Case Study for Abdominal Obstruction

Topics: Digestion, Digestive system, Liver Pages: 31 (9740 words) Published: December 5, 2012

A) Background of the Study
B) Rationale for choosing the case
C) Significance of the study
D) Scope and Limitation
A) Biographic Data
B) Chief Complaint
C) History of Present Illness
D) Past Medical History
E) Family History
F) Physical Assessment
A) Anaphysiology
B) Pathophysiology
C) Drug Study
D) Diagnostic and Laboratory Exam
A) Long Term Objective
B) Problem List
C) Nursing Care Plan
D) Course in the Ward
E) Discharged Planning

Intestinal obstruction exists when blockage prevents the normal flow of intestinal tract. The obstruction can be partial or complete. Its severity depends on the region of bowel affected, the degree to which the lumen is occluded, and especially the degree which the vascular supply to the bowel wall is disturbed. Most bowel obstructions occur in the small intestine. Adhesions are the most common cause of small bowel obstruction, followed by hernias and neoplasms. Intestinal contents, fluids and gas accumulate above the intestinal obstruction. The abdominal distention and retention of fluid reduce the absorption of fluids and stimulate more gastric secretion. With increasing distention, pressure within the intestinal lumen increases, causing a decrease in venous and arteriolar capillary pressure. This causes eventual rupture or perforation of the intestinal wall. Reflux vomiting may be caused by abdominal distention. Vomiting results in loss of hydrogen ions and potassium from the stomach, leading to reduction of chlorides and potassium in the blood and to metabolic alkalosis. Dehydration and acidosis develop from loss of water and sodium. With acute fluid losses, hypovolemic shock may occur. The initial symptom is usually crampy pain that is wavelike and colicky. The patient may pass blood and mucus but no fecal matter and no flatus. Vomiting occurs. If the obstruction is complete, the peristaltic waves initially become extremely vigorous and eventually assume a reverse direction, with the intestinal contents propelled toward the mouth instead of toward the rectum. The signs of dehydration become evident: intense thirst, drowsiness, generalized malaise, aching and a parched tongue and mucous membranes, the abdomen becomes distended. The lower the obstruction is in the GI tract, the more marked the abdominal distention. If the obstruction continues uncorrected, hypovolemic shock occurs from dehydration and loss of plasma volume.

Diagnosis is based on the symptoms described previously and on imaging studies. Abdominal x-ray and CT findings include abnormal quantities of gas, fluid, or both in the intestines. Laboratory studies (ie, electrolyte studies and a complete blood cell count) reveal a picture of dehydration, loss of plasma volume, and possible infection.

Decompression of the bowel through a nasogastric tube is successful in most cases. When the bowel is completely obstructed, the possibility of strangulation warrants surgical intervention. Before surgery, IV therapy is necessary to replace the depleted water, sodium, chloride, and potassium.

The surgical treatment of intestinal obstruction depends largely on the cause of the obstruction. In the most common causes of obstruction, such as hernia and adhesions, the surgical procedure involves repairing the hernia or dividing the adhesion to which the intestine is attached. In some instances, the portion of affected bowel may be removed and an anastomosis performed. The complexity of the surgical procedure for intestinal obstruction depends on the duration of the obstruction and the condition of the intestines.

Medical-Surgical Textbook – Brunner’s and Suddarth’s The following are statistics from various sources...
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