In this article we will look at a disease called intestinal obstruction. A general medical description will be given here. We will also get acquainted with the diagnosis of the disease, methods for eliminating the problem and a number of possible complications that can lead to obstruction.
Introduction
Intestinal obstruction (NK) is a syndrome that is characterized by a partial or absolute violation of the movement of food through the "tunnels" of the digestive tract. Violation occurs due to the presence of an obstacle in the path of food or is caused by motor dysfunction of the intestine. What to do with intestinal obstruction in the elderly, children and adults, we will consider in the article. This topic is relevant in that it will allow the reader to learn about all the dangers associated with dysfunction, which can lead to a fatal outcome.
Dynamic etiology
According to the type of etiology, there are dynamic and mechanical causes of this condition.
Etiological data of dynamicintestinal obstruction are based on the development of paralysis, which makes it difficult to move food. Most often it develops as a result of trauma (including surgery), hypokalemia (some metabolic disorders) and peritonitis.
Any disease of the abdominal organs that can potentially cause peritonitis occurs with the phenomenon of intestinal paresis. A decrease in the level of activity of perist altic movements in the gastrointestinal tract is observed when physical activity is limited (a sedentary lifestyle) or with prolonged intractable sensation of biliary or renal colic. Spastic intestinal obstruction can be caused by damage to the brain of the head or back (spinal) by metastases of a malignant tumor, back of the tabes, etc. It can also appear as a result of poisoning with s alts of heavy metals or hysteria.
Mechanical etiology
Predisposing etiological factors that can cause mechanical CI are:
- presence of congenital dolichosigma;
- caecal mobility;
- anterior or internal abdominal hernia;
- presence of lengthening of the sigmoid colon in old age;
- there was an adhesive process in the abdominal cavity;
- there is an excess of folds and pockets in the peritoneum.
The reason may be the presence of benign or malignant tumors located in different parts of the intestine. They lead to an obstructive type of obstruction, which can also be the result of compression / compression of the intestinal tube by a tumor growth from the outside, that is, the one that wasformed on neighboring organs. The phenomenon of tumor genesis and damage from 3 to 5 lymph nodes of the intestinal mesentery are curable in 99%. In an exophilic tumor, invagination may be used.
Other causes of this condition include: eating excessive amounts of high-calorie foods, changing diets when feeding an infant from breastfeeding to formula feeding, and eating too much during long-term fasting.
Description of pathogenesis
Intestinal obstruction in the elderly, children and adults is mostly identical: there is a large loss of water, as well as proteins and electrolytes. The liquid is excreted with masses of vomiting, and it is also deposited in the intestine. Another consequence of humoral disturbance is the loss of fluids within 24 hours, the size of which exceeds 4 liters or more. This causes tissue dehydration and hypovolemia, hemoconcentration and leads to tissue hypoxia. Any pathophysiological phenomenon is reflected clinically in the form of dry skin, oliguria, arterial hypotension, high hematocrit and relative erythrocytosis.
Occurring dehydration and hypovolemia lead to a decrease in diuresis, sodium reabsorption and excessive release of potassium with masses of vomiting and urine, and also causes the process of intracellular acidosis, lowers muscle tone and reduces myocardial contractility. There are many other problems that can be caused by intestinal obstruction. There is also significantloss of protein molecules (up to three hundred grams per day), leading to an aggravation of the prevalence of metabolic processes.
Knowing this leads us to the fact that the treatment of bowel obstruction, especially in acute cases, should include transfusion of fluids and administration of drugs with proteins and electrolytes, and the acid-base balance should also be normalized.
Endotoxicosis is an important link in the pathophysiological cycle of processes observed in the presence of NK. The fact is that during ecdotoxicosis there is an accumulation of a huge amount of products of incomplete protein hydrolysis - a variety of polypeptide molecules, which under normal conditions are not absorbed into the tissues of the intestinal walls, but will begin with stagnation of food. The problem is the toxicity of substances absorbed from the digestive organs.
Endogenous factor
The main factor in the pathogenesis of endogenous intoxication is microbes. Acute intestinal obstruction leads to disruption in the structure of the natural microbacteria ecosystem of the esophagus through the rapid growth and reproduction of other, more "impudent" cellular organisms. There is also a migration of microflora from the distal row of intestinal sections to the proximal one, where it will become alien. Exo- and endotoxins cause disruption of the intestinal barrier and causes the translocation of bacteria in the lymph circulation and peritoneal exudate, which, in turn, become the main causes of inflammation and abdominal surgical sepsis. Apotheosis of developmentof this problem is necrosis and aggravation of metabolism at the tissue level with the further development of multiple organ dysfunction and insufficiency.
Some features of bowel dysfunction
A sign of intestinal obstruction at an early stage of disturbances in motor and secretory-resorptive functions is increased peristalsis. Intestinal contractions become shortened, but their frequency increases. This phenomenon may be caused by the presence of an obstacle in the intestinal tract, which is difficult to overcome with food. If the “barrier” is not removed, then the parasympathetic nervous system will be excited, leading to antiperistalsis. Also a significant problem is the increasing circulatory hypoxia of the intestinal walls, leading to a gradual loss of the ability to transmit impulses through the intramural nervous apparatus. The consequence of this is the inability of the most muscle cells to receive and transmit information in the form of signals.
If the symptom of intestinal obstruction expresses itself in the form of a pronounced pain sensation, then most likely it is abturative or strangular (resulting from compression of the trunks of the nerves passing through the mesentery.
Symptomatic of obstruction
Symptoms of bowel obstruction are as follows:
- Pain in the abdomen is an early and constant sign of obstruction. Most often, it appears suddenly and does not depend on the food that the subject consumed during the day. The pain is cramping in nature. Pain attacks are caused by perist altic waves, which are repeated at intervals of 10-15 minutes. At the moment of decompensation and depletion of the energy reserve of intestinal tissues, the pain becomes permanent. The strangular type of obstruction is also characterized by constant and sudden onset of pain. As a rule, in the absence of treatment, on the 2nd - 3rd day the pain subsides, which is a sign of the cessation of intestinal perist altic activity and in the future will lead to a paralytic problem with constant pain in the abdomen of a bursting nature.
- Abdominal bloating appears and its asymmetry is observed.
- Delayed gas or lack of stool may be a sign of pathognomonic ileus. Bleeding of fluids is sometimes observed due to intussusception, due to which NK is often confused with dysentery.
- Vomiting is another sign of an obstruction. At first it is rare, but it begins to repeat more often. Also, the frequency depends on the number of obstructions in the digestive canals. At first, vomiting has a mechanical (reflex) character, but then it becomes central (intoxication).
Diagnosis and its tools
Intestinal obstruction in humans by differential diagnosis includes: pleurisy, peritonitis, acute pancreatitis and appendicitis, renal colic, lower lobe pneumonia and perforation of a hollow organ.
Among the tools and methods by which intestinal obstruction is detected, the mainare:
- An abdominal radiography procedure that allows you to determine the amount of gases and the level of liquid in any loop of the intestines and helps to examine the transverse striation of tissues;
- Ultrasound allows you to determine both mechanical and dynamic obstruction. With mechanical, an expansion of the diameter of the lumen in the intestine up to two cm is observed with the simultaneous phenomenon of "liquid sequestration". The intestinal walls thicken up to 4 mm and above, the height of the Kerckring folds increases (from 5 mm) and the appearance of a reciprocating movement of chyme along the intestinal cavity also serve as signs that help detect mechanical obstruction through ultrasound. There are other characteristic features. Dynamic NK is diagnosed in the absence of reciprocating contractions of the chyme, the presence of an unexpressed relief in the kerkring folds, hyperpneumatization of all parts of the intestine and the phenomenon of sequestration of fluids.
Irrigography is contraindicated in the presence of obstruction.
Ways to deal with obstruction
What to do with bowel obstruction? In the presence of an acute form of the syndrome, it is urgent to go to the hospital and go to the hospital. They can urgently intervene surgically only in the presence of peritonitis, and in other cases, treatment is started using conservative measures and means. First, they try to eliminate pain, hyperperist altic intoxication and problems in homeostasis. Also, during the treatment of intestinal obstruction, the upper digestive sections are freed from stagnant contents.through the use of special probes and siphon enemas.
If there is no positive effect after applying conservative methods of dealing with the problem, then resort to operational measures.
The concept of surgery
Surgery for bowel obstruction is often the only way to fix the problem. After the laparotomy has been performed, a revision of the abdominal cavity is performed. Before the procedure, it is recommended to blockade the colon and mesentery with novocaine. First, the duodenojejunal junction is examined with a gradual approach to the ileocecal angle. The surgeon is guided by intestinal loops, located slightly above the place with an obstacle. During the revision of organs, their level of viability and the etiological nature of obstruction are determined.
Intestinal obstruction in adults, children and the elderly leads to the incapacitation of organs. The indicator of the viability of the intestine is determined after it is soaked in a liquid of sodium chloride solution of an isotonic type and 20-40 ml of warm novocaine solution (0.25%) is injected into the tissues of the mesentery. Pay attention to the serous color of the membrane, which should be shiny and pinkish, to the preservation of the perist altic abilities of a certain fragment of the intestine and to the pulsation of the vessels of the mesentery.
"What to do with bowel obstruction in the elderly?" is a frequently asked question on the internet. In case of surgery, doctors try to restore the passage through the intestines,dissect adhesions, melt closures, disinvaginate and remove tumors. This problem in the intestinal tract, especially in elderly subjects, can cause various complications, including death. Therefore, if there is a suspicion of intestinal obstruction, it is recommended to contact a specialist immediately.
The radical nature of the operation is determined by the severity of intoxication in the patient. During surgery, bowel resection can be used using universal principles (for example, the use of side-to-side anastomosis). If there is a risk of leakage at the anastomotic suture, then a Meidl-type operating procedure may also be used. Often, when eliminating intestinal obstruction, they resort to obstructive resection, during which the sigmoid colon is tightly sutured and placed in the abdominal cavity.
Often when symptoms of intestinal obstruction are detected, treatment may include decompression of the gastrointestinal tract and the use of elastic tubes. Decompression is necessary to reduce intoxication, stimulate the motility of intestinal tissues, and prevent the development of anastomosis leaks. It determines the framework function. Nasogastric decompression is more commonly used than retrograde. Also, after surgery, sanitary measures (for example, washing) and drainage of the abdominal cavity are carried out.
Conservative struggle and prevention
What to do with bowel obstruction in case of using conservative methods?
It's simple here. This diagnosis, after its approval,forces the doctor to admit the patient to inpatient treatment. Among the therapeutic measures, the main ones are:
- The introduction of a flexible zone through the nasal cavity into the stomach, which is necessary to release stagnation in the upper digestive tract. It also allows you to stop vomiting.
- If there are symptoms of intestinal obstruction in adults and diagnosing a problem, patients can be administered solutions with which I restore the water-s alt balance.
- Doctor prescribes painkillers and antiemetics.
- Intestinal motility is stimulated through the use of Prozerin.
If the functional type of the problem was determined by signs of intestinal obstruction, then they try to solve it only with medication. Compounds are used that stimulate the contraction of muscle tissue in the intestine and help push the contents through the channels of the tract. If the methods of conservative therapy do not give the desired effect, then surgical intervention is used, which is carried out by the surgeon. During the procedure, tumors, loops, adhesions and nodes are removed. However, bowel obstruction in the elderly and adults with functional problems is usually treated well and quickly.
The main preventive measure to combat this problem is regular examinations of the intestinal tract. It is also important to pay due attention to the fight against helminthic invasion and observe the correct diet. SymptomsBowel obstruction in adults is a top priority because it can cause death or irreparable problems. This statement is equivalent for patients of childhood or the elderly. The main complication of obstruction is peritonitis, a condition that is extremely difficult to overcome, and sometimes even impossible.
