 Intestinal Obstruction exists when blockage prevents the normal flow of intestinal

contents through the intestinal tract.

Adhesions Loops of intestines become After surgery, adhesions produce

adherent to areas that heal a kinking of an intestinal loop.
slowly or scar after abdominal
surgery.
Intussusception One part of the intestine slips The intestinal lumen becomes
into another part located below it narrowed.
(like a telescope shortening)
Volvulus Bowel Twists and turns on itself. Intestinal lumen becomes
obstructed. Gas and fluid
accumulate in the trapped bowel.
Hernia Protrusion of intestine through a Intestinal flow may be completely
weakened area in the abdominal obstructed. Blood flow to the area
muscle or wall. may be obstructed as well.
Tumor A tumor that exists within the Intestinal lumen becomes partially
wall of the intestine extends into obstructed, if the tumor is not
the intestinal lumen, or a tumor removed, complete obstruction
outside the intestine causes results.
pressure on the wall of the
intestine.
Paralytic Loss of peristaltic motor activity
(adynamic) ileus in the intestine; associated with
abdominal surgery, peritonitis,
hypokalemia, ischemic bowel,
spinal trauma, or pneumonia.
 Adhesion
 Hernia
 Vovulus
 Cancer
 Abdominal Pain
 Surgery
 Intussusception
 Paralytic Ileus
 Abdominal Angina
 Nausea and Vomiting
 Abdominal Pain
 Severe Distention
 Increase Hgb and Hct
 Metabolic Acidosis
 Dehydration
 Intense Thirst
“Medical history and a Physical Exam. During the physical exam, your doctor will feel
your abdomen for tenderness or bloating, the abdomen is examined for evidence of scars,
hernias, distension, or pain. and will listen with a stethoscope for bowel sounds. He or
she will then confirm the diagnosis through other tests” the physician first gives a
physical examination to determine the severity of the patient's condition. For your
medical history, your doctor will ask questions about your pain, your symptoms, and
other digestive conditions or abdominal surgeries that you have had, and also certain
factors increase a person's risk of developing a bowel obstruction (including age and a
history of constipation)

the bowel normally makes some sounds such as gurgling and clicking which can be heard
at irregular intervals by using a stethoscope. If an obstruction is present, a healthcare
provider may hear high-pitched sounds while listening to the abdomen. If the obstruction
has been present for some time, there may be no bowel sounds at all.
 - this is normally the first test that is used to determine if there is an obstruction. A
radiologist or other specialist can determine if the x-ray shows the signs of a bowel
obstruction. This type of X-ray can detect blockages in the small and large intestines.

- this test may be used to determine the location of the obstruction. It can also help in
showing if the obstruction is actually inside the bowel, or if it is caused by something else
in the abdominal cavity that is pushing on the bowel.

• The health care provider will gently insert a well-lubricated tube (enema) into
your rectum. The tube is connected to a bag that contains the barium. The barium
flows into your colon. A small balloon at the tip of the enema tube may be inflated
to help keep the barium inside your colon. The flow of the barium is monitored by
the health care provider on an x-ray fluoroscope screen, which is like a TV
monitor.

- much like the barium enema, this test can help pinpoint the obstruction, especially if it
is in the upper gastrointestinal tract. It is a set of X-rays taken to examine the esophagus,
stomach, and small intestine.

- this test is often used in cases of abdominal pain or when obstructions appears to be a
chronic condition. A CT scan can help your doctor distinguish between a partial and a
complete obstruction and can help in diagnosing most cancers. It also can show signs that
help determine whether the blood supply has been cut off (strangulated) to the affected
part of the bowel.

• The health care provider may inject a dye into one of your veins. This helps
certain diseases and organs show up better on the images. Once inside the
scanner, the machine's x-ray beam rotates around you. Small detectors
inside the scanner measure the amount of x-rays that make it through the
abdomen . A computer takes this information and creates several individual
images, called slices.
- is an internal examination of the lower large bowel (colon), using an instrument called
a sigmoidoscope. The sigmoidoscope is a small camera attached to a flexible tube. It is
inserted into the colon to examine the rectum, and the sigmoid and descending portions
of the colon.

• During the test, you wear a hospital gown so that the lower half of your body is
exposed. You are positioned on your left side with your knees drawn up toward
your chest . A gastroenterologist (a specialist in diseases of the digestive system)
will gently insert a gloved and lubricated finger (or fingers) into the rectum to
check for blockage and to dilate the anus. This is called a digital rectal
examination. Following the digital rectal exam, the sigmoidoscope will be
inserted. This flexible fiberoptic tube is about 20 inches long.The scope is gently
advanced into the colon. Air is introduced into the scope to aid in viewing. The air
may cause the urge to defecate. As the sigmoidoscope is slowly removed, the
lining of the bowel is carefully examined. A channel in the scope allows for the
passage of forceps for biopsies or other instruments for therapy.

is an internal examination of the colon (large intestine), using an instrument called a

colonoscope. The colonoscope is a small camera attached to a flexible tube. Unlike
sigmoidoscopy, which examines only the lower third of the colon, colonoscopy examines
the entire length of the colon.

• You will lie on your left side with your knees drawn up toward the chest. After
administration of a sedative and pain reliever, the colonoscope is inserted through
the anus and gently advanced to the lowest part of the small bowel. Air will be
inserted through the scope to provide a better view. Suction may be used to
remove secretions. Since better views are obtained during withdrawal than during
insertion, a more careful examination is done during withdrawal of the scope.
Tissue samples may be taken with tiny biopsy forceps inserted through the scope.
Polyps may be removed with electrocautery snares, and photographs may be
taken. Specialized procedures, such as laser therapy , may also be performed.
 is a medical imaging procedure used to examine the upper GI (gastrointestinal) tract,
which includes the esophagus and, to a lesser extent, the stomach.

• The patient is asked to drink a suspension of barium sulfate. Fluoroscopy images

are taken as the barium is swallowed. This is typically at a rate of 2 or 3 frames
pers second. The patient is asked to swallow the Barium a number of times, whilst
standing in different positions, i.e. AP, oblique and lateral, to assess the 3D
structure as best possible.

- is a special x-ray of the small intestine that looks at how a liquid called contrast moves
through the area. The x-ray images taken during enteroclysis appear on a fluoroscopic
monitor (similar to a television screen) in "real time," which means they are seen as the
contrast is actually moving through bowel structures.

• This test is done in a hospital radiology department. A tube is passed from the
nose or mouth through the stomach and into part of the small bowel. Contrast
(usually barium) and air are sent through the tube, and x-rays pictures are taken.
X-rays are a form of electromagnetic radiation, as is light. They have higher
energy than light, however, so they can penetrate the body to form an image on
film. Areas that are dense look white, areas that are less dense look black, and
other areas will be shades of gray. The contrast used for this test is dense and can
be seen clearly on x-ray.The goal of the study is to image all of the loops of small
bowel. Both "real time" pictures and still images are taken. You may be asked to
change positions during the exam. The test usually lasts several hours, since it
may take a while for the contrast to move through the entire small bowel.

•
The first blood test of a patient with an intestinal obstruction usually gives normal
results, but later tests indicate electrolyte imbalances. There is no way to determine if an
obstruction is simple or strangulated except surgery.
 •
Results are usually normal or mildly elevated.

•
If the BUN level is increased, this may indicate decreased volume state (eg,
dehydration)

•
Creatinine level elevations may indicate dehydration.

•
WBC count may be elevated with a left shift in simple or strangulated
obstructions. Increased hematocrit is an indicator of volume state (ie, dehydration).

•
•
•
The patient may require surgical intervention.

The Pathophysiology alterations are presented in the figure below. Postoperative

paralytic ileus results from inhibitory neural reflexes, inflammatory mediators, and the
influence of exogenous and endogenous opioids. If the obstruction is at the pylorus of
high in the small intestine, metabolic alkalosis develops initially as a result of excessive
loss of hydrogen ions that normally would be reabsorbed from the gastric juice. With
prolonged obstruction or obstruction lower in the intestine, metabolic acidosis is more
likely to occur because bicarbonate from pancreatic secretions and bile cannot be
reabsorbed. Hypokalemia can be extreme, promoting acidosis and atony of the intestinal
wall. Metabolic acidosis also may be accentuated by ketosis, the result of declining
carbohydrates stores caused by starvation. If pressure from the distention is severe
enough, it occludes the arterial circulation and cause strangulation leading to perforation.
Lack of circulation permits the buildup of significant amounts of lactic acid, which
worsen the metabolic acidosis. Bacteria also proliferate and may cross the mucosal
barrier and cause peritonitis or sepsis.
z

Adhesions / Intussusception / Volvulus / Hernia / Paralytic ileus

Intestinal Obstruction

Fluid and gas accumulate above the intestinal

obstruction.

Distention Loss of Water

and Electrolytes

Pressure on diaphragm Colic abdominal Pain

Dehydration
Nausea and Vomiting
 Respiratory Volume
 Food intake &Nutrients absorption

Pressure in Intestinal Lumen

 Venous Return Hypovolemia

Intestinal bowel wall edema

 Capillary Permeability (Fluid loss to peritoneum)

Hypovolemic Shock
Release of Toxins (shock in which the heart is
unable to supply enough
blood to the body)
Bacterial Translocation Fever

Peritonitis