Acute intestinal obstruction (AIC) is one of the rapidly developing pathologies that, without timely medical attention, leads to death. Everyone should know the symptoms and signs of this disease, so that if it occurs, they should urgently seek medical attention.
What is acute intestinal obstruction?
In ONK, regardless of its variation, digested food and feces are not able to pass through the intestines. The disease can occur at any age, neither children nor the elderly are protected from it. However, according to statistics, most often it affects people over 40 years of age and patients with a history of gastrointestinal surgery.
There are several types of acute intestinal obstruction, they can be divided into two main groups.
Mechanical obstruction
Acute mechanical intestinal obstruction is manifested in the fact that food cannot move through the gastrointestinal tract due to some obstruction. Depending on what caused the blockage, it happens:
- Obturation KN. With this pathology, some physical objects are an obstacle to the passage of feces. For example, hairballs, large gallstones, or accidentally swallowed foreign bodies. These objects stand up inside the hollow intestine and do not allow digested food to move on. Also, the intestines can compress the tumor if it has formed in a nearby organ. With obstructive obstruction, the blood supply to the intestine does not stop.
- Strangulation KN. In this case, the vital activity of the organ leads to obstruction. Intestinal loops are wrapped in the form of impassable knots, most often the loop of the small intestine is intertwined with the caecum. In this case, the blood supply to the vessels in the mesentery is disturbed. With untimely assistance, necrosis begins, i.e., necrosis of sections of intestinal tissues.
- Intussusception. In order to understand this mechanism, it is enough to imagine how the telescope shortens. The principle of operation of this process is the same: one part of the intestine, after a strong contraction, is introduced into another. Most often, this type of acute intestinal obstruction affects children under the first year of life, which is facilitated by the special anatomical structure of the intestine. Improper complementary foods play an important role, for example, if parents decide to diversify the baby's diet before a certain period. However, adults are also absolutely not immune from intussusception.
Dynamic obstruction
Pathology occurs due to the fact that the intestine is partially orcompletely stops functioning. Various factors can lead to this state:
- Chronic or acute diseases of the gastrointestinal tract, such as appendicitis, pancreatitis, etc.
- Abdominal surgery.
- Eating large amounts of food after a long fast.
- Intestinal colic, which can also be caused by a number of diseases of various etiologies.
Regardless of the cause of acute intestinal obstruction, one of two forms of organ dysmotility develops.
With spastic blockage, spasm occurs only in a certain area of the intestine, without affecting other departments. In the more severe, paralytic form, the bowels stop functioning completely.
Symptoms of occurrence
If the patient is not provided with medical care in time, then many serious complications, including death, cannot be avoided. It is necessary to be able to recognize OKN, if you delay in going to the doctor, death can occur within 2-3 days after the onset of the disease.
The development of acute intestinal obstruction can be roughly divided into three stages.
Early Stage
This is the first 12 hours after the onset of the pathology. Body temperature is still normal or slightly lower. A person has paroxysmal pain in the abdomen, which can vary in strength and location. It all depends on what type of intestinal obstruction has occurred.
When obturation most often attacks occurundulating, severe pain is replaced by a few minutes of rest. With strangulation obstruction, on the contrary, pain is constantly present, from slight to unbearable, sometimes a person experiences a severe pain shock.
In the early period, nausea and vomiting are most often not observed. However, if the blockage occurred at the beginning of the small intestine, then they take place.
Intermediate
Starts after the first 12 hours and lasts up to a day. During this period, the clinical picture of the disease is most pronounced. Regardless of what form of intestinal obstruction has arisen, the pain no longer subsides even for a short period of time. The abdomen swells and takes on an unnatural shape, noises and seething in the intestines are clearly audible. Bloody diarrhea is sometimes possible if an internal hemorrhage has begun.
If intestinal obstruction occurs in the small intestine, then the patient vomits often and profusely, but the vomit undergoes visible changes. At first they have the appearance of semi-digested food, but gradually the smell of feces and a characteristic yellowish color appear. The body tries to expel the intestinal masses through the stomach, the so-called emergency exit.
When a blockage occurs in the large intestine, only nausea is more often present. Vomiting, even if it is, does not bring any relief. In this case, the body cannot get rid of stuck feces because the distance to the stomach is too far.
Late or terminal stage
Begins after the first day from the start of the PMC. organism withevery minute more and more reacts to the strongest poisoning with toxins. Acute intestinal obstruction is manifested by the fact that a person has a fever, the respiratory rate and pulse increase; urine ceases to be produced and the perist altic activity of the intestine disappears completely.
Often peritonitis or sepsis begins at this stage. If a person hesitates, does not call for emergency medical assistance, then a fatal outcome is inevitable.
Etiology of acute intestinal need
Obstruction can occur for many reasons. For example, if there are some anomalies in the intestine or mesentery, with which the organ is held in the peritoneum: adhesions (this type is called acute adhesive intestinal obstruction), scars, etc. They can form in any of the sections of the intestine, if earlier in history the person had some inflammatory diseases, injuries or operations on the gastrointestinal tract. In this case, these factors are considered to be predisposing.
There are also producing factors. They, on the basis of predisposing factors or without them, also cause acute intestinal obstruction. The second group includes spontaneous intestinal dysmotility, the correct functioning of which depends on various circumstances.
Intestinal peristalsis can stop working from too high a food load or a change in the usual type of food. Very often, acute obstruction begins in the summer, when people massively begin to consume a large amount of vegetables and fruits, which in their composition haveplenty of fiber.
The pressure inside the abdominal cavity can also rise sharply due to great physical exertion. In young children under the age of one year, obstruction most often occurs during the period when they are transferred from breast milk to artificial feeding.
Pathogenesis of disease
With intestinal obstruction in adults and children, pathological changes begin in the parts of the organ and the abdominal cavity. If the intestinal loops are intertwined into a knot, then it is in this place that the blood circulation is first of all disturbed.
During mechanical obturation, if an object gets in the way of the stool, the walls of the intestine under pressure are excessively stretched and a secondary disturbance of blood flow occurs. Further, the pressure only increases, the organ swells strongly. The walls, which initially increased in thickness due to edema, on the contrary, become thinner.
A day after the start of this process, if the pressure in the intestine reaches 20 mm Hg, irreversible changes occur in the intestinal walls.
In addition to the change in the abdominal cavity, there is severe dehydration. If no measures are taken to eliminate intestinal obstruction, then a person can lose about 4 liters of body fluid per day.
One of the important processes in ONK is endotoxicosis. During this process, the body experiences severe intoxication, as toxic molecules from rotting intestinal contents and digestive juices enter the bloodstream.
Diagnosis
Depending on whichit is the type of acute intestinal obstruction that has arisen, the symptoms can be more or less pronounced.
Pain can occur without visible precursors at any time of the day or night. They can be either cramping in nature, alternating with moments of calm, or last constantly.
May be lack of stools and gas. However, with obstruction in the small intestine, at first the feces, which managed to fall below the site of blockage, come out. In this case, you can not build on this symptom alone, since there is a high probability of making an incorrect diagnosis.
Vomiting is one of the earliest signs of AIO. If at first it occurs at the level of a reflex, then it continues due to the fact that the gastrointestinal tract is full.
The main signs of acute intestinal obstruction are:
- Belly is asymmetrical, often visible to the naked eye.
- You can feel the swelling of the intestinal loop and strong peristalsis on palpation.
- High tympanitis is heard on percussion (a method of research using tapping).
The collection of anamnesis must be supplemented with a rectal examination. When using this method, the doctor gently inserts a finger through the anus into the rectum, in order to determine the location of the blockage of feces or intestinal nodes.
At the final, third stage of development of acute obstruction, intestinal paralysis occurs. In this case, all the noises in the abdominal cavity disappear, and there is complete silence.
There are several ways to diagnose acute intestinal obstruction in a hospital setting.methods such as x-rays, colonoscopy, or abdominal ultrasound.
In order to make a correct diagnosis, it is necessary to exclude diseases with a similar clinical picture. So, for example, acute appendicitis, gastric ulcer, pancreatitis, ectopic pregnancy have the same symptoms at some stages.
Treatment
In acute intestinal obstruction, symptoms and treatment, as in the case of any other pathology, are interconnected. If there is even the slightest suspicion of a disease, the patient must be urgently delivered to the surgical department of the hospital. Until the moment a doctor examines a person, no manipulations can be carried out independently. It is forbidden to do enemas and gastric lavage, take any pain medication, and use drugs with a laxative or diuretic effect.
If it is precisely determined that peritonitis has not yet begun, then the method of decompression of the gastrointestinal tract is used by aspirating the contents through a tube. Then a siphon enema is placed. This type of the latter can only be performed in a medical institution, with the help of which toxins and poisons are removed from the intestines, as well as chyme that has begun to rot.
If acute intestinal obstruction is manifested by cramping pains, then antispasmodics are introduced ("Drotaverine", "Atropine", etc.). They help reduce increased intestinal motility.
There is an opposite state, whichcalled paresis. With it, a gradually developing paralysis of the intestinal muscles is observed. In this case, drugs that stimulate motor skills are used (for example, Neostigmine).
In order to reduce dehydration and minimize the resulting water and electrolyte balance in the body, various saline solutions are introduced.
If, after all the measures taken, the condition does not improve, non-surgical treatment of intestinal obstruction is ineffective, then emergency surgical intervention is required. The essence of the operation is that doctors eliminate mechanical obstruction or remove a non-viable area.
Surgeons can also remove volvulus, nodules, or cut adhesions, if any.
If the patient has already developed peritonitis, then a transversostomy procedure is performed, which is necessary for the urgent and safe removal of feces.
After the operation, the volume of circulating blood is replaced, and various types of therapies are prescribed. It is necessary to remove the remnants of toxins and poisons from the body, to prevent the development of bacterial infections. Particular attention is paid to the control of intestinal motility.
Prevention and forecasts
To make any accurate predictions, it is necessary to consider each case separately. Much depends on what type of pathology was encountered, how timely and complete the treatment of intestinal obstruction was.
If the patient asked for medical help too late, thenan unfavorable outcome is possible. At risk are the elderly, as well as those who have an inoperable tumor in the intestine.
It is impossible to completely prevent the occurrence of this acute disease, but to reduce the likelihood of its development, you need to follow a few rules:
- You need to stick to a strict eating schedule. It is absolutely not necessary to abruptly switch to another volume or type of food.
- An unprepared person should not take on huge physical exertion, as the body can respond with volvulus.
- You need to carefully monitor your he alth, for the prevention of gastrointestinal diseases or the formation of stones, ultrasound of the abdominal cavity should be performed on time. Periodically, you need to take tests for the presence of helminths, as they can also provoke acute intestinal obstruction.
Conclusion
This disease should be able to recognize not only a doctor, but also an ordinary person. According to statistics, there are about 25 deaths per 100 cases. If you seek help within the first hours after the onset of symptoms, then almost all patients receive prompt assistance and recover.
If you experience any pain in the abdomen, sudden problems with the stool, as well as bloating, you should immediately consult a doctor, because in this case, the clock counts. Only timely treatment of acute intestinal obstruction will give a positive result.
