Chapter VI PATHOPHYSIOLOGY

A. LARGE INTESTINAL OBSTRUCTION (IDEAL)

Intestinal obstruction exists when blockage prevents the normal flow of intestinal contents through the intestinal tract. Three types of processes can impede this flow:

Mechanical obstruction: an intraluminal obstruction or a mural obstruction from pressure on the abdominal wall. The lumen of the bowel is blocked due to incarceration, strangulation, neoplasm or volvulus, intussusceptions, polpypoid tumors, stenosis,strictures, adhesions, hernias, and abscesses. Crampy abdominal pain is typical; inability to pass stools is always noted. Vomiting is usually present. The abdomen is distended with hyperactive peristalsis.

Functional obstruction: the intestinal musculature cannot propel the contents along the bowel. Examples are amyloidosis, muscular dystrophy, endocrine disorders such as DM, or neurologic disorders. The blockage can be temporary and the result of manipulation of the bowel during surgery. Paralytic

ileus, obstruction is due to inhibition of intestinal motility: Vomiting

and intractable constipation are common symptoms. Peristalsis is markedly diminished or absent. The abdomen is distended and may or may not be tender. Vascular obstruction: The most common causes are mesenteric artery occlusion and mesenteric vein thrombosis. Patients are usually elderly. There is sudden onset of severe abdominal pain, vomiting, diarrhea, blood in stools and shock. The abdomen is tender, peristalsis diminished or absent. The obstruction can be partial or complete. Its severity depends on the region of bowel affected, the degree to which lumen is obstructed and especially the degree to which the vascular supply to the bowel wall is disturbed.

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Predisposing factors: Old age History of: Abdominal surgery Crohns disease Hernia Cancer/ tumors Mesentric artery ischemia Gallstones Kidney disease Metabolic diseases

Precipitating factors: Adverse effects of medications Low fiber, high fat and protein diet obesity

Blockage in the large intestine

Fecal vomiti ng Blood in stool vomiting

constipati on Lower abdominal crapms

Accumulation of intestinal contents, fluid, and gas proximal to the obstruction. Bowel distention

Feeling of fullness

Loss of appetite
weakn ess

Weight loss

Secretory and absorptive functions of the mucosa are depressed

dehydrat ion

Venous obstruction & arterial oclussion infarction

edema

Gangrene & perforation Fecal soilage of the peritoneal cavity

Increased mucosal permeability of the bowel Bacterial translocation Systemic infection

Electrolyte abnormalitie s

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B. LARGE INTESTINAL OBSTRUCTION (ACTUAL)

The patient is 84 years old with a one year background of abdominal pain. She experienced difficulty and inability to defecate. She showed signs and symptoms of the intestinal obstruction such as abdominal pain, abdominal distention, blood in stool, and vomiting. Lower abdominal cramps unproductive of feces occur. The cause of obstruction is due to the tumor present in the patients colon.
Predisposing factors: Old age Tumor History of: Abdomina l pain

Precipitating factors: Identified none

Blockage in the large intestine

Bloo d in stool vomitin g

constipat ion

Accumulation of intestinal contents, fluid, and gas proximal to the obstruction.

Feeling of fullness Loss of appetite weakne ss

Weight loss

Bowel distention
Lower abdominal crapms Inabilit y to defeca te

Secretory and absorptive functions of the mucosa are depressed

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dehydrati onon