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Basic info about intestial obstructions
- What? Intestinal Contents can’t pass through the GI tract
- Small Intestine or Colon; Partial or Complete
- Mechanical Obstruction
- Non-Mechanical
- (Paralytic Ileus)
- Pseudo-obstruction
- Vascular Obstruction
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what are some possible pathophys's of bowel obstruction
- Fluid, gas, stool accumulate proximally
- Distal bowel collapses
- Extravasation of fluids and electrolytes into peritoneal cavity
- Reduced circulating blood-->hypotension, shock
- Intestinal strangulation (infarction): bowel can become necrotic and rupture=infection, death
- Metabolic alkalosis=vomiting, NG tube
- Small bowel=dehydration/electrolyte imbalance
- Large bowel. No early SnSs.
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SnSs of bowel obstruction
- Nausea/Vomiting
- Fluid volume deficit-->s/sx hypovolemia!!!
- Abdominal pain
- Abdominal distention
- Inability to pass flatus
- Auscultation reveals “High Pitched Tinkling Sound” above area of obstruction, usually hypoactive or absent below
- Fever (if strangulation or peritonitis)
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Diagnostics involved with bowel obstruction
- Abdominal CT
- Abdominal X-ray
- Colonoscopy
- Sigmoidoscopy
- Labs:
- CBC (WBC, H/H)
- Lytes (BUN, Creatinine)
- Occult blood analysis
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collaborative care for pt w/bowel obstruction
- Emergency Surgery (strangulated bowel)
- NPO (NO ICE OR H2O…Oral Care!). patients can swab mouth with oral sponge, shouldn’t give them water-->e-lyte loss.
- NG Tube (patency/obstruction)
- IV fluids (0.9% NS or LR)
- --Electrolytes
- Analgesics
- Parenteral Nutrition
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