Intestinal obstruction symptoms and bowel obstruction treatment

LISTEN YOUR ABDOMEN......

MALFUNCTIONING OF THE BODY THEREBY BLOCKING THE INTESTINE

Undergo HOW to prevent and Treat ?

INTESTINAL OBSTRUCTION

The mall-functioning of the body thereby blocking the gut and preventing the movement of product of digestion. Its a mechanical or  useful impediment  of the gut ,veto the normal transit of the products of digestion. it can become at some level distal to the duodenum of the small gut an is a medical emergency. Although many cases are not treated surgically , is  a surgical problem.

CLASSIFICATION

• ACUTE OBSTRUCTION : Occurs in small intestine.
• CHRONIC OBSTRUCTION :  Occur in large intestine.
• ACUTE-ON-CHRONIC OBSTRUCTION : Spreads from large gut to involved small intestine.

ETIOLOGY

DYNAMIC OBSTRUCTION

  Here an obstructive agent is present.

     LUMINAL OBSTRUCTIONFecal impaction

• Gall stone ileus
• worms eg ascariasis.

     INTRINSIC LESION OF BOWL WALL

•  Inflammatory stricture
• Malignant stricture
• Intussusception

     EXTRINSIC COMPRESSION

•  Adhesions
• Hernias
• Volvulus

ADYNAMIC OBSTRUCTION

Here's no obstructive agent is present.

PARALYTIC ILEUS

• Postoperative
• Peritonitis
• Reflex
• Uremia
• Hpokalemia

 MESENTRIC VASCULAR OCCLUSION

• Embolism
• Thrombosis

SIGNS AND SYMPTOMS

Based on the extent of impediment involved, viscus impediment can result into abdominal pain, abdominal distension, vomiting and regurgitation. (This a information where half-digested concern is remove from the gut into the stomach by contraction and muscle movement, forcefully expelled through the oesophagus and finally outside from the mouth. This is not actually faecal concern that is vomited, but it smells similar). The information of viscus impediment haw be worsen by extraction and electrolyte abnormalities (acid-base imbalance) cod to vomiting. In diminutive gut obstruction, the discompose are cramping and consistent in nature. The discompose is more central and mid-abdominal. Constipation comes after vomiting. In case of large viscus impediment , the discompose is felt in the lower conception of the abdomen. Constipation occurs first and regurgitation haw be irregular.

INVESTIGATIONS

Test that shows obstruction

• Barium enema
• Abdominal CT scan
• Upper GI and small bowl series
• Abdominal film

The field diagnostic tools are blood test, X-rays of the abdomen, CT scanning (computer tomography) and or ultra-sound. In a case of identifying mass, biopsy haw be employed to determine the nature of the mass. Radio logically viscus impediment shows viscus distension and the presence of multiple gas-fluid levels. Contrast enema, diminutive gut series or CT construe can be used to define the level of obstruction, as in either partial or complete and helping to know the cause of the obstruction. In colonoscopy,small gut are diagonalised using ingested camera,while endoscopy is an instrument used to get medical information from inside the embody and laparoscopy is a form of new technique aimed at carrying out abdominal activeness through diminutive incision.unlike the usual large surgical procedure.

TREATMENT

GASTRODUODENAL OR GASROINTESTINAL SUCTION DRAINAGE

REPLACEMENT OF FLUID AND ELECTROLYTES

RELIEF OF OBSTRUCYION BY OPERATION

ANTIBIOTICS 

The treatment for diminutive viscus impediment is both non-surgical called conservative and surgical. Non-surgical treatment involves a nasogastric tub, correction of extraction and electrolyte abnormalities. For patients with cut pain, Opioid discompose reliever haw be used. Antiemetics haw be administered to regurgitation patient. Intestinal Obstruction in Children Intestinal atresia is the main causes of fetal and neonatal viscus obstruction. This is characterised by narrowing or absence of a conception of the intestine. The atresia are usually discovered before birth via Sonagram and treated with using laporotomy after if the area infected is small, surgeon haw be able to remove the damaged conception and the gut is joined back together. In a information where the narrowing is longer and the area is damaged, a temporary stoma haw be placed.

SURGERY

The surgery is performed while you are under general anaesthesia. This means you are unconscious and pain-free .A cut is prefabricated  in your abdomen. The disease conception of the super bowl is distant and the digit healthy ends of bowl are seamed back together ( resected ).The cut is winking , if the entire colon and rectum is distant , it is titled a proctocolectomy. A bowl resection haw be performed as a traditional 'open' machine or as a minimally invasive laproscopic procedure.

PREVENTION


It depends on the cause,treatment of conditions ( such as tumor and hernias ) that are attendant to obstruction,may reduce the risk.some causes of obstruction are not preventable.

EXPECTATION

The outcome varies with the cause of obstruction.

70% adult cases of chronic pancreatitis are caused by chronic alcohol use

Main culprits are heavy alcohol consumption and gallstones for chronic pancreatitis

CHRONIC PANCREATITIS 

is a relapsing disorder which may arise  insidiously or following repeated attacks of acute pancreatitis .The most commonest cause is chronic alcohol consumption and accompanied by a protien and fat rich diet .Other causes include cystic fibrosis ,hypercalcemia ,hyperlipidemiaand a rare familial pancreatitis .Pathological changes include parenchymal destruction ,fibrosis ,loss of acini ,calculi and duct stenosis with dilatation behind the stenosis.At operation the gland feels hard and irregular and may be mistaken for carcinoma .Calcification is often seen on plain abdominal X-ray.This is thought to be due to calcification of protien precipitates in ducts .

 Pancreatic duct obstruction : due to Stricture e.g.after trauma or acute pancreatitis.Occlusion by pancreatic cancer.

 Hyperparathyroidism ,cystic fibrosis ,Hereditory pancreatitis ,Infantile malnutrition ,Idiopathic ,Stenosis of ampulla of vater . In 12 % of adults ,etiology is unknown.

 Initially pancreas may appear normal.Later pancreas enlarges and becomes hard due to sclerosis ,while the ducts become distorted and dilated with areas of ectasia .Calcified stones ,weighing from a few mg 200 g ,may form within ducts .Ducts become occluded with gelatinous protein-rich fluid and debris ,to form cysts.

Lesions affect a particular lobule producing ,Ductular metaplasia and hyperplasia ,Atrophy of acini ,Interlobular fibrosis .

In clinical features there is symptom of discompose in epigastrium ,which alter to left and correct hypochondrium and finished to back .boring discompose to biliary colic in character .duration about 3-4 days ,and exacerbated by beverage consumption.Vomiting ,anorexia ,Steatorrhea ,and Weight loss ( results from anorexia ,malabsorption steatorrhea and vomiting .It can cause some symptoms of diabetes mellitus ,these are late feature and includes polyuria ,polydipsia ,weight loss and imperfectness.

Signs of jaundice haw be present ( due to narrowing of retropancreatic bile duct ) A protective ,hard epigastric mass haw indicate formation of a sac . ( best way to palpate pancreas is to invoke the enduring to correct and hips and knees are flexed .Left costal margin is deeply palpated.This will evoke tendrness in accent and habitual pancreatitis ( Mallet-Guy's sign ).

DIAGNOSTIC INVESTIGATIONS

The identification of habitual pancreatitis is typically based on tests on pancreatic structure and function, as direct biopsy of the pancreas is thoughtful excessively risky. Serum amylase and lipase may well not be elevated in cases of advanced habitual pancreatitis, but are often utilised as markers for sleuthing pancreatic inflammation in acute pancreatitis. A secretin stimulation effort is thoughtful the gold standard functional effort for identification of habitual pancreatitis but not often utilised clinically. The observation that bi-carbonate production is impaired early in habitual pancreatitis has led to the rationale of ingest of this effort in early stages of disease (sensitivity of 95%). Other ordinary tests utilised to determine habitual pancreatitis are faecal elastase measurement in stool, serum trypsinogen, Computed tomography (CT) scans, ultrasounds, EUS, MRI's, ERCP and MRCP's. Pancreatic calcification crapper often be seen on plain abdominal X-rays, as well as CT scans.

There are other non-specific laboratory studies useful in identification of habitual pancreatitis. Serum bilirubin and alkaline phosphatase crapper be elevated, indicating stricturing of the ordinary bile funiculus cod to edema, fibrosis or cancer. When the habitual pancreatitis is cod to an autoimmune process, elevations in ESR, IgG4, rheumatoid factor, ANA and antismooth hooligan antibody may be seen. The ordinary symptom of habitual pancreatits, steatorrhea, crapper be diagnosed by two assorted studies: Sudden staining of feces or soiled fruitful organic over 24hr on a 100g fruitful diet. To check for pancreatic exocrine dysfunction, the most sensitive and specific effort is the measurement of soiled elastase, which crapper be done with a azygos crap sample, and a value of inferior than 200 ug/g indicates pancreatic insufficiency.

TREATMENT

MEDICAL TREATMENT  

Aimed at controlling discompose and malabsorption .Intermittent attacks treated like accent pancreatitis.Alcohol and super fatty meals must be avoided .Narcotics for severe discompose ,but subsequent addiction is common ,Patients unable to maintain adequate hydration should be hospitalized ,while those with milder symptoms crapper be managed on an ambulatory basis. Surgery haw curb discompose if there is a ductal stricture .Subtotal pancreatectomy haw also curb discompose but at the outlay of exocrine insufficiency and diabetes .Malabsorption is managed with a low fat diet and pancreatic enzymes equal ( 8 customary tablets or 3 viscus glazed tablets with meals ).Because pancreatic enzymes are inactivated by Elvis ,agents that turn Elvis creation ( e.g . omeperazole or sodium bicarbonate ) haw improve their efficacy ( but should not be presented with viscus glazed preparation ) Insulin haw be needed to curb serum glucose .

SURGICAL TREATMENT

Traditional Surgery for Chronic Pancreatitis tends to be divided into two areas - resectional and drainage procedures.New and proven transplantation options preclude the patient from decent diabetic following the surgical removal (resection) of their pancreas. This is achieved by transplanting backwards in the patients own insulin-producing beta cells.

DISTAL PANCREATOMY it consist of distal pancreatic resection up to portal vein ,and it is performed if head of pancreas is relatively normal .

PANCREATODUDENECTOMY it is performed if head of pancreas is mainly involved .

LONGITUDINAL  PANCREATOJEJUNOSTOMY  it is performed if pancreatic duct is grossly dilated .

COMPLICATIONS  

Vitamin B6 malabsorption in 40 % of alcohol induced and all cystic fibrosis cases.Impaired glucose tolerance .Nondiabetic retinopathy due to vitamin A and/ or zinc deficiency,Gastrointestinal bleeding ,icterus ,effusion ,subcutaneous fat necrosis and bone pain occasionally occur .Increased risk for pancreatic carcinoma .Narcotic addiction common.

Here's some information when your intestine is inactive or Paralytic ileus

PARALYTIC ILEUS 

 

It is  a state in which intestine fails to transmit peristaltic waves and is due to failure in neuromuscular mechanism and Obstruction of the gut cod to paralysis of the viscus muscles. The paralysis does not need to be complete to cause ileus, but the viscus muscles must be so inactive that it prevents the passage of food and leads to a useful closure of the intestine.

 

IN POSTOPERATIVE ETIOLOGY  

Ileus commonly follows some types of surgery, especially abdominal surgery  ,Normal lyintestinal motility and absorption returns in about 16 hours ,However ,postoperative ileus may br prolonged , if there is  Hypoproteinemia ,Latent renal failure , If gastrointestinal suction is continued beyond the point at which effective bowl sounds have returned .PERITONITIS initially as a normal response to prevent dissemination .Later bacterial toxins  prevent normal activity of nerve plexuses.

It also crapper result from certain DRUGS  like Uremia ( in renal failure ,following prostatectomy ) , HYPOKALEMIA, IN REFLEX ETIOLOGY Spinal injuries or ribs injuries, ,sometime Retroperitoneal haemorrhage , inflammation anywhere within the abdomen that touches the intestines, and diseases of the viscus muscles themselves  and Application of the plaster jacket.

Irrespective of the cause, closure causes constipation ( no passage of flatus ,for upto 48 hours after laparotomy ), abdominal distention, ( more marked and drum like tympanitic ) and sickness and vomiting ( effortless ,large volume and with dirty fluid ) Respiratory distress. On listening to the abdomen with a stethoscope, some or no bowel sounds are heard (because the bowel is inactive) after laparotomy. Also titled disfunction ileus. Also simply titled ileus.with sign of Tachycardia ,there may be wound dehiscence .

Ileus may increase bond formation, because intestinal segments have more prolonged contact, allowing fibrous adhesions to form, and intestinal distention causes serosal injury and ischemia. Intestinal distention has been shown to drive adhesions in foals . Repeat celiotomy to decompress chronically distended small gut and vanish fibrinous adhesions is also a multipurpose method of treating ileus and reducting adhesions, and it has been related with a good outcome  

DIAGNOSTIC TEST FORPARALYTIC ILEUS: 

The list of diagnostic tests mentioned in various sources as used in the diagnosis of Paralytic ileus includes:

Stethoscope Examination of the abdomen : when a doctor ty o listen with a stethoscope to the abdomen there will be few or no bowel sounds ,indicating that the intestine has stopped functioning .ileus can be confirmed by X-ray of abdomen .computed tomography scans (CT  scan ) or ultrasound .it may be necessary to do more invasive test msuch as barium enema or upper GI series if the obstruction is mechanical.Blood test also are useful in diagnosing paralytic ileus .barium enema used in some obstruction cases but it can cause few problems by increasing pressure or intestinal contents if used in ileus Also in doubtful cases with mechanical obsruction involving the gastrointestinal tract .

So its use is contraindicated in these typs of cases .but in some caes it should be used first . 

TREATMENT OF PARALYTIC ILEUS 

Always seek professional medical advice about any treatment or change in treatment plans, patients may be treated with supervised bed rest in a infirmary , and bowel rest ,where nothing is taken by representative ,and patients are feed intravaneously or finished the ingest of a nasogastric

tube .A nasogastric plaything is a plaything inserted finished the nose down to the throat and into the breadbasket.A kindred plaything can be inserted in the gut .The contents are then suctioned out .In some cases ,especially where there is a machine like obstruction ,surgery may be needed . Drug therapies that encourage intestinal motility ( ability of the gut to more spontaneously ) such as morphine or pethidine , in repeated small doses .Fluid and electrolytes balance ,especially serum K and blood urea.

PROPHYLACTIC TREATMENT 

Routine nasogastric suction and withholding fluids by representative after laparotomy until normal bowel sounds returns ,and /or passage of flatus occurs .in most of the cases ileus are not preventable  ,surgery to remove a tumr or other intestinal obstruction will help prevent a repetition .

Treatment for diverticular disease of colon

Diverticulosis is generally discovered through one of the following examinations for appropriate treatment

Barium enema: This x-ray test involves injection of liquid material into the colon through a tube inserted in the rectum. The x-ray image shows the anatomy of the colon, and can identify if diverticula, large polyps or growths are present.

Colonoscopy: This test uses a thin, flexible tube with a light and camera to view the inside of the colon. Diverticula as well as polyps and other growths can be seen with this instrument.

CT scan: This x-ray test takes multiple cross section pictures of the body. It is not generally performed to make a diagnosis of diverticulosis, but this type of exam may identify diverticula.

Patients with diverticular disease should be counselled on the benefits of a high fibre diet. Bulking agents and laxatives could also be added until stools are soft and defaecation is painless.

Patients with acute diverticulitis are admitted to hospital for bed rest, nil by mouth (with iv fluids), analgesics, and IV antibiotics (e.g. cefuroxime and metronidazole). Patients presenting with PR bleeding are resuscitated and given blood transfusion.

Complicated disease (perforation, abscess, multiple attacks, uncontrollable bleeding) usually requires surgery to remove the diseased segment of colon. There are various surgical techniques available depending on the site of the disease, and a temporary stoma is usually needed (a "stoma bag"), although this is reversed after around 6 weeks.

CONSERVATIVE MANAGEMENT

Patients with acute diverticulitis are admitted to hospital for bed rest, nil by mouth (with iv fluids), analgesics, and IV antibiotics (e.g. cefuroxime and metronidazole). Patients presenting with PR bleeding are resuscitated and given blood transfusion.

Complicated disease (perforation, abscess, multiple attacks, uncontrollable bleeding) usually requires surgery to remove the diseased segment of colon. 

There are various surgical techniques available depending on the site of the disease, and a temporary stoma is usually needed (a "stoma bag"), although this is reversed after around 6 weeks.

SURGICAL TREATMENT

INDICATIONS :Recurrent attacks -and Complications

OPERATIVE PROCEDURES 

IDEAL OPERATION 

This is a one stage resection ,which involves removal of affected segment 10 - 20 cm long and restoration of continuity by end-to-end anastomosis .

IN CASES OF OBSTRUCTION & INFLAMMATORY EDEMA AND ADHESIONS a preliminary transverse colostomy can be done as a first stage. In second stage of resecion is performed after 3 weeks or later when inflammation has subsided.Colostomy is closed after a further 2 weeks.
IN ACUTE PERFORATION proximal colostomy can be done ,Exteriorization , Primary resection.

HARTMANN'S OPERATION colostomy after excision with closure of defunctioned distal bowel .

Restoration of bowel continuity can be done at a later stage by means of stapling guns .

IN FISTULA resection of diseased bowel. ,closure of fistula .

IN HAEMORRAHAGE resection of bleeding segment ...... read more

Gall stones(cholelithiasis)-Gall bladder problems common in women eat high fibre diet for prevention

PATHOLOGICAL CONDITIONS OF THE GALL BLADDER ARE COMMON SURGICAL PROBLEMS....

GALL STONES ( CHOLELITHIASIS )

In medicine, gallstones (choleliths) are crystalline bodies formed within the embody by increment or concretion of normal or deviant bile components.In 80% of patients gall stones are composed predominantly of cholesterol with smaller amounts of calcium salts and bile pigments . They are referred to as mixed stones , are usually multiple with a faceted surface , and have a characteristic laminated surface on cross section. Only about 10 % of them contain sufficient calcium to be visible on a plain X-ray .Pure cholestrol stones form less than 10% of stones .They are usually solitary ( the cholestrol " solitaire " ) up to 5 cm in diameter ,and have a characteristic radial arrangement of crystals on cross section . Cholestrol stones usually form in bile which is supersaturated with cholestrol. When bile contains more cholestrol than can be solublised in the bile- acid -lecithin micelles ,crystals of cholestrol form in the bile .

The greater the concentration of bile acids and lecithin in bile ,the greater is the amount of cholestrol that can be contained in the mixed micelles .Lecithin is important because lecithin - cholestrol mixed micelles can solubilise more cholestrol than can micelles of bile acids alone .Following Crohn's disease of the terminal ileum or ileal resection thebile salt pool is reduced because of lack of absorption of bile salts ,and the liver can not make good the losses .

Such patients are prone to cholestrol stones. Oestrogen increases the hepatic synthesis of cholestrol ,and this may explain why females of child - bearing age have a higher incidence of cholestrol stones . A high animal fat ,low fibre diet is also associated with cholestrol stones because of excretion in bile of the excess cholestrol absobed from the gut.Clofibrate , a cholestrol-lowering agent ,has been implicated in cholestrol stone formation ,because it increases excretion of cholestrol in the bile . Decreased gall bladder motility probably plays a rle in aetiology of gall stones .

Cholestrol and other substances which form the nuclei for gall stone formation must remain in the gall bladder long enough for crystal growth to occur .Stasis occurs during pregnancy due to the smooth muscle relaxing effect of progesterone.Motility of the gall bladder is also decreased during starvation and total parenteral nutrition , due to decreased stimulation of the gall bladder by CCK.Stones may also form after vagotomy ,because of lack of vagal potentiation of CCK.Bile pigment stones account for about 10 % of stones in the UK.The major constituent is the calcium salt of unconjugated bilirubin.

They are associated with chronic haemolytic disease where there is breakdown of red cells with release of excessive bilirubin.Pure pigment stones occur in sickle cell disease , thalassaemia and hereditary spherocytosis .Pigment stones are found in the Far East ,where they are associated with biliary tract infection with E.coli and Bacteroides fragilis ,These organism produce beta-glucuronidase which splits bilirubin diglucuronide and releses free bilirubin.The latter combines with calcium to form the relatively insoluble calcium bilirubinate.

PATHOLOGICAL CONSEQUENCES OF GALL STONES ARE :

• Inflammation of the gall bladder ,acute cholecystitis ,chronic cholecystitis ,acute on chronic cholecystitis
• obstructive jaundice due to impaction of a stone at the lower end of the common bile duct : secondary biliary cirrhosis may result .
• ascending cholengitis
• empyema of the gall bladder.
• mucocele
• gall stone ileus __ a fistula occurs between the gall bladder and duodenum ,and a large stone enters the small bowel ,causing obstruction .usually at the terminal ileum .
• pancreatitis ,usually associated with multiple small stones .
• carcinoma of gall bladder .
• perforation of the gall bladder .
  

Medicines titled chenodeoxycholic acids (CDCA) or ursodeoxycholic acid (UDCA, ursodiol) may be given in preventive form to dissolve cholesterin gallstones. However, they may take 2 eld or longer to work, and the stones may return after communication ends.

Rarely, chemicals are passed into the gallbladder finished a catheter. The chemical apace dissolves cholesterin stones. This communication is not used rattling often, because it is difficult to perform, the chemicals can be toxic, and the gallstones may return.

Cholecystectomy (gallbladder removal) has a 99% chance of eliminating the recurrence of cholelithiasis. Only symptomatic patients staleness be indicated to surgery. The lack of a gall bladder does not seem to have any perverse consequences in some people. However, there is a momentous assets of the population — between 5 and 40% — who amend a information called postcholecystectomy syndrome which haw drive gastrointestinal painfulness and persistent discompose in the upper right abdomen. In addition, as some as 20% of patients amend chronic diarrhea.

Electrohydraulic damper wave lithotripsy (ESWL) of the gallbladder has also been utilised for selected patients who cannot have surgery. Because gallstones often become backwards in many patients, this treatment is not utilised very often any more.

Test for appendicitis -Pinch-an-inch test

PINCH-AN-INCH TEST FOR APPENDICITIS

Its a prospective comparative assesment of two physical exam technique for evaluating patients with doubtable appendicitis.Rebound tenderness is a widely acclimated assay address for patients with doubtable appendicitis.but it can be absolutely uncomfortable.an another analysis for peritonitis is termed THE PINCH-AN-INCH TEST.

This address call two patients who presented with balmy belly affliction who subsequently were begin to accept appendicitis.In both patients classic peritoneal signs were absent but the compression an inch analysis was positive.the accomplished physicians bedside analytic assay remains the most critical component for rapidly anecdotic peritonitis.Although rebound tenderness is a broadly acclimated examination.It is afflictive and may be inaccurate.

To perform the pinch-an-inch test,a bend of belly derma over McBurney's point is grasped and animated abroad from the peritoneum.The derma is recoil back briskly against the peritoneum.If the patient has added affliction if the derma bend strikes the peritoneum, the analysis is absolute and peritonitis apparently is present.

As an added feature,if the affliction seems boundless just during the antecedent compression phase,the patient may accept a actual low affliction threshold,a factor that can be taken into account when deciding if the patient has a surgical abdomen.We anecdotally accept begin the analysis to be appreciably accessible for the appraisal of appendicitis.

Delayed analysis of acute appendicitis can advance to cogent morbidity.However recent technological advances in radiological imaging, the alert analysis of acute appendicitis can be difficult.Indeed,some experts accept that overreliance on imaging at the amount of the bedside assay may in fact access appendicitis accompanying morbitity.Arguably,both of these patients ability accept been bigger served by undergoing surgery directly without the delay of of CT imaging.Therefore analysis efforts should be directed against developing and acceptance bigger bedside assesment of peritonitis.

One important admonition to clinicians is the actuality that patients with appendicitis may in fact accept hyperesthesia over McBurney's point,and an boundless affliction acknowledgment to he compression appearance should not be absolved out of the hand.

The technique potencially allows for a added objective and reproducible physical assay than rebound tenderness which requires the examiners abjure his easily rapidly abundant to break advanced of the accustomed natural recoil of the belly wall.Rebound tenderness as well requires that the physicians does not added abase his easily in a form of backswing.Pinch an inch in contrasr allows for a added accelerated and reproducible absolution of tension.

In an accomplishment to advance patient's abundance during the belly assay we developed an alternating address for detecting peritonitis.we appellation this pinch-an-inch,we accept that compression an inch after-effects in less affliction than rebound tenderness.while not compromising effectiveness.

We achievement that our pinch-an-inch assay address may eventually action a added adequate and authentic another to classic rebound tenderness.Toward this effort,we will conduct a -to-be abstraction to appraise its accurateness and about abundance in diagnosing appendicitis.
several studies have shown it to be quite accurate in the evaluation of the appendicitis so its use should not be stoped.

Intestinal pain - Acute intussusception if you avoid can lead to death

What Could Happen If You Avoid The TREATMENT ?

IT Will Get So Extreme.........Lead To DEATH

ACUTE INTUSSUSCEPTION :

INTUSSUSCEPTION is an invagination of size of intestine ( intussuscepiens ) into the immediate portion of bowl ( intussusceptum ) and  most of cases occur in children during the first 5 decades of life. This can often result in an obstructio .The part that prolapse into the other is called the INTUSSUSCEPTUM and the part that recieves it is called INTUSSUSCEPIENS.

In some of children with intussuscetion , an anatomic predisposing condition . Such as Meckle's diverticulum , Burkitt lymphoma, or hamartomatous polyps ,can be found .And in most of the cases are associated with hyperplastic lymphoid tissue.suggesting an infectious causes ,which is not confirmed in most of the cases.By using serology and virus isolation from fecal and pharyngeal swabs.Adeno virus , Rotavirus ,Enterovirus , Human herpes virus  ,Cytomegalovirus and Epstien-barr-virus.some bacterial agents can also involved in this condition include Yersinia ,enterocolitis and salmonella typhimurium and candida albican .

TYPES

Ileocolic  ( 77 % ) 

Ileoileocolic ( 12 % ) 

Ileoileal (5 % ) 

Colocolic ( 2 % ) 

Multiple (! % ) 

Retrograde ( 0.2 % )

Others  ( 2.8 % ) .

CLINICAL FEATURES :

SYMPTOMS

• Sudden paroxymsm of abdominal pain ,with drawing up of legs and screaming  :each attack lasts a few minutes and recur about every 15 minutes.
• Facial pallor 
• Vomiting
• Listleness and somewhat drawn between the attacks .
• Stool : intially normal later  blood and mucus are evacuated called  "red currant jelly stool " 
• when not relieved upto 24-36 hours

        a . Pain becomes contineous

          b. Abdomen distends

          c. Vomiting becomes copious

          d. Absolute intestinal obstruction follows

SIGNS

• A lump is felt ,which may harden on palpation .
• PR examination : if intussuscetion has travelled far enough ,its apex ( a conical ) mass will be felt .
• When not relieved ,upto 24 - 36 hours  

         a . Dehydration

         b . Abdominal distension

         c . Abdominal guarding , tenderness and rebound tenderness if gangrene has occured.

DIAGNOSTIC INVESTIGATIONS :

INTUSSUSCEPTION is often suspected based on history and physical examination , including observation of Dance's sign .Per rectal examination is particularly helpful in children as part of thintussusceptum may be felt by the finger .A definite  diagnosis often requires confirmation by diagnostis imaging modalities .

ULTRASOUND is today considered the imaging advanced technology of choice for diagnosis and exclusion of intussusception due to its high accuracy and lack of radiation.A target like mass ,usually around 3 cm in diameter confirm the diagnosis.

PLAIN ABDOMINAL X-RAY
Revealed increased gas shadow in small intestine and at times absence of cecal gas shadow .

X-RAY WITH BARIUM ENEMA :
Reveal characteristic " claw sign " in ileocolic intussusception .

TREATMENT :

The condition is not usually immediately life threatning.The intussusception can be treated with either a barium or water soluble contrast enema or an air contrast enema .which both confirms the diagnosis of intussusception, and inmost cases successfully reduce it . The success rate is over 80% .Therefore approximately 5 - 10 % of these recur within 24 hours .If it cannot be reduced by an enema or if the intestine is damaged , then surgical reduction is necessary.

PRELIMINARY TREATMENT 


Gastric aspiration should be carried out and contiued during and after operation.
Give IV dextrose - saline solution.

REDUCTION OF INTUSSUSCEPTION
REDUCTION BY HYDROSTATIC PRESSURE


OPERATIVE REDUCTION :


Abdomen is opened through a right lower paramedian incision .First part of reduction is accomplished by squeezing lower part of sausag like mass ,and little intussusception is reduced.Last part is most difficult to reduce and should br withdrawn and gently compressed in a warm saline soaked pack,to

lessen the edema.
After reduction if a specific cause is revealed appropriate treatment is carried out ,eg Meckle's diverticulum.

PROGNOSIS :

The outlook for intussusception is excellent .when treated immediately .but when untreated it can lead to death within 2-5 days .Quick treatment can avoid this surgery .Prolonged intussusception can lead to ischemia and necrosis and it requires surgical resection.

AFTER TREATMENT


Gastric aspiration should be continued for 12-24 hours
Dextrose-saline is given IV or SC with hyaluronidase.
On 2nd day ,gastric tube is removed and sips of water are given.
Few hours later ,feeding is commenced with mother's milk ( if infant is still being breast-fed ).

COMPLICATIONS:

Intestinal obstruction
Gangrene

Biliary stricture

IT CAN OCCUR AS A RESULT OF A TECHNICAL MISHAP......

DURING CHOLECYSTECTOMY IF IGNORED CAN DRIVE  LIFE- THREATENING COMPLICATIONS

STRICTURE OF BILE DUCT 
  

A bile duct stricture is caused by narrowing of the bile duct. The narrowing bile duct prevents the bile from draining into the intestine. The bile then backs up in the liver and spills over into the blood feat obstructive jaundice  ,it crapper cause through Surgical trauma ( postoperative ) ,Stones ,Primary sclerosing cholangitis ,Carcinoma of bile funiculus Carcinoma of head of pancreas.

Bile duct pathology (biliary stricture) is an uncommon but hard clinical condition that requires a integrated multidisciplinary approach involving gastroenterologists, radiologists, and surgical specialists. Unfortunately, most benign bile duct strictures (biliary strictures) are iatrogenic, resulting from operative trauma , Bile duct strictures (biliary strictures) may be well but, if ignored, can drive life-threatening complications, such as ascending cholangitis,  liver abscess, and secondary biliary cirrhosis

POSTOPERATIVE STRICTURE it is the result of a preventable non achievement in technique , during the performance of cholecystectomy ;Blind plunge application of a hemostat to a bleeding cystic or accessory cystic artery ,or to right hepatic artery.Should cholecystectomy be performed by dissecting from fundus ,too such traction applied to freed gall sac may so tent the bile funiculus that some forceps witting for cystic funiculus apprehension angulated main channel .Failure to identify anatomy in Calot's polygon when there is such inflammation .Common hepatic funiculus is tied instead of cystic duct.Ignorance of anatomical anomalies o bile ducts.Laceration of bile patch explration for stones.Injury to bile funiculus during partial gastrectomy.

CLINICAL PRESENTATION OF POSTOPERATIVE STRICTURE

Bile funiculus injuries may be rcognized at the instance of surgery .

Postoperatively by profuse and persistent discharge of bile if evacuation has been provided.Bile peritonitis if evacuation

has not been provided.Deepening obstructive jaundice.

In the absence of symptoms of the primary disease, most patients with bile funiculus strictures (biliary strictures) rest asymptomatic until the lumen of the bile funiculus is sufficiently narrowed to drive position to the flow of bile. Occasionally, patients may hit intermittent episodes of right upper line pain (biliary colic), with or without laboratory features of biliary obstruction. Patients most often inform with features of obstructive jaundice. On occasion, a patient may inform dramatically with sepsis and hypotension due to ascending cholangitis.

Cholangitis occurs in the proximity of partial or complete obstruction of the common bile funiculus , with accumulated intraluminal pressures, bacterial infection of the bile with procreation of the organisms within the duct, and seeding of the bloodstream with bacteria or endotoxin. Cholangitis can apace embellish a life-threatening condition. Clinical show varies, with the Charcot set of fever and chills, jaundice, and right upper line abdominal pain occurring in most patients. A smaller proportion of those with cholangitis may also hit altered mental position and hypotension (ie, Reynold pentad). In the epilepsy of previous instrumentation, cholangitis is uncommon with malignant strictures.

Tests that shows stricture in the bile duct: ERCP (endoscopic retrograde cholangiopancreatography) , PTC (percutaneous transhepatic cholangiogram)  ,MRCP (magnetic kinship cholangiopancreatography)

Blood tests that indicate deviant function of biliary system:

Bilirubin level is higher than normal
ALP (alkaline phosphatase) is higher than normal

TREATMENT 

PREOPERATIVE TREATMENT temporary external biliary drainage ,by passing a cather percutaneously into an intrahepatic duct ,or by passing a cather through stricture at ERCP and left to drain through mouth.

OPERATIONS

Roux-en-Y choledochojejunostomy

Cholecystojejunostomy

Choledochoduodenostomy

Insertion of a stent  

COMPLICATIONS 

Recurrent inflammation of the biliary duct and stricture can occur in whatever patients. Patients are at risk for infection developing above the stricture. Long-standing strictures can advance to cirrhosis.

Complications of bile duct strictures (biliary strictures) include development of stones in the gallbladder and bile ducts proximal to the stricture, pyogenic liver abscess due to recurrent episodes of ascending cholangitis, secondary biliary cirrhosis, and weight loss and malnutrition from steatorrhea with fat-soluble vitamin deficiency.