Bowel obstruction

Bowel obstruction
Classification & external resources
ICD-10K56.
ICD-9560
DiseasesDB15838
MedlinePlus000260
Bowel obstruction is a mechanical or functional obstruction of the intestines, preventing the normal transit of the products of digestion. It can occur at any level distal to the duodenum of the small intestine and is a medical emergency. Although many cases are not treated surgically, it is a surgical problem.

Causes

Small bowel obstruction

Causes of small bowel obstruction include:

Large bowel obstruction

Causes of large bowel obstruction include:

Differential diagnosis

Differential diagnoses of bowel obstruction include:

Signs, symptoms and causes

Depending on the level of obstruction, bowel obstruction can present with abdominal pain, abdominal distension, vomiting, fecal vomiting, and constipation.

Obstruction may be due to causes within the bowel lumen, within the wall of the bowel, or external to the bowel (such as compression, entrapment or volvulus).

Bowel obstruction may be complicated by dehydration and electrolyte abnormalities due to vomiting; respiratory compromise from pressure on the diaphragm by a distended abdomen, or aspiration of vomitus; bowel ischaemia or perforation from prolonged distension or pressure from a foreign body.

In small bowel obstruction the pain tends to be colicky (cramping and intermittent) in nature, with spasms lasting a few minutes. The pain tends to be central and mid-abdominal. Vomiting occurs before constipation.

In large bowel obstruction the pain is felt lower in the abdomen and the spasms last longer. Constipation occurs earlier and vomiting may be less prominent. Proximal obstruction of the large bowel may present as small bowel obstruction.

Diagnosis

The main diagnostic tools are blood tests, X-rays of the abdomen, CT scanning and/or ultrasound. If a mass is identified, biopsy may determine the nature of the mass.

Radiological signs of bowel obstruction include bowel distension and the presence of multiple (more than six) gas-fluid levels on supine and erect abdominal radiographs.

Contrast enema or small bowel series or CT scan can be used to define the level of obstruction, whether the obstruction is partial or complete, and to help define the cause of the obstruction.

According to a meta-analysis of prospective studies by the Cochrane Collaboration, the appearance of water-soluble contrast in the cecum on an abdominal radiograph within 24 hours of oral administration predicts resolution of an adhesive small bowel obstruction with a pooled sensitivity of 96% and specificity of 96%. PMID 15674958

Colonoscopy, small bowel investigation with ingested camera or push endoscopy, and laparoscopy are other diagnostic options.

Treatment

Some causes of bowel obstruction may resolve spontaneously; many require operative treatment.

In adults, frequently the need for surgical intervention and the treatment of the causative lesion is required. In malignant large bowel obstruction, endoscopically placed self-expanding metal stents may be used to temporarily relieve the obstruction as a bridge to surgery, or as palliation.

Small bowel obstruction

In the management of small bowel obstructions it is often said that "[n]ever let the sun. rise or set on small-bowel obstruction"[1] because they are not infrequently fatal if treatment is delayed.

Treatment for a small bowel obstruction is both non-surgical (conservative) and surgical.

Conservative treatment involves insertion of a nasogastric tube, correction of dehydration and electrolyte abnormalities. Opioid pain relievers may be used for patients with severe pain. Antiemetics may be administered if the patient is vomiting. Adhesive obstructions often settle without surgery. If obstruction is complete a surgery is required.

Small bowel obstruction caused by Crohn's disease, peritoneal carcinomatosis, sclerosing peritonitis, radiation enteritis and postpartum bowel obstruction are typically treated conservatively, i.e. without surgery. Conversely, a small bowel obstruction in a "virgin abdomen" (an abdomen that has not seen an operation) is almost never treated conservatively.

Bowel obstruction in children

Fetal and neonatal bowel obstructions are often caused by an intestinal atresia where there is a narrowing or absence of a part of the intestine. These atresias are often discovered before birth via a sonogram and treated with using laparotomy after birth. If the area affected is small then the surgeon may be able to remove the damaged portion and join the intestine back together. In instantances where the narrowing is longer, or the area is damaged and cannot be used for a period of time, a temporary stoma may be placed.

References

1. ^ Maglinte DD, Kelvin FM, Rowe MG, Bender GN, Rouch DM (2001). "Small-bowel obstruction: optimizing radiologic investigation and nonsurgical management". Radiology 218 (1): 39-46. PMID 11152777. [radiology.rsnajnls.org/cgi/reprint/218/1/39.pdf Free Full Text]. Accessed on: July 19, 2007.

See also

External links



The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD
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List of ICD-10 codes. The version for 2007 is available online at [1]

Chapter Blocks Title
I Certain infectious and parasitic diseases
II Neoplasms
III Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism
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The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD
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The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. These codes are in the public domain.

See also


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The Diseases Database is a free website that provides information about the relationships between medical conditions, symptoms, and medications.

It directly integrates the Unified Medical Language System.

External links

  • Diseases Database

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MedlinePlus is a website containing health information from the world's largest medical library, the United States National Library of Medicine. The site is intended to be used by health care providers and patients, and designed to provide up-to-date, authoritative information.
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Medical Emergency is an Australian reality television series screened on the Seven Network. Medical Emergency is narrated by actor Chris Gabardi who also appears in drama series All Saints.
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surgery (from the Greek χειρουργική meaning "hand work") is the medical specialty that treats diseases or injuries by operative manual and instrumental treatment.
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In biology the small intestine is the part of the gastrointestinal tract (gut) between the stomach and the large intestine and includes the duodenum, jejunum, and ileum. It is where the vast majority of digestion takes place.
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Adhesions are abnormal bands of tissue that grow in the human body. They may be thought of as internal scar tissue. In the case of frozen shoulder (also known as adhesive capsulitis) adhesions grow between the shoulder joint surfaces, restricting motion.
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Hernia
Classification & external resources

ICD-10 K40-K46
ICD-9 550 - 553

MedlinePlus 000960
eMedicine emerg/251   ped/2559

A hernia
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Crohn's disease
Classification & external resources

The three most common sites of intestinal involvement in Crohn's disease are ileal, ileocolic and colonic.[]
ICD-10 K 50.
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Neoplasia (new growth in Greek) is abnormal and purposeless proliferation of cells in a tissue or organ. A neoplastic growth is called a neoplasm. Most neoplasms proliferate to form distinct masses, or tumors
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Intussusception
Classification & external resources

ICD-10 K 38.8 , K 56.1
ICD-9 543.9 , 560.0

OMIM 147710
DiseasesDB 6913
MedlinePlus 000958
eMedicine emerg/385   An intussusception
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Volvulus
Classification & external resources

ICD-10 K56.2
ICD-9 537.3 , 560.2

A volvulus is a loop of the bowel whose nose has twisted on itself.
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In medicine, ischemia (Greek ισχαιμία, isch- is restriction, hema or haema is blood) is a restriction in blood supply
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Effects of foreign body entering through natural orifice
Classification & external resources

ICD-10 T 15. -T 19.
ICD-9 930 - 939

In physiology, a foreign body (Latin: corpus alienum) is any object originating outside the body.
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Gallstone
Classification & external resources

gallstones
ICD-10 K 80.
ICD-9 574

OMIM 600803
DiseasesDB 2533
MedlinePlus 000273
eMedicine emerg/97   In medicine, gallstones
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Ileus, formerly called iliac passion, refers to limited or absent intestinal passage.

Types

Mechanical ileus

Main article: Bowel obstruction

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Intestinal atresia is a malformation where the there is a narrowing or absence of a portion of the intestine. This defect can either occur in the small or large intestine.

Types of intestinal atresia


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Carcinoid
Classification & external resources

Picture of a carcinoid tumour that encroaches into lumen of the small bowel (centre of image). Pathology specimen. The prominent folds are plicae circulares, a characteristic of small bowel.
ICD-10 E 34.
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colon is another name for the large intestine. The main function of the colon appears to be extraction of water from feces. In mammals, it consists of the ascending colon, transverse colon, the descending colon, and the sigmoid colon.
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Neoplasia (new growth in Greek) is abnormal and purposeless proliferation of cells in a tissue or organ. A neoplastic growth is called a neoplasm. Most neoplasms proliferate to form distinct masses, or tumors
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Hernia
Classification & external resources

ICD-10 K40-K46
ICD-9 550 - 553

MedlinePlus 000960
eMedicine emerg/251   ped/2559

A hernia
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MeSH D015212
IBD redirects here. For the national newspaper, see Investor's Business Daily. For bike shops, see Independent bicycle dealer.
In medicine, inflammatory bowel disease (IBD
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Volvulus
Classification & external resources

ICD-10 K56.2
ICD-9 537.3 , 560.2

A volvulus is a loop of the bowel whose nose has twisted on itself.
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Constipation
Classification & external resources

ICD-10 K 59.0
ICD-9 564.0

DiseasesDB 3080
MedlinePlus 003125
eMedicine med/2833   Constipation or irregularity
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Intestinal atresia is a malformation where the there is a narrowing or absence of a portion of the intestine. This defect can either occur in the small or large intestine.

Types of intestinal atresia


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In medicine, differential diagnosis (sometimes abbreviated DDx or ΔΔ) is the systematic method physicians use to identify the disease causing a patient's symptoms.

Before a medical condition can be treated, it must be identified.
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Ileus, formerly called iliac passion, refers to limited or absent intestinal passage.

Types

Mechanical ileus

Main article: Bowel obstruction

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