Intestinal Obstruction

• most common site: small intestine
• most common cause (small intestine): adhesions, hernia, neoplasms
• most common site for large bowel obstruction: sigmoid colon
• most common cause of large bowel obstruction: carcinoma, diverticulitis, IBD, tumor
• clinical manifestations: (small intestine)

  • crampy, wavelike and colicky abdominal pain
  • passage of blood and mucus; no fecal matter, no flatus
• (small intestine) cinical manifestations:

  • vomiting
  • s/s of dehydration
  • abdominal distention
  • hypovolemic shock
• (small intestine)medical management:

  • decompression of the bowel
  • IVF
• (small intestine)medical management:

  • surgical - herniorrhaphy, adhesiotomy, bowel resection
• (small intestine)nursing management:

  • monitoring NG drainage
  • assess for F&E imbalances
  • monitor nutritional status
  • assess for improvement
• s/s of improvement:

  • return of normal bowel sounds
  • decreased abdominal distention
  • decreased pain
  • passage of flatus or stool
• Large bowel obstruction can lead to:

  • severe distention and perforation
  • undramatic unless blood supply is cut off
  • dehydration occurs more slowly
• Large bowel obstruction can lead to:

  • symptoms progess slowly - constipation only
  • blood loss results to iron deficiency anemia
• Large bowel obstruction can lead to:

  • fecal vomiting, s/s of shock
  • barium studies are contraindicated
• large bowel obstruction medical management:

  • NG aspiration and decompression
  • colonoscopy - to untwist bowel
  • cecostomy - for relief obstruction
• large bowel obstruction medical management:

  • rectal tube for decompression
  • surgical resection
  • colostomy