Materiały źródłowe

• #1 Intestinal Obstruction – Gastrointestinal Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/gastrointestinal-disorders/acute-abdomen-and-surgical-gastroenterology/intestinal-obstruction

  Intestinal obstruction is significant mechanical impairment or complete arrest of the passage of contents through the intestine due to pathology that causes blockage of the bowel. […] Mechanical obstruction is divided into obstruction of the small bowel (including the duodenum) and obstruction of the large bowel. Obstruction may be partial or complete. […] Overall, the most common causes of mechanical obstruction are adhesions, hernias, and tumors. […] In simple mechanical obstruction, blockage occurs without vascular compromise. Ingested fluid and food, digestive secretions, and gas accumulate above the obstruction. The proximal bowel distends, and the distal segment collapses. The normal secretory and absorptive functions of the mucosa are depressed, and the bowel wall becomes edematous and congested. Severe intestinal distention is self-perpetuating and progressive, intensifying the peristaltic and secretory derangements and increasing the risks of dehydration and progression to strangulating obstruction.

• #2 Small Bowel Obstruction – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK448079/

  Small bowel obstruction (SBO) is a common surgical emergency resulting from mechanical or functional disruption of intestinal transit. This condition is most frequently caused by postoperative adhesions, followed by hernias, tumors, or less common conditions like volvulus, gallstone ileus, or endometriosis. The pathophysiology includes bowel distension, impaired venous return, mucosal ischemia, bacterial translocation, and, in severe cases, necrosis, perforation, and peritonitis. Diagnosis involves clinical assessment and imaging, with computed tomography being the gold standard to identify the transition point, ischemia, or perforation. Initial management includes fluid resuscitation, electrolyte correction, and nasogastric decompression, with surgery indicated for strangulation, ischemia, or unresolved obstruction.

• #3 Bowel obstruction – Wikipedia

  https://en.wikipedia.org/wiki/Bowel_obstruction

  In large bowel obstruction, the pain is felt lower in the abdomen and the spasms last longer. Common symptoms include abdominal pain, distension, and severe constipation. Constipation occurs earlier and vomiting may be less prominent. Proximal obstruction of the large bowel may present as small bowel obstruction. […] The main diagnostic tools are blood tests, X-rays of the abdomen, CT scanning, and ultrasound. If a mass is identified, biopsy may determine the nature of the mass. Radiological signs of bowel obstruction include bowel distension (small bowel loops dilated 3 cm) and the presence of multiple (more than 2) air-fluid levels on supine and erect abdominal radiographs. […] Causes of small bowel obstruction include adhesions from previous abdominal surgery (most common cause), hernias containing bowel, Crohn’s disease causing adhesions or inflammatory strictures, neoplasms, intussusception, volvulus, and ischemic strictures. After abdominal surgery, the incidence of small bowel obstruction from any cause is 9%. In those where the cause of the obstruction was clear, adhesions are the single most common cause (more than half).

• #4 JCM | Special Issue : Intestinal Obstruction: Etiology and Pathophysiology, Clinical Presentation and Imaging, Diagnosis and Treatment

  https://www.mdpi.com/journal/jcm/special_issues/Intestinal_Obstruction

  Intestinal obstruction is among the most common surgical emergencies worldwide and is considered one of the most serious problems in surgery, with relatively high morbidity and mortality. In 80% of cases, it concerns the small intestine, and in 20%, the large intestine, and it can be incomplete or complete, acute or chronic, high or low. The clinical presentation varies depending on the etiology and level of the obstruction. Imaging studies are of great importance to establish the diagnosis, determine the cause, and guide treatment. Treatment can be either medical or surgical. Today, with the advancement of minimally invasive techniques, surgical treatment in addition to open surgery can be carried out laparoscopically and robotically, and there is great interest in implementing enhanced recovery protocols in the surgical management of these patients.

• #5 Intestinal obstruction and Ileus: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/000260.htm

  Intestinal obstruction is a partial or complete blockage of the bowel. The contents of the intestine cannot pass through it. […] Obstruction of the bowel may be due to: A mechanical cause, which means something is partially of fully blocking the bowel; Ileus, a condition in which the bowel does not work correctly, but there is no structural problem causing the obstruction. […] Paralytic ileus, also called pseudo-obstruction, is one of the major causes of intestinal obstruction in infants and children. […] Mechanical causes of intestinal obstruction may include: Adhesions or scar tissue that form after surgery; Foreign bodies (objects that are swallowed and block the intestines); Gallstones (rare); Hernias; Impacted stool; Intussusception (telescoping of one segment of bowel into another); Tumors blocking the intestines; Volvulus (twisted intestine); Inflammatory diseases such as Crohn disease.

• #6 Intestinal obstruction – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/intestinal-obstruction/symptoms-causes/syc-20351460

  Intestinal obstruction is a blockage that keeps food or liquid from passing through your small intestine or large intestine (colon). Causes of intestinal obstruction may include fibrous bands of tissue (adhesions) in the abdomen that form after surgery; hernias; colon cancer; certain medications; or strictures from an inflamed intestine caused by certain conditions, such as Crohn’s disease or diverticulitis. […] Without treatment, the blocked parts of the intestine can die, leading to serious problems. However, with prompt medical care, intestinal obstruction often can be successfully treated. […] The most common causes of intestinal obstruction in adults are: Intestinal adhesions bands of fibrous tissue in the abdominal cavity that can form after abdominal or pelvic surgery; Hernias portions of intestine that protrude into another part of your body; Colon cancer.

• #7 Small Bowel Obstruction – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK448079/

  SBO results from an interruption in the normal flow of intestinal contents due to a mechanical blockage or functional impairment. This disruption triggers a series of pathological processes affecting the bowel wall, vascular supply, and systemic physiology. These processes can escalate rapidly, especially in cases of strangulation or ischemia, underscoring the critical need for timely diagnosis and intervention. […] In mechanical SBO, a physical barrier obstructs the bowel lumen, creating a transition point where proximal bowel distention and distal bowel decompression occur. The obstructing lesion prevents the passage of intestinal contents, leading to increased intraluminal pressure proximal to the obstruction. This pressure gradient causes proximal bowel distention, which may induce vomiting as the bowel attempts to relieve pressure, and distal bowel decompression, which occurs along with inhibition of peristalsis distal to the obstruction, while proximal peristalsis temporarily increases to overcome the blockage.

• #8 Intestinal Obstruction – Gastrointestinal Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/gastrointestinal-disorders/acute-abdomen-and-surgical-gastroenterology/intestinal-obstruction

  Intestinal obstruction is significant mechanical impairment or complete arrest of the passage of contents through the intestine due to pathology that causes blockage of the bowel. […] Mechanical obstruction is divided into obstruction of the small bowel (including the duodenum) and obstruction of the large bowel. Obstruction may be partial or complete. […] Overall, the most common causes of mechanical obstruction are adhesions, hernias, and tumors. […] In simple mechanical obstruction, blockage occurs without vascular compromise. Ingested fluid and food, digestive secretions, and gas accumulate above the obstruction. The proximal bowel distends, and the distal segment collapses. The normal secretory and absorptive functions of the mucosa are depressed, and the bowel wall becomes edematous and congested. Severe intestinal distention is self-perpetuating and progressive, intensifying the peristaltic and secretory derangements and increasing the risks of dehydration and progression to strangulating obstruction.

• #9 Acute intestinal obstruction: Pathophysiology – Creative Med Doses

  https://creativemeddoses.com/topics-list/acute-intestinal-obstruction-pathophysiology/

  Acute intestinal obstruction occurs either mechanically from blockage or functionally from intestinal dysmotility when there is no blockage. […] Following are sequence of events in intestinal obstructions of all kinds. Closed loop obstruction tends to have faster deterioration and early strangulation and perforation. Strangulation means vascular insufficiency along with intestinal obstruction. […] Obstruction as soon as the intestinal obstruction occurs the distal segment of intestine collapses and proximal segment has increased intestinal contractility. This increased intestinal contractility along with accumulation of fluid and swallowed air leads to loud intestinal sound which are also called Borborygmi. […] Dilation of proximal segment – intestinal segment Proximal to obstruction has increased accumulation of intestinal content and swallowed air. With passing time, the intestinal content starts to ferment and amount of gas increases.

• #10 mechanical-bowel-obstruction-and-ileus-pathogenesis-and-clinical-findings | Calgary Guide

  https://calgaryguide.ucalgary.ca/mechanical-bowel-obstruction-and-ileus-pathogenesis-and-clinical-findings/mechanical-bowel-obstruction/

  Continued peristalsis proximal to obstruction continues to push GI contents against the obstruction […] If obstruction is proximal (closer to mouth), higher luminal pressure may force regurgitation of GI contents […] Bowel ischemia and infarction, tissue necrosis, possible perforation +/- bacterial invasion.

• #11 Intestinal Obstruction: Evaluation and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/0915/p362.html

  Acute intestinal obstruction occurs when the forward flow of intestinal contents is interrupted or impaired by a mechanical cause. It is most commonly induced by intra-abdominal adhesions, malignancy, and herniation. The pathologic effects of acute intestinal obstruction are fluid and electrolyte imbalances, and mechanical consequences of increased luminal pressure on intestinal perfusion. Fluid loss from emesis, bowel wall edema, and loss of absorptive capacity lead to dehydration. Emesis causes loss of gastric potassium, hydrogen, and chloride, which generates metabolic alkalosis. Significant dehydration stimulates renal proximal tubule reabsorption of bicarbonate and loss of chloride, which perpetuates metabolic alkalosis. In addition, stasis leads to overgrowth of intestinal flora, which may lead to bacterial translocation across the bowel wall, and formation of stool within the small intestine, referred to as fecalization. In a low-grade (incomplete) intestinal obstruction, some gas and/or fluid passes beyond the point of obstruction, whereas nothing passes beyond it in a high-grade (complete) SBO. Proximal to the point of obstruction, the intestinal tract dilates, filling with gastrointestinal secretions and swallowed air, and increasing luminal pressures. When intraluminal pressure exceeds venous pressures, loss of venous drainage exacerbates edema and congestion of the bowel. This may compromise arterial flow, causing ischemia, necrosis, and ultimately perforation. A closed-loop obstruction, in which a segment of bowel is obstructed proximally and distally, may undergo this process rapidly and is considered a surgical emergency. Intestinal volvulus, the prototypical closed-loop obstruction, causes torsion of arterial inflow and venous drainage, immediately compromising bowel viability.

• #12 Acute intestinal obstruction: Pathophysiology – Creative Med Doses

  https://creativemeddoses.com/topics-list/acute-intestinal-obstruction-pathophysiology/

  Emesis increase accumulation of fluid and obstruction leads to increased intraluminal pressure. Increased pressure leads to bilious vomiting and loss of Hydrogen, potassium, and chloride ion in vomitus. […] Compression of vessels increased intraluminal pressure in proximal segment leads to compression of venous and arterial circulation. […] Full thickness Ischemia obstruction in arterial circulation leads to full thickness ischemia of bowel wall. […] Bacterial growth – combination of stasis and ischemia leads to bacterial overgrowth. It caused severe inflammation, release of inflammatory mediators and increased Gas production. […] Necrosis and edema of intestinal wall – ischemia and inflammation leads to epithelial necrosis and edema of intestinal epithelium in proximal segment. […] Perforation necrosis can lead to perforation and leakage of intestinal content along with intestinal bacteria and inflammatory mediators in peritoneal cavity.

• #13 Small Bowel Obstruction – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK448079/

  Impaired venous flow and bowel wall edema occur as the proximal bowel distends, compromising venous outflow from the bowel wall, resulting in bowel wall edema and inflammation. These changes can exacerbate luminal narrowing and impair the oxygenation of the bowel tissue. […] Prolonged obstruction increases intraluminal pressure to a point where arterial blood flow is compromised. This results in ischemia, necrosis, and, if untreated, perforation. Perforation leads to peritonitis, which can progress to sepsis and death. […] In functional SBO, peristalsis fails due to metabolic disturbances, neural inhibition, or inflammation (paralytic ileus). While there is no mechanical barrier, the resulting pathophysiology is similar, with stasis leading to fluid sequestration, bowel distention, and bacterial overgrowth.

• #14 Intestinal Obstruction – Gastrointestinal Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/gastrointestinal-disorders/acute-abdomen-and-surgical-gastroenterology/intestinal-obstruction

  Strangulating obstruction is obstruction with compromised blood flow; it occurs in nearly 25% of patients with small-bowel obstruction. It is usually associated with hernia, volvulus, and intussusception. Strangulating obstruction can progress to infarction and gangrene in as little as 6 hours. […] The ischemic bowel becomes edematous and infarcts, leading to gangrene and perforation. […] Perforation may occur in an ischemic segment (typically small bowel) or when marked dilation occurs. The risk is high if the cecum is dilated to a diameter 13 cm. […] Prolonged obstruction can cause bowel ischemia, infarction, and perforation.

• #15 Small-Bowel Obstruction: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/774140-overview

  Strangulated SBOs are most commonly associated with adhesions and occur when a loop of distended bowel twists on its mesenteric pedicle. The arterial occlusion leads to bowel ischemia and necrosis. If left untreated, this progresses to perforation, peritonitis, and death. […] Bacteria in the gut proliferate proximal to the obstruction. Microvascular changes in the bowel wall allow translocation to the mesenteric lymph nodes. This is associated with an increase in the incidence of bacteremia due to Escherichia coli, but the clinical significance is unclear.

• #16 Acute intestinal obstruction: Pathophysiology – Creative Med Doses

  https://creativemeddoses.com/topics-list/acute-intestinal-obstruction-pathophysiology/

  Peritonitis the intestinal content, bacteria and inflammatory mediators causes peritoneal irritation and peritonitis. […] Shock – if immediate interventions are not started patients condition deteriorate exponentially leading to hemodynamic compromise, hypotension, oliguria, and tachycardia. […] Death intestinal obstruction cases with perforation and shock may die if not attended immediately.

• #17 Evaluation and Management of Intestinal Obstruction | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/0115/p159.html

  Ongoing dilation of the intestine increases luminal pressures. When luminal pressures exceed venous pressures, loss of venous drainage causes increasing edema and hyperemia of the bowel. This may eventually lead to compromised arterial flow to the bowel, causing ischemia, necrosis, and perforation. A closed-loop obstruction, in which a section of bowel is obstructed proximally and distally, may undergo this process rapidly, with few presenting symptoms. Intestinal volvulus, the prototypical closed-loop obstruction, causes torsion of arterial inflow and venous drainage, and is a surgical emergency.

• #18 Large Bowel Obstruction | Concise Medical Knowledge

  https://www.lecturio.com/concepts/large-bowel-obstruction/

  Bowel dilation results from accumulation of: […] intraluminal pressure compression of intramural vessels intestinal ischemia and/or perforation. […] Open-loop LBO (10%20%): Incompetent ileocecal valve allows reflux of contents into the ileum. […] Closed-loop LBO (80%90%): Competent ileocecal valve or volvulus results in proximal and distal occlusion. […] Risk of ischemia or perforation. […] Pathophysiology for specific etiologies: Mechanical: Malignancy: 70% at, or distal to, the transverse colon. […] Volvulus: Torsion of a colonic segment obstruction of the colonic lumen can result in vascular perfusion impairment. […] If untreated ischemia and perforation is a common complication. […] Strictures can result from recurrent inflammation. […] Functional obstruction (pseudo-obstruction): Exact mechanism is unknown. […] Impairment of parasympathetic fibers has been implicated. […] Risk of ischemia: Cecal diameter 1012 cm (3.94.7 in) […] Distention present for 6 days.

• #19 Bowel Obstruction – Causes – Management – TeachMeSurgery

  https://teachmesurgery.com/general/presentations/bowel-obstruction/

  The term bowel obstruction refers to a mechanical blockage of the bowel, whereby a structural pathology physically blocks the passage of intestinal contents. […] Once the bowel segment has become occluded, gross dilatation of the proximal limb of the bowel occurs. There becomes an increased peristalsis of the bowel, which in turn leads to secretion of large volumes of electrolyte-rich fluid into the bowel (often termed third spacing). Urgent fluid resuscitation and a careful fluid balance is required. […] A closed-loop obstruction is a surgical emergency as if not corrected, the bowel will continue to distend within a closed segment of bowel, stretching the bowel wall until it becomes ischaemic and this can further lead to perforation. […] The most common causes of bowel obstruction depend on location: Small bowel adhesions or hernia; Large bowel malignancy, diverticular disease, or volvulus. […] The complications of bowel obstruction include bowel ischaemia or bowel perforation leading to faecal peritonitis (high mortality). […] Patients in bowel obstruction can often be severely intravascularly fluid deplete, resulting in acute kidney injury and other end-organ injury if mismanaged.

• #20 Intestinal obstruction | PPT

  https://www.slideshare.net/syedubaid4/intestinal-obstruction-73556139

  STARANGULATED OBSTRUCTION: Strangulating obstruction is obstruction with compromised blood flow; it occurs in nearly 25% of patients with small-bowel obstruction. […] CLOSED LOOP OBSTRUCTION is a specific type of obstruction in which two points along the course of a bowel are obstructed at a single location thus forming a closed loop. […] Intussusception is a medical condition in which a part of the intestine has invaginated into another section of intestine. […] Volvulus can lead to gangrene and death of the involved segment of the gastrointestinal tract.

• #21 Intestinal obstruction – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/intestinal-obstruction/symptoms-causes/syc-20351460

  Other possible causes of intestinal obstruction include: Inflammatory bowel diseases, such as Crohn’s disease; Diverticulitis a condition in which small, bulging pouches (diverticula) in the digestive tract become inflamed or infected; Twisting of the colon (volvulus); Impacted feces. […] Intestinal pseudo-obstruction (paralytic ileus) can cause signs and symptoms of intestinal obstruction, but it doesn’t involve a physical blockage. In paralytic ileus, muscle or nerve problems disrupt the normal coordinated muscle contractions of the intestines, slowing or stopping the movement of food and fluid through the digestive system. […] Diseases and conditions that can increase your risk of intestinal obstruction include: Abdominal or pelvic surgery, which often causes adhesions a common intestinal obstruction; Crohn’s disease, which can cause the intestine’s walls to thicken, narrowing the passageway; Cancer in your abdomen.

• #22 Large-Bowel Obstruction: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/774045-overview

  The pathophysiology of acute colonic pseudo-obstruction (ACPO), or Ogilvie syndrome, is not clear, but it is thought to result from an autonomic imbalance, which results from decreased parasympathetic tone or excessive sympathetic output. This condition usually occurs in the setting of a wide range of medical or surgical illnesses. If it goes untreated, colonic ischemia or perforation can occur. ACPO is characterized by a loss of peristalsis and results in the accumulation of gas and fluid in the colon. The right colon and cecum are most commonly involved. The risk of perforation for ACPO ranges from 3% to 15%.

• #22 Large-Bowel Obstruction: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/774045-overview

  The prevalence of mechanical large-bowel obstruction (LBO) increases with age, as does that of its main causes, colon cancer and diverticulitis. Sigmoid volvulus and cecal volvulus are also potential causes of this disorder. […] Mechanical LBO causes bowel dilatation above the obstruction, which in turn, causes mucosal edema and impaired venous and arterial blood flow to the bowel. Bowel edema and ischemia increase the mucosal permeability of the bowel, which can lead to bacterial translocation, systemic toxicity, dehydration, and electrolyte abnormalities. Bowel ischemia can lead to perforation, fecal soilage of the peritoneal cavity, and dead bowel. […] In cases of closed loop obstructions, such as colonic obstruction in the presence of a closed ileocecal valve or incarcerated hernia, this process may be accelerated.

• #23 Pseudo-Obstruction – TeachMeSurgery

  https://teachmesurgery.com/general/large-bowel/pseudo-obstruction/

  Pseudo-obstruction is a disorder characterised by dilatation of the colon due to an adynamic bowel, in the absence of mechanical obstruction. […] The exact mechanism is unknown, yet it is thought to be due to an interruption of the autonomic nervous supply to the colon resulting in the absence of smooth muscle action in the bowel wall. […] As with mechanical obstruction, untreated cases can result in an increasing colonic diameter, leading to an increased risk of bowel ischaemia and bowel perforation. […] There are a variety of causes of pseudo-obstruction, including: Electrolyte imbalance or endocrine disorders, such as hypercalcaemia, hypothyroidism, or hypomagnesaemia; Medication, including opioids, calcium channel blockers, or anti-depressants; Recent surgery, severe systemic illness, or trauma; Neurological disease, including Parkinsons disease or Multiple Sclerosis.

• #24 Pathogenesis of abdominal pain in bowel obstruction: Role of mechanical stress-induced upregulation of nerve growth factor in gut smooth muscle cells

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5354958/

  Abdominal pain is one of the major symptoms in bowel obstruction (BO); its cellular mechanisms remain incompletely understood. […] We tested the hypothesis that mechanical stress in obstruction upregulates expression of nociception mediator nerve growth factor (NGF) in gut smooth muscle cells (SMC), and NGF sensitizes primary sensory nerve to contribute to pain in BO. […] Mechanical stress-induced upregulation of NGF in colon SMC underlies the visceral hypersensitivity in BO through increased gene expression and activity of TTX-resistant Na+ channels in sensory neurons. […] The mechanisms of distension-associated abdominal pain in mechanical and functional obstructions remain unknown, and no specific analgesics are available to target distension-associated pain. […] Our study demonstrates that mechano-transcription of NGF in colonic smooth muscle plays a critical role in visceral hypersensitivity in bowel obstruction, and this may be through the increased gene expression and activity of TTX-r Na+ channel (i.e. Nav1.8) in colon neurons.

• #25 Microbiota dysbiosis and its pathophysiological significance in bowel obstruction | Scientific Reports

  https://www.nature.com/articles/s41598-018-31033-0

  Bowel obstruction (OB) causes local and systemic dysfunctions. […] Partial colon obstruction was maintained in rats for 7 days. […] OB did not cause bacterial overgrowth or mucosa inflammation, but induced profound changes in fecal microbiota composition and diversity. […] At the phylum level, the 16S rRNA sequencing showed a significant decrease in the relative abundance of Firmicutes with corresponding increases in Proteobacteria and Bacteroidetes in OB compared with sham controls. […] In conclusion, obstruction leads to marked dysbiosis in the colon. […] Antibiotic eradication of microbiota had limited effects on obstruction-associated changes in inflammation, motility, or bacterial translocation. […] Bowel obstruction causes a series of local and systemic changes. […] Gut motility dysfunction is one of the most prominent local pathological changes in OB and is responsible for symptoms such as abdominal distention, nausea, vomiting, and constipation.

• #26 Intestinal obstruction – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/intestinal-obstruction/symptoms-causes/syc-20351460

  Untreated, intestinal obstruction can cause serious, life-threatening complications, including: Tissue death. Intestinal obstruction can cut off the blood supply to part of your intestine. Lack of blood causes the intestinal wall to die. Tissue death can result in a tear (perforation) in the intestinal wall, which can lead to infection.

• #27 Bowel obstruction – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/bowel-obstruction/

  Bowel obstruction stasis of luminal contents and gas proximal to the obstruction intraluminal pressure, which leads to the following: […] Compression of intestinal veins and lymphatics bowel wall edema compression of intestinal arterioles and capillaries bowel ischemia, which leads to: […] Bowel wall permeability translocation of intestinal microbes to the peritoneal cavity sepsis. […] Necrosis and perforation of the bowel wall peritonitis. […] Anaerobic metabolism and lysis of ischemic cells accumulation of lactic acid and release of intracellular K+ metabolic acidosis and hyperkalemia.

• #28 Intestinal Obstruction | 5-Minute Pediatric Consult

  https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617480/all/Intestinal_Obstruction?q=Sepsis

  Blockage of normal flow of air and other contents through the intestine. […] May arise from intrinsic abnormalities (e.g., meconium ileus, intestinal atresia) or extrinsic abnormalities (e.g., adhesions, bands, or volvulus). […] May also be caused by neuromotor dysfunction of the gastrointestinal (GI) tract (i.e., hypomotility or paralysis of the intestine). […] Pathophysiology depends on the mechanism of the obstruction. […] Functional obstruction (paralytic ileus) occurs due to failure of intestinal motor function without mechanical obstruction. […] Mechanical obstruction leads to intestinal dilation proximal to the site of obstruction as the bowel fills with intestinal contents and air. […] Ischemic obstruction occurs secondary to occlusion of intestinal blood supply. […] Damage to the normal gut barrier may enable bacteria, bacterial toxins, and inflammatory mediators to enter the circulation, causing sepsis.

• #29 Bowel obstruction – Wikipedia

  https://en.wikipedia.org/wiki/Bowel_obstruction

  Depending on the level of obstruction, bowel obstruction can present with abdominal pain, abdominal distension, and constipation. 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 ischemia or perforation from prolonged distension or pressure from a foreign body and subsequently sepsis due to bowel flora. […] 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 may occur before constipation. Common physical exam findings may include signs of dehydration, abdominal distension with tympany, nonspecific abdominal tenderness, and high pitched tinkly bowel sounds.

• #30 Etiologies, clinical manifestations, and diagnosis of mechanical small bowel obstruction in adults – UpToDate

  https://www.uptodate.com/contents/etiologies-clinical-manifestations-and-diagnosis-of-mechanical-small-bowel-obstruction-in-adults

  Bowel obstruction occurs when the normal flow of intraluminal contents is interrupted. The small bowel is involved in approximately 80 percent of cases of mechanical intestinal obstruction. […] Mechanical small bowel obstruction is caused by intraluminal or extraluminal mechanical compression. In developed countries, adhesion is the most common cause, followed by hernias, malignancies, and various other infectious and inflammatory disorders.

• #31 Pathophysiology of Intestinal Obstruction

  http://surgstudent.org/lectures/obs/node3.html

  The essence of intestinal obstruction is that there is a blockage in the intestine. Impairment of the passage of material through the bowel results in cessation of passage of flatus and faeces. Blockage results in distension of the proximal intestine with solids, fluid and gas; this results in pain, an increase in abdominal girth, and increased tension in the intestinal wall. Increased tension in the intestinal wall and/or impairment of the blood supply of the intestine due to twisting and external pressure results in necrosis and perforation of the bowel. Blockage of the intestine with distension and/or impairment to its blood supply will result in activation of local and systemic inflammatory responses and translocation of bacteria through the wall of the intestine.

• #32 Mechanical Intestinal Obstruction – Gastrointestinal Obstruction – Intestinal Diseases – Gastrointestinal Diseases – Gastroenterology – Diseases – McMaster Textbook of Internal Medicine

  https://empendium.com/mcmtextbook/chapter/B31.II.4.25.2.

  Mechanical obstructions are typically categorized as involving the small or large bowel and may also be classified as being due to intraluminal, intramural, or extramural causes. […] The most worrisome complications of intestinal obstruction include bowel necrosis and perforation. Intestinal strangulation may be caused by incarceration of a hernia or by adhesive bands. […] Necrosis of the bowel may develop due to increased pressure in a bilaterally occluded segment, also known as a closed loop obstruction. […] Bowel necrosis may also develop by direct compression of mesenteric vessels at the hernia neck. […] It is crucial to promptly establish indications for surgery in patients with strangulation and subsequent intestinal ischemia. […] A rapid increase in white blood cell counts is often observed in patients with intestinal necrosis.

• #33 Mechanical Intestinal Obstruction – Gastrointestinal Obstruction – Intestinal Diseases – Gastrointestinal Diseases – Gastroenterology – Diseases – McMaster Textbook of Internal Medicine

  https://empendium.com/mcmtextbook/chapter/B31.II.4.25.2.

  Because intestinal obstruction may lead to fluid and electrolyte disturbances as well as kidney failure and acidosis, it is necessary to measure serum electrolyte levels, kidney function parameters, and blood gas levels. […] Patients should always be referred for surgical consultation because mechanical intestinal obstruction often requires surgical treatment.

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