Obstructions

Obstructions

Definition/Etiology:

A big “something” that blocks material from passing into the gut

• Post -surgical adhesions are a very common cause
• Cancers
• Hernia
• Ingestions of foreign body
• Constipation

Pathophysiology:

• Job of the gut is to absorb water and vitamins.
• Long tube from the mouth to the butt.
• Obstruction causes dilation of the bowel before the area of obstruction and possible bowel collapse post obstruction.
• Your body attempts to decompress by getting rid of the material prior to the obstruction. Closest exit with the path of least resistance = your mouth (vomiting)

Clinical Presentation:

Nausea/Vomiting

• Stomach contents, bile, fecal material

Distention

• Tenderness upon palpation
• Absence of flatus/stool

Abdominal Pain

• Crampy and “wavelike”
  Can feel better after vomiting

High pitched or absent bowel sounds

• High pitched before the obstruction/absent after the site of the obstruction

Collaborative Management:

Diagnostics-

• Labs
  • CBC
  • BMP
    • May see an elevated BUN secondary to dehydration and lack or oral intake

• Imaging
  • Abdominal x-ray
    • Dilated small bowel loops
  • Abdominal CT

Interventions-

• NG tube
  • Bowel decompression
• IV Therapy
  • Analgesic
  • Antiemetics
  • Fluid to treat and prevent further dehydration

Management-

• Surgical consultation

Evaluation | Patient Monitoring | Education:

Hemodynamic monitoring

• Address and treat possible shock

Pain Management

• Analgesia

Monitor for Bowel movements and NG output

Linchpins: (Key Points)

• Absence of bowel movements are a key sign
• Abd pain that may be temporarily relieved after an episode of emesis
• No farts = good indication that there is a complete blockage not even allowing gas to pass
• Hx of abdominal surgeries or previous obstructions puts these patients at high risk.
• Patients are unable to absorb so make sure you are supplementing with IV hydration.