Lower GI Video 2

Intestinal Obstructions

• Definition: Failure of intestinal contents to move through the bowel, can occur in small or large intestine, but most common in small intestine.

• Types of Obstructions:

  • Functional Obstruction (e.g. Paralytic ileus):

  • Peristalsis stops, preventing content propulsion.

  • Common postoperative complication.

  • Mechanical Obstruction:

  • Common Causes:

    • Tumors: Colorectal adenocarcinoma; can cause partial or complete obstruction if untreated.

    • Inflammatory Bowel Disease: Causes swelling and obstruction.

    • Fecal Impaction: Blocks intestinal lumen.

    • Adhesions: Scar tissue from previous surgery causes kinking, most often occurring in the small intestine.

    • Strangulated Hernia: Affects blood supply; more deadly complication.

• Consequences of Obstruction:

  • Distension of bowel lumen.

  • Risk of necrosis, perforation, and potentially peritonitis, which is an emergency condition.

Small Bowel Obstruction Manifestations

• Symptoms:

  • Cramping or colicky abdominal pain, can be intermittent.

  • Vomiting, possibly containing bile or fecal matter (especially in complete obstruction).

  • Absent flatus and feces.

  • High pitched bowel sounds initially, then silent bowel sounds.

  • Abdominal distension and tenderness.

• Complications:

  • Hypovolemia leading to hypovolemic shock (tachycardia, hypotension, elevated temperature, decreased urine output).

  • Strangulation risk from incarcerated hernias.

  • Peritonitis from strangulation causing perforation.

  • Patients may need immediate ICU care and surgery.

Large Bowel Obstruction Manifestations

• Symptoms:

  • Constipation, possible colicky abdominal pain.

  • Late stage vomiting, if at all., projectile vomiting

  • Diarrhea around the obstruction.

  • Distended abdomen, high pitched bowel sounds, and localized tenderness.

• Complications:

  • Massive colon dilation, risking gangrene or perforation.

  • Peritonitis and impaired venous return due to pressure.

  • Atelectasis due to diaphragmatic function impairment.

Nursing Care for Intestinal Obstructions

• Monitoring:

  • Bowel sounds and abdominal distension.

  • Vital signs to check for hypovolemia.

• Fluid and Electrolyte Balance:

  • Post-surgery recovery is crucial to restore balances.

• NG Tube Care:

  • Assess every 2-4 hours, keep patient NPO for bowel rest.

• Medication Management:

  • Antibiotics, sometimes prophylactically administered.

  • Colonoscopy may be performed for decompression.

• Patient Education:

  • Importance of remaining NPO and understanding surgical processes.

Irritable Bowel Syndrome (IBS)

• Definition: A motility disorder of the lower GI tract affecting small intestine and colon, involves hyperactivity.

• Manifestations:

  • Abdominal pain, often relieved by defecation.

  • Bloating, nausea, diarrhea or constipation, mucus in stool.

• Diagnosis: Rule out other causes of abdominal pain.

• Management:

  • Use of bulk-forming laxatives, anticholinergics, antibiotics, and antidepressants (e.g., SSRIs).

  • Identify and manage both physical and psychological triggers.

  • Increase dietary fiber and water intake; avoid gas-forming foods.

  • Bristol Stool Chart: Used for assessing types and characteristics of stools to determine IBS type.

Inflammatory Bowel Disease (IBD)

• Types:

  • Crohn's Disease: Affects all bowel layers, common in ileum, causes fistulas, diarrhea, and malnutrition.

  • Diagnostic Findings: Narrowing of colon, thickened bowel wall, distinct ulcerations in colonoscopy.

  • Management: Corticosteroids, immunomodulators, possible surgery.

  • Ulcerative Colitis: Affects rectum and colon, severe bleeding, less common for fistulas, extensive diarrhea.

  • Diagnostic Findings: Abnormal inflamed mucosa with ulcers, no narrowing seen.

  • Management: Similar to Crohn's but may require proctocolectomy.

  • Systemic Complications: Toxic megacolon, perforations, colon cancer risk.

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Summary Comparisons of IBD Types