THEME IV: INTESTINAL OBSTRUCTION (ILEUS)
1. What does the term “Mechanical obstructions” mean?
➯ The term “mechanical obstruction” means that the luminal contents cannot pass through the gut tubes because the lumen is blocked.
Hernia, Adhesion, Tumor, Intussception, Volvulus, Foreign object
2. What does the term ”Functional obstruction” mean?
➯ There are neurogenic or functional obstructions in which luminal contents are prevented from passing because of disturbances in gut motility that prevent coordinated peristalsis from one region of the gut to the next.
3. What does the term “Simple obstruction” mean?
➯ In simple obstruction the intestinal lumen is partially or completely occluded without compromise of intestinal blood flow.
4. What does the term “Strangulation obstruction” mean?
➯ In strangulation obstruction, blood flow to the obstructed segment is compromised and tissue necrosis and gangrene is imminent.
5. What does the term “Open loop obstruction” mean?
➯ An open loop obstruction means that intestinal flow is blocked but proximal decompression is possible through vomiting.
6. What does the term “Closed loop obstruction” mean?
➯ A closed loop obstruction means that inflow to the loop of bowel and outflow from the loop are both blocked. This obstruction permits gas and secretions to accumulate in the loop without a means of decompression proximal or distally.
7. Which are the general symptoms of intestinal obstruction?
Abdominal Distention
- Abdominal pain
- Nausea
- Vomiting
- Constipation + obstipation
8. What is the character of abdominal pain in strangulation obstruction?
- The pain is crampy or colicky in the early stages, and can progress to severe, constant pain as the process progresses.
- A strangulated loop in contact with the inner aspect of the abdominal wall causes well localised severe pain. engages parietal peritoneum (visceral -> somatic pain)
9. What is the standard method of image diagnosis in patients with intestinal obstruction?
Plain abdominal x-rays taken in the erect and/or supine positions are the standard and most reliable means of diagnosis
10. What is the characteristic X-ray appearance for intestinal obstruction?
The characteristic X-ray appearance for intestinal obstruction is distended gas and fluid filled loops of bowel with fluid levels.
11. What does the term Volvulus mean?
- The term volvulus indicates that a loop of bowel twisted more than 180 degrees about the axis of its mesentery.
- Volvulus is a form of closed loop obstruction (both obstruction and ischaemia of the involved loop occurs)