Symptom finder - The causes of intestinal obstruction

Symptom finder - The causes of intestinal obstruction
Small and large intestine are predispose to intestinal obstruction. The causes of small bowel/intestine obstruction are intussusception, volvulus, adhesions and hernia ( outside the wall), lymphoma or carcinoma ( tumor), tuberculosis ( common in a tuberculosis endemic area ), atresia and Crohn’s disease ( in the wall ) and food bolus due to bypass surgery or destruction of pylorus) and gallstone ileus ( in the lumen).
Large bowel /intestine obstruction are caused by adhesions, hernia and volvulus( outside the wall) , Hirschsprung ‘s disease, Crohn’s disease, diverticular disease and carcinoma ( in the wall ) and feces ( in the lumen).
Paralytic ileus or adynamic obstruction may also cause intestinal obstruction . The causes of a dynamic obstruction or paralytic ileus are immobilization, drugs ( anticholinergic ,ganglion blocker), retroperitoneal hemorrhage, peritonitis, retroperitoneal malignancy, pelvis and spinal fractures , hypokalemia and post operative.
Mechanical obstruction of the intestine may be close loop which is obstruction at two point enclosing a segment of bowel or just one point obstruction ( simple). Non strangulating obstruction is associated with viability of the bowel . Strangulating obstruction may occur due to the compromise of the arterial supply which later lead to infarction of the bowel. Intestinal obstruction is the common form of surgical emergency . Urgent surgical exploration is needed in case the patient present with localized tenderness, pyrexia, tachycardia and neutrophil leukocytosis.
Urgent laparotomy is required in case of close loop obstruction of the large bowel that is characterized by tender,tense,palpable cecum with risk of perforation, if the cecum diameter is over 10 cm , it is an indication of imminent cecum rupture. In this case, urgent laparotomy is needed. Large bowel obstruction is characterized as a sharp ‘cut off” of the shadow of the gas in the colon suggestive of obstruction. Pseudo- obstruction is presented with gaseous distention , all along the large bowel including the rectum.
Obstruction of the small bowel is presented as central abdominal pain and vomiting of feculent , bile or food ( depends on the obstruction level). Distention of the abdomen need to be noticed. Distention is associated with the degree and level of obstruction . High small bowel obstruction is presented with little distention. There will be gross distention in low obstruction of the small bowel. Patient may also aware of hernia . Besides that, the patient may present with history of constipation. Any history of abdominal surgery in the past is important as it is a predisposing factor for adhesive obstruction.
Large bowel obstruction is presented with colicky pain ( right colon that is two third along the transverse colon)or lower abdominal colicky pain due to the remain of the colon.
Constipation may also occur with large bowel obstruction as well as bleeding per rectum ot change in bowel habit. Late features of large bowel obstruction is vomiting. Abdomen distention is obvious. Any history of constipation for years and abdominal distention are suggestive of Hirshsprung’s disease. Any severe pain which is constant and severe is suggestive of infarction.
Small and large intestine are predispose to intestinal obstruction. The causes of small bowel/intestine obstruction are intussusception, volvulus, adhesions and hernia ( outside the wall), lymphoma or carcinoma ( tumor), tuberculosis ( common in a tuberculosis endemic area ), atresia and Crohn’s disease ( in the wall ) and food bolus due to bypass surgery or destruction of pylorus) and gallstone ileus ( in the lumen).
Large bowel /intestine obstruction are caused by adhesions, hernia and volvulus( outside the wall) , Hirschsprung ‘s disease, Crohn’s disease, diverticular disease and carcinoma ( in the wall ) and feces ( in the lumen).
Paralytic ileus or adynamic obstruction may also cause intestinal obstruction . The causes of a dynamic obstruction or paralytic ileus are immobilization, drugs ( anticholinergic ,ganglion blocker), retroperitoneal hemorrhage, peritonitis, retroperitoneal malignancy, pelvis and spinal fractures , hypokalemia and post operative.
Mechanical obstruction of the intestine may be close loop which is obstruction at two point enclosing a segment of bowel or just one point obstruction ( simple). Non strangulating obstruction is associated with viability of the bowel . Strangulating obstruction may occur due to the compromise of the arterial supply which later lead to infarction of the bowel. Intestinal obstruction is the common form of surgical emergency . Urgent surgical exploration is needed in case the patient present with localized tenderness, pyrexia, tachycardia and neutrophil leukocytosis.
Urgent laparotomy is required in case of close loop obstruction of the large bowel that is characterized by tender,tense,palpable cecum with risk of perforation, if the cecum diameter is over 10 cm , it is an indication of imminent cecum rupture. In this case, urgent laparotomy is needed. Large bowel obstruction is characterized as a sharp ‘cut off” of the shadow of the gas in the colon suggestive of obstruction. Pseudo- obstruction is presented with gaseous distention , all along the large bowel including the rectum.
Obstruction of the small bowel is presented as central abdominal pain and vomiting of feculent , bile or food ( depends on the obstruction level). Distention of the abdomen need to be noticed. Distention is associated with the degree and level of obstruction . High small bowel obstruction is presented with little distention. There will be gross distention in low obstruction of the small bowel. Patient may also aware of hernia . Besides that, the patient may present with history of constipation. Any history of abdominal surgery in the past is important as it is a predisposing factor for adhesive obstruction.
Large bowel obstruction is presented with colicky pain ( right colon that is two third along the transverse colon)or lower abdominal colicky pain due to the remain of the colon.
Constipation may also occur with large bowel obstruction as well as bleeding per rectum ot change in bowel habit. Late features of large bowel obstruction is vomiting. Abdomen distention is obvious. Any history of constipation for years and abdominal distention are suggestive of Hirshsprung’s disease. Any severe pain which is constant and severe is suggestive of infarction.

The patient who is on anticoagulant and retroperitoneal hemorrhage is presented with abnormal clotting faIn case such as adynamic obstruction, check the drug history of the pain. Retroperitoneal hemorrhage may occur especially while taking anticoagulant. Other causes include fracture of the spine and recent surgery. Any distention fo the abdomen is uncomfortable but painless. This is followed by vomiting and constipation. Immobile elderly people is predispose to adynamic obstruction.
On examination, observe for the present of scar. It is vital to exclude obstructed incisional hernia. Hernia orifices are checked. In an obese patient, small femoral hernia is easily miss. The abdomen is usually distended , non tender and tympanic on palpation. The obstructed bowel will produce high - pitched tickling bowel sound. Impending infarction is characterized by localized tenderness, tachycardia and pyrexia. Cecal carcinoma may obstruct the ileocecal valve. This later will lead to small bowel obstruction. Cecal carcinoma and Crohn’s disease may present as mass in the right iliac fossa. This is follow by digital rectal examination.
Large bowel obstruction will present as tense tympanic distended abdomen with an obstructed sound of the bowel. Per rectum examination is performed. Fecal impaction may result in obstruction. A mass is suggestive of obstructing carcinoma. A tender, palpable tense cecum may suggest closed loop obstruction with an ileocecal valve which is competent. Imminent cecal perforation may occur.
Adynamic bowel obstruction will present as tense, distended, tympanic abdomen. The bowel sound is absent. Look for evidence of peritonitis, trauma, fractures, surgery and retroperitoneal hemorrhage.
The investigation may include full blood count, urea and electrolytes, abdominal x ray, clotting screen, sigmoidoscopy, small bowel enema , barium enema and CT scan.
Full blood count may reveal low in the hemoglobin level ( anemia) due to malignancy or raised white cell count due to infarcted bowel or infection. Creatinine , urea and electrolytes are useful to detect hypokalemia as a leading causes of paralytic ileus and dehydration.
Abdominal x ray may reveal distended bowel in the central of the abdomen. The small bowel is identify by the present of valvulae conniventes or lines arranged together closely which completely cross the lumen of the bowel. These lines are getting farther apart until it reach the terminal ileum where none is seen . Gallstone ileus is presented as gas in the biliary tree. Sigmoid volvulus is characterized as coffee bean shaped of distended loop of bowel that arises from the left sides of the pelvis.ctor. Sigmoidoscopy may has a therapeutic approach as it allow the decompression of the sigmoid volvulus by careful inspection of sigmoidoscope. Sigmoidoscopy is also useful in detection of tumor of rectosigmoid. Biopsy is performed to detect any carcinoma or signs of Hirschsprung disease ( absence of ganglion cells).
Small bowel enema is useful for detection of small bowel carcinoma ,tuberculosis of terminal ileum and Crohn’s disease. Barium enema may show bird beak sign that indicates the present of sigmoid volvulus and ‘ apple core lesion ‘ in carcinoma. Small bowel enema is also useful in detecting intussusception. CT scan is useful for detection of retroperitoneal tumor and retroperitoneal hemorrhage