Intestinal Obstruction

Intestinal Obstruction

1. Signs & Symptoms

   • Large Intestine
     • Low grade Cramping Abdominal Pain
     • Absolute Constipation
     • Gradual onset
     • Abdominal Distention
     • Lack of Flatus
   • Small Intestine
     • Metabolic Alkalosis (vomiting Stomach Acids)
       • Bile Color Emesis
       • Distal Small intestine more Gradual & may even smell like feces
         • Needs Surgery Immediately
     • Rapid Dehydration
     • Colicky & Cramp Like Pain (Intermittent)
     • Feces (for short time)
     • Minimal Distention
   • Bowel Sounds High Pitched Above Obstructure
     • Borborgymi (Hyperactive)
   • Nonmechanical Absent Bowel Sounds
   • Paralytic Ileus (Constant pain
   • Mechanical (Pain in Waves0

2. Intervention

   • NG tube
     • Check q 4hrs
   • NPO
   • IV Fluids
     • Lactated Ringers or NS (GI losses Isotonic)
   • Surgery if Intestines are Strangulated
   • Analgesic (pain)
   • Monitor BUN, Creatinine, Electrolytes, Dehydration, Metabolic Alkalosis
     • Rising BUN & Creatinine is indicator of Acute Kidney Injury
   • Immediately report if output is less than 0.5kg/ml per hour
   • Low obstruction (Metabolic Acidosis) Lossing Bicarb
   • Oral Care (Mouthwash Frequently) & Water soluble lubricant

3. Causes

   • Mechanical
     • hernia
     • strictures from crohn's disease
     • Diverticular Disease
     • Occulusion
     • Volvolus
   • Nonmechanical
     • Something Interferes with the parasympathetic nervous System. 
     • Hypokalemia
     • Spinal Fracture
     • Anasthesia
     • Abdominal Surgery

4. No Passage of Stool

5. Complications

   • Intraluminal Pressure Increases
     • Increased Permeability of Capillaries
       • Content Leaks into Peritoneal Cavity
       • Hypovolemic Shock
       • Third Spacing
       • Hypotension
   • Bowels Can become Extremely distended
     • Blood Flow stop
       • Intestinal Strangulation/Intestinal Infarction
       • Needs to Be corrected Immediately (Septic Shock Risk)

6. Diagnostics

   • Elevated WBC
     • Preforation
     • Strangulation
   • Decreased hct/hgb?
     • Bleeding
     • Strangulation/Necrosis
   • CT scans, X Rays, Sigmoidoscopy, Colonoscopy