Wednesday, July 21, 2010

Why Gallstones can cause obstruction?

Gallstones can sometimes block the intestines and cause intestinal obstruction, intestinal obstruction caused by a gallstone blocking medicine called gallstone ileus. Stones caused by gallstone ileus are large in diameter is generally greater than 2. 5cm, this stone is initially inside the gallbladder. Gallbladder in these large stones to cause intestinal obstruction, gastrointestinal fistula first occurrence of the gall bladder. Gastrointestinal fistula occurred after the gallbladder, gallbladder stones may enter the intestine by the fistula. Smaller stones into the intestine, will as in the gastrointestinal tract peristalsis and excreted and does not cause obstruction. Such as large stones, it will mechanically blocked intestine, caused by gallstone ileus. Gallstone blocking the site often occur in the terminal ileum, small intestine because of here.

Gallstone ileus and more older patients, when luminal gallstone obstruction, the obstruction will lead to a series of symptoms. The patient will feel pain in the abdomen feels bloated, and accompanied by nausea and vomiting. Intestinal obstruction can cause the intestine of product gas and fluid, so the patient's abdomen will gradually swell. The intestine because the gas can not function properly, the patient's anus to stop the defecation and exhaust. If you did not receive timely and effective treatment, the patient eventually died from shock. Therefore, gallstones gallstone ileus is a serious complication caused by another.

Abdominal X-ray examination in the diagnosis of gallstone ileus is very helpful. Abdominal X-ray, you can see a product gas, fluid and the expansion of intestinal loops, and sometimes you can see the shadow of gallstone obstruction of bowel, according to these doctors can make the correct diagnosis. Gallstone ileus on patients to active treatment, such as transfusion, blood transfusions, to correct shock and timely surgery, remove the stone block in the intestine to relieve the obstruction. After effective treatment, most patients can pull through.

Eat smaller meals should be to prevent intestinal obstruction

My daughter two years and seven months of this year, has been in poor health, mainly for the diarrhea, frequent abdominal pain, intussusception, twice, in January of this year, check out the hospital, because she had congenital digestive tract duplication in January in hospitals were small intestine (short) excision of, and sometimes still have stomach pain, but after a while, will have their own self, in general, better than before, but last week she had stomach pain that doctors determined as intestinal obstruction, through the stomach cannula, gastrointestinal decompression after discharge. We were in her diet, has been more attention, would usually be what to do in order to avoid further obstruction, doctors said the disease is not good, is that true? Could any Herbal Treatment to prevent intestinal obstruction?

Overeating, intestinal disorders are caused by obstruction of the incentives, so pay attention to the diet rich in digestible nutrients, smaller meals, not to eat strong food irritation, thus reducing the incidence of intestinal obstruction; another if Herbal Treatment differentiation accurate, will also receive very good results.

What is the typical signs of intestinal obstruction?

The typical signs of intestinal obstruction, mainly in the abdomen.

1, abdominal swelling

More common in low small bowel obstruction in late. Closed loop intestinal obstruction often asymmetric local expansion, and paralytic ileus is marked expansion of the whole abdomen. Prior to palpation in the abdomen, the best start for a few minutes of abdominal auscultation.

2, bowel sounds (or bowel sounds) or the disappearance of hyperthyroidism

Mechanical intestinal obstruction in early, when the colic attack, the site of obstruction can be heard often hyperactive bowel sounds, such as the intensive burst of air through the water sound. Significant expansion of the intestine, the peristaltic sounds can sound was a high-profile nature of the metal. In paralytic ileus or mechanical bowel obstruction complicated with peritonitis, bowel sounds extremely reduced or completely disappear.

3, intestinal peristalsis and

In chronic cases of intestinal obstruction and abdominal wall thinner, intestinal peristalsis, and was particularly evident.

4, abdominal tenderness

Common in mechanical intestinal obstruction, tenderness with muscle tension and rebound tenderness were mainly seen in strangulated intestinal obstruction, especially when complicated by peritonitis.

5, abdominal mass

Into the group in the roundworm, gallstones, intussusception, or bowel obstruction caused by colon cancer, can often touch the corresponding abdominal mass; in closed loop intestinal obstruction, sometimes touched with tenderness of the expansion segments of intestine.

How the formation of intestinal obstruction?


Simple complete mechanical intestinal obstruction occurred, over parts of the intestine obstruction expansion. Wall thinning, mucosal erosions and ulcers occur easily. Serous membrane can be torn, the entire wall can be due to blood supply and necrosis, intestinal obstruction most often isolated and empty the following collapses.

Expansion when the bowel paralytic ileus, bowel wall thinning.

Strangulated intestinal obstruction in the early, due to venous obstruction, veins and hair cells in blood vessels can occur bleeding, increased permeability, or even rupture or leakage of blood plasma. At this time intestines internal congestion and edema and purple. Then the arterial blood flow obstruction, thrombosis, intestinal ischemia and necrosis due to, intestinal bacteria and toxins can damage the intestinal wall into the abdominal cavity. Necrosis of the bowel was dark purple, and finally free to break.


Obstruction of the major pathophysiological changes as swelling, fluid and electrolyte loss and infection and toxaemia. The extent of these changes depending on the level of obstruction, intestinal obstruction, and whether the length of the blood supply to different obstacles.

(A) of the intestinal swelling

Mechanical intestinal obstruction, the obstruction of the intestine above the swelling due to fluid pneumatosis, bowel obstruction in the first reaction to the increased peristalsis, and strong peristalsis caused by colic. At this point the upper esophageal sphincter relaxation reflex occurred, the patient unconsciously when inhaling air swallowed a large number of gastrointestinal, the lumen 70% of product gas swallow air, mostly nitrogen, can not easily be gastrointestinal absorption, the remaining 30% of the product gas is the intestinal pH and bacteria in and produced by fermentation, or from the Notes to the lumen dispersion CO2, H2, CH4 and other gases. Normal adult gastrointestinal tract daily saliva secretion, gastric juice, bile, pancreatic juice and intestinal fluid of the total of about 8L, most were small intestinal absorption, in order to maintain fluid balance. Obstruction when a large number of liquids and gases to accumulate in the proximal intestinal obstruction expansion, while inflation could inhibit the intestinal mucosa to absorb moisture, and later to stimulate the increased secretion of the intestine that have piled up liquid, so that sexual increase intestinal swelling. In the simple obstruction, the pressure generally lower intestine, is often lower than first 8cmH2O.

However, with the obstruction time, the pressure within the intestine can be achieved even 18cmH2O. Obstruction of the intestine only an average pressure in the 25cmH2O. Obstruction of the intestine when the pressure in the 25cmH2O above average, even higher to 52cmH2O water column. Intestinal wall can increase the pressure within the venous return disorder, caused by bowel wall congestion and edema. Permeability. The pressure continues to increase intestinal blood flow could block the intestinal wall into the simple obstruction to strangulating intestinal obstruction. Intestinal swelling and even make a serious push up the diaphragm, affecting the patient's respiratory and circulatory functions.

(B) the loss of body fluids and electrolytes

Swelling can cause intestinal obstruction pregnant vomiting reflex. When high intestinal obstruction and vomiting frequently, large amounts of water and electrolytes are excreted. Such as pyloric or duodenal obstruction in the upper section, Ouchu excess stomach acid, is easy to produce dehydration and low-chloride potassium alkalosis. Such as obstruction in the duodenum or jejunum on the lower section of the severe loss of bicarbonate. Low intestinal obstruction, vomiting, although far less rare in high positions, but due to the decrease of intestinal absorption increased secretion of fluid volume, obstruction of the intestine in the plot to stay for more than a lot of liquid, sometimes as many as 5 ~ 10L, contains a large number of sodium bicarbonate. The liquid has not yet been eliminated from the body, but can not be closed in the intestine into the blood, equal to the loss of body fluids. In addition, the excessive expansion of influence of intestinal venous return, leading to bowel wall edema and plasma extravasation, in strangulated intestinal obstruction, the blood and plasma loss is particularly serious. Therefore, occurrence of dehydration in patients with multi-oliguria, azotemia and acidosis. Such as dehydration continued, further enrichment of blood, have resulted in hypotension and hemorrhagic shock. Loss of potassium and not into the diet can cause low potassium-induced intestinal paralysis, and then add to the development of intestinal obstruction.

(C) infection and toxaemia

Normal bowel movements so that forward movement of intestinal contents and updated regularly, so the small intestine is sterile, or only a very small number of bacteria. Simple mechanical obstruction of the small intestine, the intestinal bacteria and toxins are also vertical can not be a normal mucosal barrier, which is little risk. If the strangulated obstruction into the beginning of blood flow is blocked, the involved bowel wall blood and plasma exudation to further reduce blood volume, blood flow is blocked and then accelerated ischemic bowel necrosis . Strangulated section of intestine with a large number of bacteria in the liquid (such as Clostridium, Streptococcus, E. coli, etc.), blood and necrotic tissue, bacteria and toxins and the decomposition of blood and necrotic tissue is highly toxic product of both. This liquid through the broken wall into the abdominal cavity or perforation, may cause strong peritoneal irritation and infection, were peritoneal absorption of causing sepsis. Severe peritonitis and sepsis are major causes of death of patients caused intestinal obstruction.

In addition to these three main pathophysiological changes, the case of strangulating intestinal obstruction is often accompanied by intestinal wall and bleeding within the abdominal cavity and intestine, strangulated bowel loop longer, the greater the blood loss is also patients with intestinal obstruction caused the death of one of the reasons.

How to do prevention and care of intestinal obstruction

Care: Water fasting, gastrointestinal decompression to relieve abdominal distention. Selected semi-supine position to reduce the pressure on the diaphragm. Closely observe the condition changes, if sicker. Strangulated intestinal obstruction should be alert to the occurrence and timely treatment.

Prevention: The adhesive intestinal obstruction in remission should pay attention to diet, do not eat hard food, soft food diet in order to dilute the main. Obstruction of the Ascaris parasite treatment should be performed after remission, in addition to deworming drugs, the use of oxygen therapy can get rid of intestinal roundworm. Do not eat three square meals for after strenuous exercise to prevent the occurrence of volvulus.

Antibiotics may cause intestinal obstruction baby

A new study says that taking antibiotics in infants suffering from a rare disease, intestinal obstruction - intussusception - the risk increases. But this conclusion does not mean that certain antibiotics cause intussusception, it is contributed to infants and young children suffering from one of the factors of this disease, it may be prudent use of antibiotics to be one of the reasons.

"Intussusception is 3 months -6 years old children, the most common intestinal obstruction, we believe that this is the first antibiotic may be a risk factor for intussusception, a preliminary study", the first of spino (David M. Spiro ) told Reuters that the conclusions "should be emphasized to parents and pediatricians, and only when absolutely necessary to use antibiotics wisely." Causes of intussusception are unknown between, there is research that American children of the disease incidence was 1 / 5, 000.

Since antibiotics can affect the intestinal activities, spino and colleagues began to study the use of antibiotics affected the risk of intussusception, which no one has done before. They will be 93 children with intussusception and 353 children seeking treatment for trauma were compared. In January the "pediatric and adolescent medical literature" (Archives of Pediatrics and Adolescent Medicine 2003; 157:54-59), the authors report, taking antibiotics, the risk of children suffering from intestinal obstruction than those who did not serve a large four times, in which the children used the greatest risk of cephalosporin, more than 20 times. Used antibiotics in children - mostly because of otitis media - a 1 / 4 in the development of intestinal obstruction within 48 hours.

But Spinozzi and colleagues noted that more research is needed to confirm this conclusion.

Saturday, July 17, 2010

Surprise! Intestinal obstruction due to a coin into trouble

University of Chicago Medical School and colleagues Tupesis JP diagnosis and treatment of one case of 22-year-old female who presented with abdominal pain 3 weeks of emergency admission. In the initial history taking, the patient denied history of foreign body ingestion, but in the abdominal and pelvic CT examination of patients admitted after the reach of a one-cent coin. Coins found in surgical exploration of incarcerated in the intestine near the ileocecal valve, and the local formation of 10 * 7 cm size of inflammatory mass was completely blocked intestine.

Dr. Tupesis speculated that because the coin surface oxidation in patients after exposure to zinc core, leading to the final form a series of inflammatory response of inflammatory mass.

This is mechanical intestinal obstruction: the more common. Caused due to organic lesions smaller lumen, intestinal contents through the occurrence of obstacles. The disease groups as insects, fecal material, stones and plastic pipe blockage, intestinal torsion, incarcerated in the hernia sac neck, adhesion with oppression and involved, as well as tumors and other intra-abdominal mass to lumen pressure; or tumor, set stack, inflammatory bowel disease induced.

Treatment: All patients with suspected intestinal obstruction should be hospitalized, the treatment and diagnosis of acute intestinal obstruction must be at the same time. Treatment should be based on the fact that: surgery on the specific diagnosis of strangulated obstruction is necessary.

Small bowel obstruction nasal catheter insertion, and to attract. In small bowel obstruction, the use of a long intestine, rather than surgery, for a simple suction tube can be tested in the treatment of early postoperative obstruction or adhesions caused by repeated obstruction without abdominal symptoms. Although 2 or 3 hours to be spent to improve the situation of dehydration in patients with poor access to some status and urine output, but most surgeons prefer early stage caesarean section.

Indwelling bladder catheter to monitor urine output. Intravenous fluids should be started (in lactate Ringer's solution is appropriate) and the electrolyte. If repeated vomiting, decreased serum sodium and potassium may be added, must continue to maintain fluid balance, measured at least once a day serum electrolytes. On dehydrated patients, the determination of central venous pressure can be helpful. If possible, try to remove the primary tumor. Should take measures to prevent recurrence, including hernia repair, removal of foreign bodies and full release adhesions.

Obstructive gallstone surgery can be removed through the stones, but also at the same time or after a cholecystectomy gastrolith is another reason for causing obstruction may be removed by endoscopy. More common approach is laparotomy be removed through bowel resection. Involving the small intestine with diffuse peritoneal tumor was small bowel obstruction in adults leading cause of death. Short-circuit the efforts of any obstruction seems to have only a short help.

Adult treatment, including removal of duodenal obstruction in the lesion can not be removed or used palliative gastrojejunostomy.

Treatment of large bowel obstruction and small bowel obstruction is basically similar. In emergency surgery the stomach is necessary before its nose to attract, intravenous fluids and electrolytes and urinary catheters.

Can usually be Ⅰ resection and anastomosis of the treatment of obstructive colon cancer. Other options include bypass of colostomy and anastomosis, and occasionally need to make colostomy, further extension of resection. When diverticulitis causing obstruction, may be associated with perforation. In case of perforation and diffuse peritonitis, although it is difficult to involvement in regional resection, but indications for surgery, that is, resection and colostomy surgery, anastomosis should be deferred. Fecal impaction are more common in the rectum, the stool can remove your fingers. However, with simple fecal or barium or a mixture of antacids can cause complete obstruction (often in the sigmoid colon), required laparotomy.

Cecal volvulus treatment, including involvement of bowel resection and anastomosis or colostomy will by cecal appendix fixed to the normal position. Reversed in the sigmoid colon, the abdominal X-ray shows that the expansion of the sigmoid colon bowel, endoscopy, or a long rectal tube can be used for regular bowel decompression, surgical resection and anastomosis may be delayed a few days, if not for resection, recurrence is almost inevitable.

Care: Water fasting, gastrointestinal decompression to relieve abdominal distention. Selected semi-supine position to reduce the pressure on the diaphragm. Closely observe the condition changes, if sicker. Strangulated intestinal obstruction should be alert to the occurrence and timely treatment.

Prevention: intestinal obstruction in remission should diet, not to eat hard food, soft food diet in order to dilute the main.