Intestinal obstruction

موضوع: Intestinal obstruction السبت نوفمبر 06, 2010 9:54 am

Intestinal obstruction Definition

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Intestinalobstruction is a blockage of your small intestine or colon that prevents foodand fluid from passing through. Intestinal obstruction can be caused by manyconditions, including fibrous bands of tissue in the abdomen (adhesions),hernias and tumors.
Intestinalobstruction can result in an array of uncomfortable signs and symptoms,including abdominal pain and swelling, nausea, and vomiting. If left untreated,intestinal obstruction can cause the blocked parts of your intestine to die.This tissue death can lead to perforation of the intestine, severe infectionand shock. However, with prompt medical care, intestinal obstruction can oftenbe successfully treated.
Symptoms
Signs and symptoms ofintestinal obstruction include:
§ Crampy abdominal pain thatcomes and goes
§ Nausea
§ Vomiting
§ Diarrhea
§ Constipation
§ Inability to have a bowelmovement or pass gas
§ Swelling of the abdomen(distention)
When to see a doctor
Because of the serious complications that can develop from intestinal obstruction,seek immediate medical care if you develop the signs or symptoms listed above. Causes

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Many conditions can causeintestinal obstruction. Intestinal obstruction can occur as the result of a"mechanical" obstruction — when something, such as a hernia or tumor,is physically blocking your intestine. Or intestinal obstruction can occur asthe result of a condition in which your intestines don't function properly.This type of intestinal obstruction is called paralytic ileus(pseudo-obstruction).
Mechanical obstruction of the small intestine
Common causes of mechanical obstruction in the small intestine include:
§ Intestinal adhesions —bands of fibrous tissue in the abdominal cavity that often form after abdominalor pelvic surgery
§ Hernias — portions ofintestine that protrude into another part of your body
§ Tumors in the smallintestine
§ Inflammatory bowel diseases,such as Crohn's disease
§ Twisting of the intestine(volvulus)
§ Telescoping of theintestine (intussusception)
Mechanical obstruction of the colon
Mechanical intestinal obstruction is much less common in the colon than in thesmall intestine. Causes of mechanical colonic obstruction can include:
§ Colon cancer
§ Diverticulitis — acondition in which small, bulging pouches (diverticula) in the digestive tractbecome inflamed or infected
§ Twisting of the colon(volvulus)
§ Impacted feces
§ Narrowing of the coloncaused by inflammation and scarring (stricture)
Paralytic ileus
Paralytic ileus can cause signs and symptoms of intestinal obstruction, butdoesn't involve an actual obstruction. In paralytic ileus, the intestines don'tfunction properly due to muscle or nerve problems. Movement of the intestinesis greatly reduced or absent, making it difficult for food and fluid to flowsmoothly through the digestive system.
Paralytic ileus canaffect any part of the intestine. Causes can include:
§ Abdominal surgery
§ Pelvic surgery
§ Infection
§ Certain medications
§ Muscle and nerve disorders,such as Parkinson's disease
Risk factors
Diseases andconditions that can increase your risk of intestinal obstruction include:
§ Abdominal or pelvicsurgery, which often causes adhesions — a common cause of intestinalobstruction
§ Crohn's disease — aninflammatory condition that can cause the intestine's walls to thicken,narrowing its passageway
§ Cancer within your abdomen,especially if you've had surgery to remove an abdominal tumor or radiationtherapy
Complications
If left untreated,intestinal obstruction can cause serious, life-threatening complications,including:
§ Deathof the affected intestine. Intestinal obstruction cancut off the blood supply to the affected portion of your intestine. If leftuntreated, lack of blood causes the intestinal wall to die. Tissue death canresult in a tear (perforation) in the intestinal wall, which can lead toinfection.
§ Infectionin the abdominal cavity. Peritonitis is the medicalterm for infection in the abdominal cavity. It's a life-threatening conditionthat requires immediate medical and surgical attention.
Tests anddiagnosis
Tests and proceduresused to diagnose intestinal obstruction include:
§ Physicalexam. Your doctor will ask about your medicalhistory and your symptoms. He or she will also do a physical exam to assessyour situation. The doctor may suspect intestinal obstruction if your abdomenis swollen or tender or if there's a lump in your abdomen.
§ Imagingtests. To confirm a diagnosis of intestinalobstruction, your doctor may recommend abdominal X-ray or computerizedtomography (CT) scans. These tests also help your doctor determine if theobstruction is paralytic ileus or if it's a mechanical obstruction, and if it'sa partial or a complete obstruction.
Treatments anddrugs
Treatment forintestinal obstruction depends on the cause of your condition.
Hospitalization to stabilize your condition
Treatment for intestinal obstruction requires hospitalization. When you arriveat the hospital, the doctors will first work to reverse your medical conditionand stabilize you so that you can undergo treatment. This may include:
§ Placing an intravenous (IV)line into a vein in your arm so that fluids can be given
§ Putting a nasogastric (NG)tube through your nose and into your stomach to suck air and fluid out torelieve abdominal swelling
§ Placing a thin, flexibletube (catheter) into your bladder to drain urine and collect it for testing
Treatment for a partial mechanical obstruction
If you have mechanical obstruction in which some food and fluid can still getthrough (partial obstruction), you may recover after you've been stabilized inthe hospital. You may not require further treatment. Your doctor may alsorecommend a special low-fiber diet that is easier for your partially blockedintestine to process. If the obstruction does not clear on its own, you mayneed surgery to relieve the obstruction.
Treatment for a complete mechanical obstruction
Complete obstruction, in which nothing can pass through your intestine, usuallyrequires surgery to relieve the blockage. The procedure you undergo will dependon what's causing the obstruction and which part of your intestine is affected.Surgery typically involves removing the obstruction, as well as any section ofyour intestine that has died.
Treatment for paralytic ileus
If your doctor determines that your signs and symptoms are caused by paralyticileus, he or she may monitor your condition for a day or two in the hospital.Paralytic ileus is often a temporary condition that gets better on its own. Ifparalytic ileus doesn't improve within several days, your doctor may prescribemedication that causes muscle contractions, which can help move food and fluidsthrough your intestines.

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