In this article, we will consider a disease called bowel obstruction. A general medical description will be given here. We will also familiarize ourselves with the diagnosis of the disease, methods of eliminating the problem, and a number of possible complications that can lead to obstruction.
Introduction
Bowel obstruction (NK) is a syndrome that is characterized by a partial or absolute violation of the movement of food along the "tunnels" of the digestive tract. The violation occurs due to the presence of an obstacle to food or is caused by intestinal motor dysfunction. What to do with bowel obstruction in the elderly, children and adults, we will consider in the article. This topic is relevant in that it allows 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, the dynamic and mechanical causes of the appearance of this condition are distinguished.
The etiological findings of dynamic intestinal obstruction are based on the development of paralysis, which impedes the movement of food. Most often develops as a result of a trauma (including operating ones), hypokalemia (some metabolic disorders) and peritonitis.
Any disease of the organs of the abdominal cavity that can potentially cause peritonitis proceeds with the phenomenon of intestinal paresis. The decline in the level of activity of peristaltic movements in the gastrointestinal tract is observed when physical activity is limited (sedentary lifestyle) or with a prolonged unoccupied sensation of biliary or renal colic. Spastic intestinal obstruction can be caused by damage to the brain of the head or back (spinal) metastases of a malignant tumor, the back of a dry stomach, etc. It can also occur as a result of heavy metal poisoning or hysteria.
Mechanical etiology
Predisposing etiological factors that can cause mechanical CN are:
- the presence of congenital dolichosigma;
- motility of the cecum;
- anterior or internal abdominal hernia;
- the presence of lengthening of the sigmoid colon in old age;
- adhesive process in the abdominal cavity;
- there is an excess of folds and pockets in the peritoneum.
The cause 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 a consequence of compression / compression of the intestinal tube of a tumor from the outside, that is, one that was formed on neighboring organs. The phenomenon of tumor genesis and damage from 3 to 5 lymph nodes of the intestinal mesentery are curable in 99%. With an exophilic tumor, intussusception can be used.
Other causes of this condition may include: eating excessive amounts of food with a high calorie content, changing the diet in feeding the baby during the transition from breastfeeding to artificial nutrition, and abuse of the amount of food during long-term fasting.
Description of pathogenesis
Intestinal obstruction in the elderly, children and adults is for the most part identical: there is a large loss of water, as well as proteins and electrolytes. The liquid is excreted with masses of vomit, and it is also deposited in the intestines. Another consequence of a humoral disorder 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 clinically reflected in the form of dry skin, oliguria, arterial hypotension, high hematocrit and relative erythrocytosis.
The occurring dehydration and hypovolemia lead to a decrease in diuresis, sodium reabsorption and excessive excretion of potassium with masses of vomiting and urine, and also causes the process of intracellular acidosis, reduces muscle tone and reduces myocardial contractility. There are many other problems that can be caused by intestinal obstruction. There is also a significant loss of protein molecules (up to three hundred grams per day), leading to aggravation of the prevalence of metabolic processes.
Knowing this leads us to the fact that treatment of bowel obstruction, especially in acute cases, should include transfusion of fluids and the introduction of drugs with proteins and electrolytes, it is also necessary to normalize the acid-base state.
Endotoxicosis is an important link in the pathophysiological cycle of processes observed in the presence of NK. The fact is that during ecdotoxicosis, an enormous amount of products of incomplete protein hydrolysis is accumulated - a variety of polypeptide molecules, which under normal conditions are not absorbed into the tissues of the intestinal wall, but will begin to stagnate. The problem is the toxicity of substances absorbed from the digestive system.
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 ecosystem of microbacteria of the esophagus through rapid growth and reproduction of other, more “impudent” cell organisms. Microflora also migrates from the distal intestine to the proximal, where it will become foreign. Exo and endotoxins cause a malfunction of the intestinal barrier and cause translocation of bacteria in the bloodstream of lymph and peritoneal exudate, which, in turn, become the main causes of inflammation and abdominal surgical sepsis. The apotheosis of the development of this problem is necrosis and aggravation of metabolism at the tissue level with the further development of multi-organ type dysfunction and insufficiency.
Some features of intestinal dysfunction
A sign of intestinal obstruction at an early stage of disorders in the motor and secretory-resorptive functions is increased peristalsis. Intestinal contractions become shortened, but their frequency increases. A similar phenomenon is caused by the presence of an obstruction in the intestinal tract, which is difficult to overcome with food products. If you do not remove the "fence", then there will be a stimulation of the parasympathetic nervous system, 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 system. The consequence of this is the inability of the most muscle cells to receive and transmit information in the form of signals.
If a symptom of intestinal obstruction expresses itself in the form of a pronounced pain sensation, then, most likely, it is abutational or strangular (arising as a result of compression of the nerve trunks passing through the mesentery.
Symptoms of obstruction
Symptoms of bowel obstruction are as follows:
- Pain in the abdomen is an early and constant sign of obstruction. Most often appears suddenly and does not depend on the food that the subject consumed during the day. The nature of the pain is cramping. Pain attacks are caused by peristaltic waves, which are repeated at intervals of 10-15 minutes. At the time of decompensation and depletion of the energy supply of intestinal tissues, the pain becomes permanent. The strangular type of obstruction is also characterized by a constant and sudden onset of pain. As a rule, in the absence of treatment, on the 2nd - 3rd day the pain subsides, which serves as a sign of cessation of intestinal peristaltic activity and in the future will lead to a paralytic problem with persistent pain in the abdomen bursting.
- Bloating appears and its asymmetry is observed.
- Delayed gas or lack of stool can be a sign of pathognomonic intestinal obstruction. Due to intussusception, bloody discharge of fluids is sometimes observed, due to which NK is often confused with dysentery.
- Vomiting is another sign of 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).
Diagnostics and its tools
Differential diagnosis of intestinal obstruction in humans includes: pleurisy, peritonitis, acute pancreatitis and appendicitis, renal colic, lower lobe pneumonia, and perforation of the hollow organ.
Among the tools and methods by which intestinal obstruction is detected, the main ones are:
- The procedure of radiography of the abdomen allows you to determine the amount of gas and fluid level in any loop of the intestines and helps to study the transverse striation of tissues;
- Ultrasound allows you to determine both mechanical and dynamic obstruction. With mechanical, there is an expansion of the diameter of the lumen in the intestine to two cm with the simultaneous phenomenon of "fluid sequestration". The walls of the intestine thicken up to 4 mm and higher, the height of the curcring folds increases (from 5 mm) and the appearance of the reciprocating movement of the chyme along the intestinal cavity also serve as signs that help to detect mechanical obstruction by ultrasound. There are other characteristic signs. Dynamic NK is diagnosed in the absence of reciprocal contractions of the chyme, the presence of an unexpressed relief in the Kerkring folds, by hyperpneumatization of all parts of the intestine and by the phenomenon of fluid sequestration.
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 hospital. Surgery can be urgently intervened only in the presence of peritonitis, and in other cases they begin treatment using conservative measures and means. First, they try to eliminate pain, hyperperistaltic intoxication and problems in homeostasis. Also, during the treatment of bowel obstruction, the upper digestive departments are freed from stagnant contents through the use of special probes and siphon enemas.
If there is no positive effect after applying conservative methods to combat the problem, then resort to operational measures.
The concept of surgery
Bowel obstruction is often the only way to resolve this problem. After a laparotomy has been performed, an abdominal cavity is revised. Before the procedure, it is recommended to block the colon and mesentery with novocaine. First, the duodenojejunal transition 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 audit of organs, their level of vitality and the etiological nature of obstruction are determined.
Bowel obstruction in adults, children and the elderly leads to disability by organs. The intestinal viability indicator is determined after it is soaked in a liquid of sodium chloride solution of the isotonic type and 20-40 ml of warm novocaine solution (0.25%) is introduced into the mesentery tissues. Pay attention to the serous color of the membrane, which should be shiny and pinkish, to preserve the peristaltic abilities of a certain fragment of the intestine and to the pulsation of the mesenteric vessels.
"What to do with bowel obstruction in the elderly?" - A frequently asked question on the Internet. In the case of surgical intervention, doctors are trying to restore the passage through the intestines, dissect adhesions, melt the gates, perform disinvagination 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 that you contact a specialist immediately.
Radicality of the operation is determined by the severity of intoxication in the patient. During surgery, bowel resection with the exploitation of universal principles (for example, the use of an anastomosis “side to side”) can be used. If there is a risk of developing insolvency in the stitched anastomosis, then an operational procedure such as Maidl can 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 probes. Decompression is necessary to reduce intoxication, stimulate motility of intestinal tissues, and prevent the development of insolvency in the anastomosis. It causes the frame function. Nasogastric decompression is more commonly used than retrograde. Also, after surgical intervention, sanitary measures (for example, washing) and drainage of the abdominal cavity are carried out.
Conservative control and prevention
What to do with bowel obstruction if conservative methods are used?
Everything is simple here. This diagnosis, after its approval, forces the doctor to put the patient in hospital. Among 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 gagging.
- In the presence of symptoms of intestinal obstruction in adults and the diagnosis of a problem, patients can be given solutions with which to restore the water-salt balance.
- The doctor attributes 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. Use compounds that stimulate the contraction of muscle tissue in the intestine and promote the pushing of the contents along the channels of the tract. If methods of conservative therapy do not give the desired effect, then surgery 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 examination of the intestinal tract. It is also important to pay due attention to the fight against helminthic invasion and observe the correct diet. Symptoms of bowel obstruction in adults are the primary consideration, as they can cause death or irreparable problems. This statement is equivalent for patients of pediatric or elderly age. The main complication of obstruction is peritonitis, a condition that is extremely difficult to overcome, and sometimes even impossible.