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Acute abdomen

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DefinitionFailure of intestinal contents to

move through the bowel lumen .

most common site is small

intestine

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Types;

Mechanical

functional /Paralytic/ a

dynamic

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Causes of mechanical obstruction;

Adhesions;the most common cause of small

bowel obstruction.

Intussusceptions;

One part of the intestine slips into

another part located below it.

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Intussusceptions

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Volvulus

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Strangulation hernia

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Tumor;

-a tumor that exists within the

wall of the intestine or a tumor

outside the intestine causespressure on the wall of the

intestine.

Impaction of stool

Foreign bodies;

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paralytic/Funct ionalobst ruct ion:

Failure ofperistalsis

to move intestinalcontents: due to neurologic or

muscular impairment.

in which The intestinal muscles

cannot propel(push) the contents

along the bowel.

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Causes;

Abdominal surgery and trauma.Spinal injuries

PeritonitisVascular insufficiency

muscular dystrophy,

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Intestinal obstruction

can be:partial

complete/ acute

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Most bowel obstructions occur

in the small intestine.About 15% of intestinal

obstructions occur in the largebowel; most of these are found

in the sigmoidcolon.

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Pathophysiology

Intestinal contents, fluid, and gas

accumulateabovethe obstruction.Resulting in abdominal distention and

retention of fluid.

With increasing distention, pressurewithin the lumen increases, causingadecreasein venous and arteriolar

capillary pressure.This causesedema, congestion,

necrosis, and perforation of the

intestinal wall.

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Complications

Hypovolemia and hypovolemic

shock can result in multiple organdysfunction.

Strangulated bowel can result

in;-Perforation peritonitis septicshock

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ClinicalManifestat ions:-

depend on level & type of

obstruction.The patient initially complains of

wavelikeabdominalpain

abdominal distention.

vomiting.

The patient may pass blood andmucus, but no fecal no f latus.

Signs of dehydration

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in complete obstruction ,peristaltic waves reverse,propelling the intestinal contents

toward the mouth, leading tofecalvomiting.

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Peristaltic waves may be visible in a

thin person. In mechanical obstructions, high-

pitched, bowel sounds are heard

proximalto the obstruction and areabsent distalto it.

If the obstruction is nonmechanical,

there is an absence of bowel sounds.

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Assessment and Diagnos t ic Find ings;

Diagnosis is based on the history.

Physical examination

x-ray; show abnormal quantities

of gas, fluid, or both in the bowel.

Laboratory studies (ie, electrolyte

studies).

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In most cases the patient is keptNPO.

NGtube to decompressed , which

relieves symptoms and may resolvethe obstruction.

I.V solution with electrolytes is

initiated to correct the fluid andelectrolyte imbalance.

Sometimes IV antibiotics are begun.

MedicalTreatment

Surgical treatment;

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Surgicaltreatment;

Required in Complete mechanical

obstruction. Preoperativecare;

1.Insertion of NG tube to relieve

vomiting, abdominal distention, and toprevent aspiration of intestinalcontents.

2.Restore fluid and electrolyte balance;correct acid and alkaline imbalances.

.

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3.Laparotomy: inspection of

intestine and removal of infractedor gangrenous tissue.

4.Removal of cause of obstruction,

gangrenous portion of intestinesand anastomosisor creation ofcolostomydepending on

individual case

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Nurs ing Process ASSESSMENT.

Assess pain

assessment of Abdomen byauscultationof bowel for 5 minutes .Palpationfor distention, firmness,and tenderness.

assess the vomiting .

Assess S/S of dehydration.

Vital signs are assessed.

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IMPL;NGT is maintained on lowintermittent suction to relievediscomfort from distention.

NPO to rest the bowel

The patient is placed in semi-Fowlersposition to reduce tension on the

abdomen. pain killers as ordered.

Opioidsare given cautiously because

they may mask symptoms ofperforation and decrease intestinalmotility.

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deficient fluid volume R/T collection of

fluid in the intestine and vomiting.

Goal; prevention of dehydration and

electrolyte imbalance.

IMPL;- assess fluid status

Ineffective Breathing Pattern R/T

abdominal distention.

Knowledge deficit about disease,

surgery

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G

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Goo y