Clinical features of intestinal obstruction
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Transcript of Clinical features of intestinal obstruction
CLINICAL FEATURES OF INTESTINAL OBSTRUCTION
Dynamic obstruction
• Pain
• Vomiting
• Distension
• Constipation
• Other manifestations
Pain
• 1st symptom, usually sudden• Colicky nature• Centered on the umbilicus (small bowel) or
lower abdomen (large bowel)• Coincides with increased peristaltic activity• Severe pain indicates presence of
strangulation
Vomiting
• The more distal the obstruction ,the longer the
interval between the onset of symptoms and
the appearance of nausea and vomiting.
• As obstruction progresses the character of
vomitus alters from digested food to faeculent
material.
Distension
• Degree of distension dependent on site
• The more distal the lesion greater is the
distension
Constipation
• Absolute (neither faeces nor flatus is passed) cardinal feature of complete intestinal
obstruction• Relative (only flatus is passed)
Other manifestations
• Dehydration : in small bowel obstruction because of repeated vomiting
• Hypokalaemia • Pyrexia : onset of ischemia intestinal perforation associated inflammation hypothermia indicates septicaemic shock• Abdominal tenderness
Clinical features of strangulation
• Constant pain –pain never completely absent• Tenderness with rigidity –indicates early
laparotomy• Shock –indicates underlying ischaemia
Clinical features of intussusception
• Classical presentation –episodes of screaming and drawing up of legs in previously well male infant
• Vomiting –conspicuous and bile stained
• ‘Redcurrant jelly’ stool
• Lump which hardens on palpation in 60%• Feeling of emptiness in the right iliac fossa
(the sign of dance)• On rectal examination blood stained mucus
may be found on the finger• Unrelieved, progressive dehydration and
abdominal distension, followed by peritonitis secondary to gangrene.
• D/D : a/c gastroenteritis Henoch-Schoenlein purpura Rectal prolapse
Clinical features of volvulus
• Volvulus of the small intestine
• Caecal volvulus: usually a clockwise twist in 25% ,a palpable tympanic swelling in
midline or left side of abdomen
Sigmoid volvulus: large bowel obstruction abdominal distension vomiting absolute constipation