Intestinal Obstruction

Intestinal
Obstruction
Mechanical Obstructions Non mechanical Obstructions
Obstruction of the GI tract, is commonly Non mechanical obstruction results

caused by from absence of peristalsis.
• Hernias • Paralytic ileus (electrolyte imbalance)
• Intestinal adhesions • Hirschsprung’s disease
• Intussusception • Hypothyroidism
• Volvulus • Acute pancreatitis
• Tumors
• Infarction
• Crohn's disease (strictures)
Clinical Manifestations
Intestinal obstruction presents with symptoms such

as
• Abdominal pain
• Distention
• Vomiting (fecal content if its

lower GI obstruction)
• Constipation
Hernias
Any weakness or defect Hernias are the most Obstruction usually occurs
in the abdominal wall may frequent cause of because of visceral
permit the protrusion of a intestinal obstruction protrusion (external
serosa-lined pouch of worldwide, but not the herniation) and is most
peritoneum called a hernia most common in Zambia. frequently associated with
sac. inguinal hernias, which
tend to have narrow
orifices and large sacs.
Adhesions
Surgical procedures, infection, or These fibrous bridges can create
1 2
other causes of peritoneal closed loops through which other
inflammation, such as viscera may slide and become
endometriosis, may lead to the entrapped, resulting in internal
development of adhesions. herniation.
3 Sequelae, including obstruction and strangulation, are similar to external hernias.

Volvulus
Occurs when a loop of Volvulus presents with Occurs most often in large
bowel twists about its features of both redundant loops of
mesenteric point of obstruction and infarction. sigmoid colon, followed
attachment and results in in frequency by the
both luminal and vascular cecum, small bowel,
compromise. stomach, or, rarely,
transverse colon.
Intussusception
1 Epidemiology 3 Pathogenesis
Intussusception is the most common Intussusception occurs when a
cause of intestinal obstruction in segment of the intestine
children younger than 2 years of telescopes into the immediately
age. distal segment, leading to intestinal
obstruction and compression of
2 Aetiology mesenteric vessels.
4 Diagnostic Approach
Associated with viral infection and
rotavirus vaccines, perhaps due to Contrast enemas can be used both
reactive hyperplasia of Peyer diagnostically and therapeutically, and
patches and other mucosa- surgical intervention is necessary
associated lymphoid tissues. In when a mass is present.
most cases, the cause is unknown.
Ischaemic Bowel Disease
1 Introduction 2 Morphology
Ischaemic bowel disease can result Ischaemic damage can range from
from acute compromise of either/both mucosal infarction to transmural
superior or inferior mesenteric infarction. The colon is the most
arteries, leading to infarction. common site of GI ischemia, with
lesions often being segmental and
patchy.
Causes of Ischaemic Bowel Disease
Thrombosis and Embolism Other Causes
Severe atherosclerosis is a major risk Intestinal hypoperfusion may also occur

factor for thrombosis, less common due to systemic conditions like shock,
causes include vasculitides. dehydration, or use of vasoconstrictive
drugs.
Obstructive emboli often originate from
aortic atheromas or cardiac mural
thrombi.
Ischaemic Bowel
Disease: Pathogenesis
Reperfusion Injury
Reperfusion injury, initiated by restoration of the blood
supply, includes mechanisms such as free radical
production and release of inflammatory mediators.
Pathogenesis continues
1 Vascular
Anatomy
Intestinal segments at the end of their respective arterial supplies are
particularly susceptible to ischemia. These watershed zones include the
splenic flexure, where the superior and inferior mesenteric arterial
circulations terminate, and, to a lesser extent, the sigmoid colon and
rectum, where inferior mesenteric, pudendal, and iliac arterial circulations end.
2 Vascular
Anatomy
Intestinal capillaries run alongside the glands, from crypt to surface (villus),
before making a hairpin turn and descending to the post-capillary venules.
This arrangement makes the surface epithelium particularly vulnerable to
ischemic injury,
This pattern relative protects
of circulation to the crypts.
the epithelial stem cells, which are located
within the crypts and are necessary for recovery from epithelial injury.
Ischaemic Bowel
Disease: Clinical
Features
1 Acute Colonic Ischaemia
Typically, it presents with sudden onset of
cramping, left lower abdominal pain, and
bloody diarrhea, often progressing to shock and
vascular collapse in severe cases.
2 Chronic Ischaemia
May masquerade as inflammatory bowel disease,
with episodes of bloody diarrhea interspersed
with periods of healing.
Ischaemic Bowel Disease: Morpholog
Lesion Characteristics Ischemic lesions are often segmental
and patchy, with the mucosa being
hemorrhagic and ulcerated.
Transmural Infarction Transmural infarction involving all three

wall layers caused by acute arterial
obstruction results in coagulative
necrosis of the muscularis propria, and
perforation may occur.
Angiodysplasia
Prevalence Morphology
Angiodysplasia is less than 1% prevalent Angiodysplastic lesions are characterized
in adults but accounts for 20% of major by malformed submucosal and
episodes of lower intestinal bleeding in mucosal blood vessels that are
older populations. dilated and thin-walled, often leading
to chronic or acute bleeding.

Intestinal Obstruction

Uploaded by

Copyright:

Available Formats

Intestinal Obstruction

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Intestinal Obstruction

Uploaded by

Copyright:

Available Formats

Intestinal

Obstruction of the GI tract, is commonly Non mechanical obstruction results

Intestinal obstruction presents with symptoms such

• Vomiting (fecal content if its

3 Sequelae, including obstruction and strangulation, are similar to external hernias.

Severe atherosclerosis is a major risk Intestinal hypoperfusion may also occur

Transmural Infarction Transmural infarction involving all three

You might also like