Intestinal obstruction is a disease that combines a set of symptoms that are characterized by absolute or partial loss of the intestines, both thick and thin. It is characterized by the absence of movement of any type of food, including solid and liquid masses, as well as the presence of intense inflammation in the abdominal cavity. Intestinal obstruction can be dynamic and mechanical.
Features of the disease
Dynamic ileus is a separate type of the mentioned disease and occurs in 10% of patients with intestinal obstruction. Doctors are often led to this diagnosis by the need to exclude mechanical obstruction, which requires an urgent surgical operation.
The difficulty of diagnosing this disease is that the pathogenesis of dynamic intestinal obstruction is not characterized by the presence of an unambiguousobstruction of the movement of juices and food fragments through the intestinal tract. In this case, only a short reduction in the processes of this body is inherent.
However, the danger of the disease lies in the fact that it can provoke neurohormonal dysfunction in the patient's body, as well as disrupt the functionality of the small and large intestine. Consider what factors affect the occurrence of such a disease as dynamic intestinal obstruction.
Causes of disease
Although modern science is distinguished by great merits and achievements in medicine, it has not yet been able to unravel the specific mechanisms that provoke the appearance of the disease in question. The appearance of such a problem as dynamic intestinal obstruction can be caused by the following factors:
- peritonitis, which can lead to appendicitis or pancreatitis;
- acute mesenteric infarction;
- toxic megacolon (Crohn's disease, Hirschsprung's disease, ulcerative colitis);
- reflex circumstances (postoperative condition, colic, bleeding, abdominal trauma, spinal fractures, as an aggravation of mechanical intestinal obstruction);
- diseases of a neurogenic nature;
- changes in hormonal levels (for example, pregnancy);
- metabolic diseases (hypokalemia, ketoacidosis, uremia, intoxication).
Classification of dynamicintestinal obstruction
In medicine, each diagnosis has its own individual code, name and generally accepted standards of medical care. Such a disease as dynamic intestinal obstruction is no exception. ICD 10 (International Classification of Diseases) classifies the disease in question as follows:
- class XI "Diseases of the digestive system" (K00-K93);
- section "Other bowel diseases" (K55-K63);
- diagnosis code - K56.6;
- name - "Other and unspecified intestinal obstruction".
In medical practice, it is customary to distinguish between two main types of dynamic intestinal obstruction:
- spastic;
- paralytic.
Spastic bowel obstruction
It is rare in clinical practice, it is usually found in tandem with another disease. Often the cause of the disease is infection of the body with worms or pylorospasm, as a consequence of birth trauma. Also among the other causes of this type of disease can be noted: diseases of the nervous system, neurosis, dyskinesia.
You can get rid of this problem only with the help of conservative methods, since it makes no sense to resort to surgical intervention in this case.
Spastic bowel obstruction: symptoms
In adults, this disease occurs much more often than in children, but its symptoms are the same at any age. This disease is characterized by a sudden onset. The patient complains of shortbouts of pain in the abdomen that do not have a specific location.
Patients with this diagnosis report the following symptoms:
- cramping pains in the abdomen;
- uneven bloating and fullness feeling;
- nausea, possible vomiting, constipation.
During palpation of the abdomen, a diseased segment of the small intestine is palpated, the abdomen itself remains soft. Violations from other systems are not observed. The general condition of the patient is not critical.
Paralytic ileus
Determined by paralysis of intestinal peristalsis, accompanied by a sudden regression of the functional vivacity of neuromuscular formations. There are reflex and postoperative paralytic ileus.
With the reflex form of the disease, irritation of the sympathetic branch of the autonomic nervous system is observed. Postoperative obstruction has a more complex genesis and is more common after various operations performed on the abdominal organs.
The following factors provoke the formation and development of the disease:
- inflammatory processes in the abdomen;
- bruising (phlegmon) of the retroperitoneal region;
- general picture observed after an operation such as laparotomy;
- consequences of such pathological diseases as pleurisy, pneumonia, myocardial infarction;
- thrombosis of mesenteric vessels;
- past infectious diseases, including toxic paresis.
There are several stages of thisdisease:
I stage. "Compensated violations" - it is equivalent to a typical postoperative intestinal paresis. The duration of symptoms lasts for 2-3 days.
II stage. "Subcompensated disorders" - characterized by the fact that there is a significant swelling, there are signs of intoxication and peritonism of the body. Perist altic noises are not audible. Many signs are seen on the x-ray.
III stage. "Decompensated disorders" - the body is in a state of significant intoxication. You can observe intestinal adynamia, vomiting of intestinal contents. There are symptoms of abdominal irritation, the abdomen is significantly swollen. X-ray examination shows many horizontal levels of fluid in the loops of the intestines (small and large at the same time).
IV stage. "Paralysis of the gastrointestinal tract" - at this stage, there is a violation of all organ systems important for human life. Negative systems are felt continuously by the sick.
Since modern medicine does not yet have developed differential diagnostic signs of various pathologies that appear in the postoperative period, therefore, early diagnosis of the disease is almost impossible
Paralytic ileus: symptoms
In adults, against the background of this disease, the general condition is significantly aggravated. He feels constant pain, which has a diffuse character. However, it is not as intense as with mechanical intestinal obstruction. There is vomiting withgreen admixture. The patient notes an increase in symptoms of exsicosis, toxicosis, as well as cardiovascular depression.
With paralytic obstruction, the patient's stomach swells, through its front wall you can notice an increase in the volume of loops of non-perist altic intestines. If there are no peritoneal symptoms, then the abdominal area is soft to the touch.
Since this disease is a staged process, the patient's condition worsens as the disease progresses. In the later stages, tachycardia and shortness of breath, bloating, sluggish perist altic noises, which are rarely audible, can be noted. Vomiting worsens.
At the last stages, there is a sharp predominance of morphological changes in the neuromuscular apparatus. The patient complains of gas and stool retention, has rare urination.
Dynamic intestinal obstruction in children
In children, acute dynamic intestinal obstruction is more common, which most often manifests itself in a paralytic form. The following reasons can be distinguished that provoke the development of the disease in childhood:
- obstructive or strangulation obstruction;
- limited or diffuse peritonitis;
- abdominal injury;
- pneumonia;
- pleural empyema;
- disorders of intestinal functions.
Quite often, dynamic intestinal obstruction affects children in the postoperative period. Also the cause of the maturation of the paralytic form of this diseasemay be hypokalemia.
The danger of illness in childhood is the possible loss of a large amount of fluid and s alt due to constant vomiting, loss of appetite, excretion of potassium by the kidneys, hypoproteinemia. The severity of the condition may be exacerbated by negative toxic and bacterial conditions.
Dynamic intestinal obstruction in newborns can be triggered by a number of the following reasons:
- prematurity;
- violation of intervention;
- use of medications (including by a woman in labor during pregnancy);
- hypermagnesemia;
- parturient use of heroin;
- using hexamethonium;
- sepsis;
- enteritis;
- CNS disease;
- necrotizing enterocolitis;
- endocrine disorders.
Dynamic intestinal obstruction in children is not uncommon, but it is easily diagnosed and makes timely treatment possible. In case of suspicion of the presence of such an obstruction, the main thing is not to succumb to the temptation of self-treatment, but to strictly adhere to the instructions provided by the relevant specialist. A lethal outcome is a completely possible development of events with such a problem as dynamic intestinal obstruction.
Disease diagnosis
The symptoms of this disease are specific and bright, which does not complicate the process of its diagnosis. The following diagnostic methods are used:
- gathering anamnesis;
- examination of the patient;
- x-ray examination of organs in the abdominal region (the presence of gases above the liquid level in the intestine matters);
- Ultrasound (not mandatory, as it is not a sufficiently informative indicator);
- CBC.
Dynamic ileus: treatment
As a rule, the treatment of a disease is focused on eliminating the initial causes that provoke its development (infectious diseases, pneumonia, peritonitis, etc.). If the disease is a consequence of toxic or reflex circumstances, conservative treatment is appropriate, which consists in drug therapy for all negative manifestations, which lead to a stop of standard intestinal peristalsis. Such therapy can be carried out by introducing drugs such as sodium chloride into the human body along with glucose. Then you need to rinse the intestines with an enema, if necessary, insert a gastric tube. When pain is high, painkillers are allowed.
In the event that the patient's condition does not improve within six hours of conservative treatment, surgery is performed. Also, emergency surgery is performed for congenital intestinal obstruction.
Usually, the operation consists of partial removal of the intestine, which no longer performs its functions. In particularsevere episodes, you have to impose a colostomy (an artificial anus in the abdominal wall, through which the feces move and have the opportunity to go into a special attached bag).
It is possible to do without removal of a segment of the intestine only in case of intussusception. Under this circumstance, you can straighten the intestines by passing air through the intestines and further monitoring the overall picture with the help of X-rays.
Post-surgery treatment consists of an individual diet, which depends on the volume of surgical intervention. The first two days after the operation, the patient is recommended to be in the Fowler position, it is also necessary to perform breathing exercises. Also at this stage, it is necessary to undergo drug therapy, which includes detoxification therapy, normalization of electrolyte metabolism, the use of broad-spectrum antibiotics, stimulants of the gastrointestinal tract, and, if indicated, hormonal treatment.
With complications in the postoperative period, aggravation of the wound, bleeding, peritonitis, peritoneal adhesive disease is possible.
With dynamic intestinal obstruction, as with any other disease, it is not so much the treatment that matters, but rather the prevention of the development of this problem. Preventive methods include:
- correction of electrolyte balance;
- drug treatment with prokinetics;
- taking antibiotics;
- an appropriate diet that is low in fat, dairy and plant foods high in indigestible ingredientshuman body.
