Here is an approach to diagnosis of acute intestinal obstruction in which, we are going to discuss the symptoms, signs and diagnostic investigations of I.O .
2. more in Small IO > Large IO
3. starts allover the abdomen but mainly around the umbilicus
4. absent in paralytic ileus, in strangulation à ischemic stabbing
Clinical Picture Of Acute IO
Symptoms
: Characterized by Pain, Vomiting & Absolute constipation.
Pain
1. suddenly severe colicky pain (in bouts) 2. more in Small IO > Large IO
3. starts allover the abdomen but mainly around the umbilicus
4. absent in paralytic ileus, in strangulation à ischemic stabbing
Vomiting
Onset
1.
High
small IO à early with the onset of pain
2.
low
small IO à after few
hours from the onset of pain
3.
colonic
obstruction à
delayed for 1-2 days.
Content à digested food àgastric juice à bile à Faeculant vomiting.
Absolute Constipation
-
No faeces
or flatus is passed inspite of desire.
-
Blood may
pass per rectum in intussusceptions or MVO
Signs
General
-
Dehydration.
-
Pulse:& Temp.: à Normal
-
B.P: (affected
except in extensive strangulation)
Local
Inspection
1. Rigidity
-
Absent in
simple occlusion.
-
may be
present in strangulation
2. Distension of the abdomen
-
high small
IO à may be absent.
-
low IO à
mainly central (Step-Ladder pattern).
-
Colonic
obstruction à mainly in the flanks except volvulus of pelvic colon
à
central.
3. Visible peristalsis.
4.
Hernial orifices
5. Scars of previous
operations
Palpation
1. Tenderness à in strangulation à tenderness & rebound tenderness.
2. Tumor Mass
-
in
malignancy.
-
intussusception
à sausage-shaped swelling.
-
volvulus
of pelvic colonà tense tympanitic balloon.
Percussion à Tympanitic
abdomen.
Auscultation
-
Intestinal
sounds à frequent, loud (Mad abdomen).
-
In
paralytic ileus à silent.
PR:
-
Carcinoma
of the rectum
-
Impacted
faeces in the rectum.
Investigations
Routine CB4 +
-
C.B.C à
Hemoconcentration, leucocytosis.
-
KFT à
Pre-renal failure, disturbed pH, Na, K, Cl
Diagnosis
Double Enema Test: à On admission & After ½ hr
Plain X-Ray Abdomen:
Erect à multiple fluid
levels (sign of obstruction).
Supine
-
Jejunal
loops à fine
transverse striations (concertina effect).
-
Ileal
loops à cylindrical shadows.
-
Colon