Download
1 / 13
E N D
Bowel obstruction (or intestinal obstruction) is a mechanical or functional obstruction of the intestines, preventing the normal transit of the products of digestion. It can occur at any level distal to the duodenum of the small intestine and is a medical emergency. • It can occur as partial or complete obstruction • May be due to mechanical or paralytic causes. • Can occur due to congenital or acquired conditions
CAUSES • Congenital intestinal obstruction • Intestinal atresia • Malrotation of gut • Meconium plug syndrome • Meconium ileus • Annular pancreas • Meckel’s diverticulum • Hirschsprung’s disease
Acquired intestinal obstruction • Intussusception • Volvulus/ twisted loop of intestine • Tumor, haematoma • Hernia • Stricture/ stenosis of intestine • Inflammatory diseases • Foreign body • Worm mass • paralytic ileus
Pathophysiology • Obstruction leads to accumulation of gases and secretions above the blockage • Increase in intraluminal pressure • Venous pressure of affected area increases leading to circulatory stasis and edema. • Bowel necrosis and gangrene due to tissue anoxia and compression of arterial supply. • Peritonitis develops due to passage of bacteria and toxins across the intestinal membrane
Clinical Manifestations: • Depending on the level of obstruction, bowel obstruction can present with colicky abdominal pain, abdominal distension, vomiting, fecal vomiting, and constipation. • Bowel obstruction may be complicated by dehydration and electrolyte abnormalities due to vomiting • respiratory compromise from pressure on the diaphragm by a distended abdomen, or aspiration of vomitus; • bowel ischaemia or perforation from prolonged distension or pressure from a foreign body.
Diagnosis: • History • P/E • X-Ray abdomen and chest • Barium enema • Proctoscopy, sigmoidoscopy • USG • Blood examination shows low NA, K, Cl levels, elevated WBC and serum amylase level
Management: • IV fluid therapy to correct fluid and electrolyte balance. • Nasogastric suctioning to decompress the bowel • Analgesics and sedatives • Antibiotics • Treatment of the cause • Symptomatic management
Surgical management • Laparotomy followed by specific surgery • Resection of bowel is done for obstructing lesions or strangulated bowel, along with end to end anastamosis • In malrotation cutting the Ladd’s band and lengthening of the roots of mesentry is done. • Enterotomy is performed for removal of foreign bodies in the intestine. • Closed bowel procedures may be done to reduce volvulusndintussusception. Conservative hydrostatic reduction is performed in case of intussussception • Hypertonic enema is given to relieve the obstruction due to round worm mass.
NURSING DIAGNOSIS • Pain related to intestinal obstruction and abdominal distension • Risk for fluid and electrolyte imbalance related to vomiting, poor intake of fluid and diarrhoea • Ineffective breathing related to abdominal distension • Risk for shock related to toxicity • Fear related to severity of illness • Ineffective coping related to life threatening symptoms • Knowledge deficit regarding long term care.
Reference • Hockenberry, Wilson, Judie. Wong’s essentials of pediatric Nursing. South India Edition. Elsevier publication. • Dorothy R Marlow, Barbara A Redding, Raman Kalia. Marlow’s textbook of pediatric Nursing. Harcourt Brace & Company Asia Pte Ltd. • ParulDatta. Pediatric Nursing. 4th edition. Jaypee Publishers. New Delhi.
