Git6 obstruction
- 1. DR S C GAN FMHS/UTAR 12102012 1 GIT6: OBSTRUCTION DR GAN SENG CHIEW Associate Professor FACULTY OF MEDICINE & HEALTH SCIENCES UNIVERSITY TUNKU ABDUL RAHMAN
- 2. DR S C GAN FMHS/UTAR 12102012 2 Intestinal Obstruction An obstruction may occur anywhere along the small or large intestine and can be partial or complete. The part of the intestine above the obstruction continues to function. This part of the intestine enlarges as it fills with food, fluid, digestive secretions, and gas. The intestinal lining becomes swollen and inflamed. If the condition is not treated, the intestine can rupture, leaking its contents and causing inflammation and infection of the abdominal cavity (peritonitis).
- 3. DR S C GAN FMHS/UTAR 12102012 3 Causes • Birth defect in newborns and babies. • In adults, internal scar tissue from previous abdominal surgery (adhesions), parts of the intestine bulging through an abnormal opening (hernias), and tumors. • An obstruction of the duodenum may be caused by cancer of the pancreas; scarring from an ulcer, a previous operation, or Crohn's disease; or adhesions. Rarely, a gallstone, a mass of undigested food, or a collection of parasitic worms may block the intestine. • An obstruction of the large intestine is commonly caused by cancer, diverticulitis, or a hard lump of stool (fecal impaction). Adhesions and volvulus are less common causes of large intestine obstruction.
- 4. DR S C GAN FMHS/UTAR 12102012 4 What Causes Intestinal Strangulation? Intestinal strangulation (cutting off of the blood supply to the intestine) usually results from one of three causes. Strangulation occurs in nearly 25% of people with small- intestinal obstruction. Usually, strangulation results when part of the intestine becomes trapped in an abnormal opening (strangulated hernia); volvulus; or intussusception. Gangrene can develop in as few as 6 hours. With gangrene, the intestinal wall dies, usually causing rupture, which leads to peritonitis, shock, and, if untreated, death.
- 5. DR S C GAN FMHS/UTAR 12102012 5 Symptoms and Diagnosis • Intestinal obstruction usually causes cramping pain in the abdomen, accompanied by bloating and disinterest in eating (anorexia). Vomiting is common with small-intestinal obstruction but is less common and begins later with large-intestinal obstruction. Complete obstruction causes severe constipation, whereas partial obstruction may cause diarrhea. With strangulation, pain may become severe and steady. A fever is common and is particularly likely if the intestinal wall ruptures. • When an obstruction occurs, the abdomen is almost always swollen. • X-rays may show dilated loops of intestine that indicate the location of the obstruction.
- 6. DR S C GAN FMHS/UTAR 12102012 6 Treatment • Usually, a long, thin tube is passed through the nose and placed in the stomach or intestine. Suction is applied to the tube to remove the material that has accumulated above the blockage. Fluid and electrolytes (sodium, chloride, and potassium) are given intravenously to replace water and salts lost from vomiting or diarrhea. • Occasionally, an endoscope, which is advanced through the anus, or a barium enema, which inflates the large intestine, may be used, such as in a twisted intestinal segment in the lower part of the large intestine. Most often surgery is performed as soon as possible. In some cases, a colostomy is required.
- 7. DR S C GAN FMHS/UTAR 12102012 7 Acute GastrointestinalAcute Gastrointestinal EmergenciesEmergencies DR GAN SENG CHIEW Associate Professor FACULTY OF MEDICINE & HEALTH SCIENCES UNIVERSITY TUNKU ABDUL RAHMAN
- 8. DR S C GAN FMHS/UTAR 12102012 8 Classify By Site Oesophagus Acute dysphagia • Perfusion • Bleeding Stomach/duodenum • Perfusion • Bleeding
- 9. DR S C GAN FMHS/UTAR 12102012 9 Gallbladder/Biliary Tract • Cholecystitis • Cholangitis • Obstructive jaundice Pancreas • Acute pancreatitis Small intestine • Intestinal obstruction • Mesenteric Infarct • (Infectious diarrhoea) • Crohn’s Disease • Meckel’s Diverticulum Large Bowel (+ App) • Acute Appendicitis • Acute Diverticulitis • Lower GI bleeding • Perforation • Intestinal obstruction • Uncontrolled ulcerative colitis Perintoneal cavity • Peritonitis • Intra-abdominal abscess
- 10. DR S C GAN FMHS/UTAR 12102012 10 Oesophagus - BleedingOesophagus - Bleeding Oesophagitis, Mallroy Weiss, Varices • Variceal bleeding – can be catastrophic • Treatment - varices – Sengstaken tube – Somatostatin injection
- 11. DR S C GAN FMHS/UTAR 12102012 11 Oesophagus – AcuteOesophagus – Acute DysphagiaDysphagia • Presentation – cannot swallow – May have benign stricture or cancer – Triggered by food bolus or tablet – Treatment - – remove bolus – deal with underlying • oesophageal disease
- 12. DR S C GAN FMHS/UTAR 12102012 12 Oesophagus – PerforationOesophagus – Perforation High mortality May follow endoscopy Presentation – acute chest/abdominal pain Air in mediastinum and soft tissues Treatment - surgery - benign intubation - malignant
- 13. DR S C GAN FMHS/UTAR 12102012 13 Stomach/duodenum – Perforation Presentation – • abdominal pain • rigidity • peritonism, shock • Air under diaphragm on X-ray Treatment - • antibiotics, resuscitate • repair
- 14. DR S C GAN FMHS/UTAR 12102012 14 Stomach/duodenum –Stomach/duodenum – BleedingBleeding Presentation – • Haematemesis +/- • Melaena • Severity • Increased PR>90 • Fall BP<100 Causes • DU, erosions, GU Treatment – • ransfusion • inject DU
- 15. DR S C GAN FMHS/UTAR 12102012 15 Gall bladder/Biliary TractGall bladder/Biliary Tract Obstructive Jaundice • Yellow skin, sclerae • Pale stools, dark urine • +/- Pain • +/- Courvoisier’s sign • CT – dilated bile ducts • Establish diagnosis • Gallstones • Ca Head of Pancreas • Appropriate treatment
- 16. DR S C GAN FMHS/UTAR 12102012 16 Gall bladder/Biliary TractGall bladder/Biliary Tract Acute Cholecystitis • Presentation • Acute RUQ pain • +/- Pyrexia • +/- Rigors • Diagnosis – FBC, WBCC, USS • Treatment – Antibiotics, • analgesics • Early surgery
- 17. DR S C GAN FMHS/UTAR 12102012 17 PancreasPancreas Acute pancreatitis • Constant pain, vomiting, • Shock Causes • Gallstones, or • Alcohol Diagnosis • Serum amylase • elevation, USS • complications • pseudocyst, phlegmon • abcess
- 18. DR S C GAN FMHS/UTAR 12102012 18 Small IntestineSmall Intestine Meckel’s Diverticulum • rare • diverticulum of terminal ileum • can be lined by gastric epithelium • can perforate • can present like appendicitis
- 19. DR S C GAN FMHS/UTAR 12102012 19 Small IntestineSmall Intestine Intestinal obstruction • May arise due to • adhesions, hernia, tumour Presentation • colicky abdominal pain, • vomiting, constipation • Treatment • resuscitate/operate
- 20. DR S C GAN FMHS/UTAR 12102012 20 Small IntestineSmall Intestine Mesenteric infarct • Sudden occlusion of small • bowel arterial supply • Sudden onset of abdominal pain, shock • Peritonitis Treatment • resuscitate/operate
- 21. DR S C GAN FMHS/UTAR 12102012 21 Large bowelLarge bowel Acute diverticulitis • Maximal in (L) colon • Presentation LIF pain, • fever, tenderness, • leukocytosis • Middle aged or elderly Treatment – • conservative • antibiotics, fluids, bed rest
- 22. DR S C GAN FMHS/UTAR 12102012 22 Large bowelLarge bowel Lower GI bleeding • Diverticulum, colitis, • Crohn’s tumour • Present with Fresh Red Blood P/R • Tendency to be more conservative than with upper GI • Resuscitate, transfusion
- 23. DR S C GAN FMHS/UTAR 12102012 23 Large bowelLarge bowel Perforation • Diverticulum, colitis, • sudden severe abdominal pain, • rigidity • Faecal peritonitis • Pyrexia, shock • Free gas on X-ray Treatment • resuscitate, operate
- 24. DR S C GAN FMHS/UTAR 12102012 24 Inflammatory Bowel DiseaseInflammatory Bowel Disease • Recurrent regeneration • Increased risk of tumour formation • 14.8 X
- 25. DR S C GAN FMHS/UTAR 12102012 25 Large BowelLarge Bowel Ulcerative colitis • Presents – bloody • diarrhoea, pyrexia • leukocytosis • may develop toxic megacolon Treatment – • steroids • Surgery on failure
- 26. DR S C GAN FMHS/UTAR 12102012 26 Peritoneal cavityPeritoneal cavity Acute peritonitis • any perforation, • pancreatitis • abdominal pain, tenderness • guarding, silent abdomen • shock Treatment – underlying condition