforation Hypokalemia Increase in serum amylase ,LDH

Features of strangulation:

Features of strangulation Continuous severe pain Shock indicates underlying ischemia Symptoms commence suddenly and recur regularly Local tenderness associated with rigidity and rebound tenderness ( Blumberg sign )

PowerPoint Presentation:

Proximal small bowel Distal small bowel Large bowel Severe vomiting Moderate vomiting Late vomiting Less distension Central distension Early distension , pronounced Colicky pain Central abdominal pain Less pain Constipation late Varies in appearance Constipation is early feature Severe dehydration Moderate Less dehydration Comparison of clinical aspects

Complications :

Complications Peritonitis Shock Renal failure ARDS Intra abdominal abscess Moribund status

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