This a mechanical or functional obstruction of the intestines, preventing the normal transit of product of digestion. It can occur at any level distal to duodenum of the small intestine and is medical emergency. Although many cases are not treated surgically, it is a surgical problem. It can occur within the intestine, within the intestine lumen, and external to the intestine. Intestinal obstruction also called bowel obstruction is divided into two, namely; small intestinal obstruction and large intestinal obstruction.
Small Intestinal Obstruction
Before I go into the causes of small intestinal obstruction I will like to talk about the function of small intestine. Small intestine is part of the gastrointestinal tract which follow immediately after the stomach, where the vast majority of digestion and absorption of food take place.
The causes of small intestinal obstruction are:
Adhesions- which are fibrous bands that form between tissue and organs, often as a result of injury during surgery. Adhesion can also be caused by pelvic inflammatory disease such as endometriosis. Small intestinal obstruction is a consequence of post-surgical adhesions. The small intestinal obstruction may be caused when an adhesion pulls the small intestine and prevent the flow of content trough the digestive tract. It can take up to 20 years or more for small intestinal obstruction to occur after the first surgical procedure. If the previous adhesion allows the small intestine to twist around itself and obstruct. Small intestinal obstruction could result in death without immediate medical attention.
Hernia-Is a protrusion of a tissue, structure, or part of an organ through muscle tissue or the membrane by which it is normally contained.
Neoplasm-Is an abnormal mass of tissue as a result of neoplasia. Neoplasm is the abnormal proliferation of cells. The growth of the these cells is larger than the surrounding normal cells.
Carcinoid- Excessive growth of some cells in the neuron forming tumour.
Foreign Body- This is any object originating outside the body. It involves movement through natural passage into hollow organs.
Intestinal Atresia-This is a malformation where there is a narrowing or absence of a portion of the intestine. This defect can either occur in the small or large intestine.
Intussusceptions (blockage of the intestine)- Is a medical condition in which a part of the small intestine has in-vaginated into another section of intestine. The part which inters into the other is called intussusceptum and the part receive it is intussuscipiens.
Large Intestinal Obstruction
The part of the gastrointestinal tract where water is removed from the digested food before coming out as faeces.
The causes of large intestinal obstruction are:
Inflammatory intestine disease- These are group of inflammatory conditions of the colon and small intestine. The major type are crohn’s disease and ulcerative colitis. Inflammation is a protective attempt by the organism to remove the injurious stimuli as well as initiate the healing process for the tissue.
Faecal Impactions (constipation, costiveness)- When colon absorbs too much water from the food due to the food moving slowly through gastro-intestinal tract, resulting in faeces that are dry and hard. Defecation may be extremely painful and in severe cases (faecal impaction) lead to symptoms of intestinal obstruction.
Avolvulus- This an obstruction in which a lop of intestine has abnormally twisted on itself.
Other causes of large intestinal obstruction are; Colon Atresia, Neoplasm, Hernias, Endometriosis
Signs and Symptoms
Based on the extent of obstruction involved, intestinal obstruction can result into abdominal pain, abdominal distension, vomiting, faecal vomiting (This a condition where half-digested matter is remove from the intestine into the stomach by contraction and muscle movement, forcefully expelled through the oesophagus and finally outside from the mouth. This is not actually faecal matter that is vomited, but it smells similar).
The condition of intestinal obstruction may be worsen by dehydration and electrolyte abnormalities (acid-base imbalance) due to vomiting. In small intestine obstruction, the pain are cramping and consistent in nature. The pain is more central and mid-abdominal. Constipation comes after vomiting.
In case of large intestinal obstruction , the pain is felt in the lower part of the abdomen. Constipation occurs first and vomiting may be irregular.
Diagnosis
The major diagnostic tools are blood test, X-rays of the abdomen, CT scanning (computer tomography) and or ultra-sound. In a case of identifying mass, biopsy may be employed to determine the nature of the mass.
Radio logically intestinal obstruction shows intestinal distension and the presence of multiple gas-fluid levels. Contrast enema, small intestine series or CT scan can be used to define the level of obstruction, as in either partial or complete and helping to know the cause of the obstruction.
According to Colonoscopy (small intestinal investigation with ingested camera) or Endoscopy (instrument used to look inside the body for medical reasons), and Laparoscopy (Morden surgical technique in which operations in the abdomen are performed through small incision, compared to larger incision used in the usual surgical procedure.
Treatment
The treatment for small intestinal obstruction is both non-surgical called conservative and surgical. Non-surgical treatment involves a nasogastric tub, correction of dehydration and electrolyte abnormalities. For patients with sever pain, Opioid pain reliever may be used. Antiemetics may be administered to vomiting patient.
Intestinal Obstruction in Children
Intestinal atresia is the main causes of fetal and neonatal intestinal obstruction. This is characterised by narrowing or absence of a part of the intestine. The atresia are usually discovered before birth via Sonagram and treated with using laporotomy after if the area infected is small, surgeon may be able to remove the damaged part and the intestine is joined back together. In a condition where the narrowing is longer and the area is damaged, a temporary stoma may be placed.
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