Acute Intestinal obstruction - PowerPoint Presentation

Slide1

Acute Intestinal

obstruction

Slide2

characterized by a violation of the passage of intestinal contents in the direction from the stomach to the anus

Acute Intestinal obstruction

Slide3

1.

Dynamic

(functional) obstruction

Spastic Paralytic 2. Mechanical obstruction Strangulation (infringement, curvature, nodulation) Obturation (obturation with a tumor, foreign body, caloric or gallstone, phytobezoar, ascaris ball) Mixed (invaginative, adhesive) 3. By obstacle level High (intestinal) Low (large intestine)

Classification

Slide4

At the basis of the development of mechanical (especially

strangulatory

) intestinal obstruction lie the anatomical prerequisites of an innate or acquired

character.congenital dolichosigma - movable cecum additional pockets and folds of the peritoneum adhesive process in the abdominal cavity lengthening of the sigmoid colon in senile age hernia of the anterior abdominal wall and internal hernia- benign and malignant tumors of various parts of the intestine, leading to obstruction. Obturation can also occur as a result of compression of the intestinal tube by a tumor from the outside, coming from neighboring organs, as well as constriction of the intestinal lumen as a result of perifocal tumor or inflammatory

infiltration

 Exophytic tumors (or polyps) of the small intestine, as well as diverticulum of Meckel can cause invagination. For other types of obstruction as the provoking factors are often changes in intestinal motility associated with changes in the diet: the use of a large number of vegetables and fruits in the summer-autumn period;

Etiology

and

predisposing

moments

Slide5

Humoral disorders

Endotoxicosis

Disorders of motor and secretory-resorptive bowel functionPathogenesis

Slide6

Pain

in the abdomen - a constant and early sign of obstruction, usually occurs suddenly, regardless of food intake, at any time of the day, without harbingers; the nature of the pain is cramped. Attacks of pain are associated with a peristaltic wave and repeat after 10-15 minutes. During the period of decompensation, exhaustion of the energy reserves of the musculature of the intestine, the pain begins to have a permanent character. With strangulation obstruction the pain is immediately constant, with periods of amplification during the wave of peristalsis. With the progression of the disease, acute pain, as a rule, subsides for 2-3 days, when peristaltic activity of the intestine ceases, which is a poor prognostic sign. Paralytic intestinal obstruction occurs with constant, blunt, rushing pains in the abdomen

;

Stool and gas retention is a pathognomonic sign of an intestinal obstruction. This is an early symptom of low obstruction. At its high nature, at the beginning of the disease, especially under the influence of therapeutic measures, there can be a stool, sometimes multiple due to the emptying of the intestine, located below the obstruction. When intussusception from the anus sometimes there are spotting. This can cause a diagnostic error when the acute intestinal obstruction is taken for dysentery;Main symptoms

Slide7

3. Swelling and asymmetry of the abdomen;

4. Vomiting

- after nausea or yourself, often repeated vomiting. The higher the obstacle in the digestive tract, the earlier there is vomiting and is more pronounced, multiple, indomitable. Vomiting first has a mechanical (reflex), and then a central (intoxication) character

.5. Anamnesis, postponed operations on the organs of the abdominal cavity, open and closed abdominal injuries,  inflammatory diseases, Indication of intermittent abdominal pain, swelling, rumbling, stool disorders, especially alternating constipation with diarrhea, can help in diagnosing tumor obstructive obstructionMain symptoms

Slide8

it is necessary to begin with a survey of all possible sites of herniation to exclude their infringement, as the cause of this dangerous syndrome.  

Particular

attention is needed to femoral hernia in elderly women. Infringement of a site of a gut without a mesentery in narrow

hernial gates is not accompanied by the expressed local painful sensations. Bloating Visible peristalsisThe study of the patient with acute intestinal obstruction must necessarily be supplemented with a digital rectal examination.Examination of the abdomen

Slide9

Val's symptom is a relatively stable non-displaced asymmetric abdominal swelling, notable by eye, determined by touch;

Symptom

Schlange

- visible peristalsis of the intestines, especially after palpation; Symptom Sklyarov - listening to "noise splash" over the loops of the intestine; The symptom of Spasokukotsky-Wilms is "the noise of a falling drop"; Symptom Kivul - enhanced tympanic sound with a metallic tinge over the stretched bowel loop; A symptom of the Obukhov hospital is a sign of low colonic obstruction: a balloon-like swelling of an empty ampulla of the rectum against the background of an anus gaping;The symptom of Czege-Manteuffel is a sign of low colonic obstruction: a small capacity (no more than 500-700 ml of water) of the distal intestine when setting a siphon enema;Specific symptoms

Slide10

Symptom

Mondor

- increased intestinal peristalsis is replaced by the gradual fading of peristalsis ("Noise at first, silence at the end

");"Dead (grave) silence" - the absence of sounds of peristalsis; ominous sign of intestinal obstruction. During this period, with a sharp swelling of the abdomen above him, you can listen not to peristalsis, but breathing noises and heart tones, which are not normally passed through the abdomen; Symptom of Shiman - with the turn of the sigmoid colon, the swelling is localized closer to the right hypochondrium, whereas in the left ileal region, that is, where it is usually palpated, note the abdominal depression;Symptom Tevenar (with strangulation obstruction on the basis of the turn of the small intestine) - a sharp pain when pressing on two transverse fingers below the navel in the middle line, that is, where the root of her mesentery is usually projected.Specific symptoms

Slide11

1. Initial - the stage of local manifestations of acute intestinal passage disorder lasting from 2 to 12 hours, depending on the form of obstruction. This period is dominated by pain syndrome and local symptoms from the side of the abdomen.

2

. Intermediate - stage of imaginary well-being, characterized by the development of acute intestinal insufficiency, water-electrolyte disorders and

endotoxemia. It usually lasts from 12 to 36 hours. In this phase, the pain loses its cramping character, becomes constant and less intense. The abdomen is heavily swollen, the peristalsis of the intestine weakens, the "splashing noise" is heard. The stool and gas delay is complete. 3. Late - the stage of peritonitis and severe abdominal sepsis, it is often called the terminal stage, which is not far from the truth. It occurs 36 hours after the onset of the disease. For this period, the manifestations of severe systemic inflammatory reaction, the appearance of multiple organ dysfunction and insufficiency, pronounced intoxication and dehydration, as well as progressive disorders of hemodynamics are characteristic. The abdomen is significantly inflated, the peristalsis is not listened to, the peritoneal symptomatology is determined.Stages of acute intestinal obstruction

Slide12

X-ray examination. An overview radiograph of the abdominal cavity. Intestinal arches.

Slide13

Kloiberg`s

cups on

X

-ray

Slide14

Irrigoscopy

. Tumor of the descending colon with resolved intestinal obstruction

Slide15

Paralytic intestinal obstruction develops as a result of an infectious-toxic effect, which leads to a disruption in the content of electrolytes in the serum, which are so important for the body or a decrease in the rate of blood flow in the intestinal wall. Infectious-toxic causes that cause the development of paralytic intestinal obstruction are in most cases peritonitis, pneumonia, uremia (high urate in the blood as a result of impaired uric acid excretion), acidosis (acid-base shift), diabetes mellitus, porphyrin disease and poisoning morphine.

Causes of paralytic intestinal obstruction

Slide16

postoperative

stress

biliary

and renal colicpancreatitis ovarian torsion, large omentum trauma of the abdominal cavity and retroperitoneal space myocardial infarction, etc.Reflex factors that can lead to paralytic intestinal obstruction:

Slide17

Constant blunt abdominal pain in the abdomen with periodic enhancements in the type of contractions, nausea, vomiting stagnant contents. Bloating. The tongue is dry, coated. The abdomen is relatively soft. When palpation - soreness of the abdominal wall in all parts without symptoms of irritation of the peritoneum. A weakly positive symptom of

Schetkin

can be caused by a sharp swelling of the intestinal loops (

pseudoperitonism). With auscultation - complete absence of peristaltic noise; well conducted heart sounds and respiratory noises. When X-ray examination of the abdominal organs - pneumatosis and multiple thin and large intestine levels. Oliguria is characteristic, leukocytosis in the blood. When stimulating the activity of the intestine, there is no effect.Symptomatology

Slide18

Spastic

obstruction occurs rarely. The cause of persistent spasm of one or several areas of the intestine can be

ascarids

, lead poisoning, irritation of the intestinal wall by a foreign body. In the future, spasm can be replaced by paresis and paralysis of the entire intestine. Symptoms of spastic obstruction do not differ from obturation. Characteristic rapid development of symptoms until the hypermotor reaction, exhausted, does not give way to suppression of intestinal motility.   TreatmentIn all cases when the diagnosis of acute mechanical intestinal obstruction is established or expected, the patient should be urgently hospitalized in a surgical hospital.Spastic obstruction

Slide19

The frequency of

strangulation

intestinal obstruction is 40-50% of all observations of acute obstruction.

Twists (volvulus) are the curling of the intestine with its mesentery around the longitudinal axis. They account for 4-5% of all types of intestinal obstruction. There are twists of thin, sigmoid colon and cecum.In the first hours of the disease against a background of constant pain, cramping pains periodically arise, the intensity of which increases synchronously with peristalsis, reaching a character unbearable. Often patients become restless, screaming in pain, taking a forced position with the legs brought to the stomach. From the very beginning of the disease there is a multiple vomiting, not bringing relief, at first - unchanged gastric contents and bile, and then it becomes fecaloid. Stool and gas retention is a non-permanent symptom of the disease: often at first there is a single stool due to emptying the lower intestine, not bringing relief.

Slide20

The

general condition of the patient is severe. The abdomen is moderately inflated, sometimes the swelling is manifested only by the smoothening of the

hypochondrium regions. Often find a positive symptom Will - balloon-like stretched and fixed in the stomach loop of the jejunum, above which determine the high tympanitis and the noise of splashing. When the survey fluoroscopy of the abdomen, Clauber's bowls are found, which appear 1-2 hours after the onset of the disease and are localized in the left half of the epigastric region and in the mesogastric region. Treatment is surgical. It consists of a detortion or "untying" of the nodulation, removal of the contents of the intestine through a long naso-intestinal probe. With undoubted viability, intestines are limited to detoria. With bowel necrosis, a non-viable loop is resected with an anastomosis end to end. The line of intersection of the intestine should be 40-60 cm above the obstacle and 10-15 cm below it.

Slide21

Colonoscopy

Ultrasound

examination of the abdominal cavity

Survey radiography of the abdominal cavity organs Irrigoscopy CT scan Magnetic resonance imagingDiagnostics

Slide22

All patients with suspected obstruction should be urgently hospitalized in a surgical hospital.

All

kinds of strangulation intestinal obstruction, as well as any types of intestinal obstruction, complicated by peritonitis require urgent surgical intervention

Dynamic intestinal obstruction is subject to conservative treatmentDoubts in the diagnosis of mechanical intestinal obstruction in the absence of peritoneal symptoms indicate the need for conservative treatment Conservative treatment should not justify an unreasonable delay in surgical intervention. Surgical treatment of mechanical intestinal obstruction assumes persistent postoperative therapy of water-electrolyte disorders, endogenous intoxication and paresis of the gastrointestinal tractTreatment

Slide23

1. Elimination of the obstacle for the passage of intestinal

contents.

2

. Elimination (if possible) of the disease that led to the development of this pathological condition. 3. Performing resection of the intestine with its non-viability. 4. Prevention of the growth of endotoxicosis in the postoperative period. 5. Prevention of recurrence of obstruction.Operative treatment of acute intestinal obstruction assumes the surgical solution of the following treatment tasks

Slide24

Scheme of

naso

-intestinal intubation

Slide25

Right-sided hemicolectomy. Tumor localization and resection margins.