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Intestinal Obstruction & Ileus

Definition
  • Intestinal Obstruction: Blockage preventing the normal flow of intestinal contents through the digestive tract.
  • Ileus: A type of bowel obstruction caused by a lack of peristalsis or motility, without any physical blockage.
Types & Causes
  • Mechanical Obstruction: Physical barrier such as tumours, hernias, or strictures.
  • Functional Obstruction (Ileus): Resulting from neuromuscular dysfunction, e.g., post-operative ileus, medications, or spinal injuries.
Clinical Presentation
  • Colicky abdominal pain.
  • Vomiting: faeculent in lower obstruction.
  • Constipation and absence of flatus.
  • Distended abdomen.
  • Audible bowel sounds, or “tinkling” in mechanical; absent in ileus.
Complications
  • Strangulation leading to bowel ischaemia.
  • Dehydration and electrolyte imbalances.
  • Peritonitis if bowel perforates.
  • Bowel necrosis.
Investigations
  • Plain abdominal X-ray: dilated bowel loops, air-fluid levels in obstruction.
  • CT scan: Detailed view, especially in suspected strangulation.
  • Abdominal ultrasound: Particularly in suspected intussusception in children.
  • Blood tests: Electrolytes, kidney function, lactate (if strangulation suspected).
Management
  • Nil by mouth (NBM) and nasogastric tube insertion for decompression.
  • Fluid resuscitation and correction of electrolyte imbalances.
  • Surgery: In cases of mechanical obstruction, especially if strangulation or necrosis is suspected.
  • For ileus, treat the underlying cause, e.g., discontinuing causative medications.
Differential Diagnoses
  • Gastroenteritis, pancreatitis, mesenteric ischaemia, and more.

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