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BY :

1.DICKY ADITYA DWIKA

2.MARADEWI MAKSUM

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• Bowel obstruction occurs wen te nor!"l#ro#ulsion "n$ #"ss"%e o& intestin"l contents$oes not occur. Tis obstruction c"n in'ol'eonl( te s!"ll intestine )s!"ll bowelobstruction*+ te l"r%e intestine )l"r%e bowel

obstruction*+ or 'i" s(ste!ic "lter"tions+in'ol'in% bot te s!"ll "n$ l"r%e intestine)%ener"li,e$ ileus*.

•  Te -obstruction- c"n in'ol'e " !ec"nic"l

obstruction or+ in contr"st+ !"( be rel"te$ toineecti'e !otilit( witout "n( #(sic"lobstruction+ so/c"lle$ &unction"l obstruction+-#seu$o/obstruction+- or ileus.

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 Tis ter! is use$ to $e0ne intestin"l

obstruction c"use$ b( " #(sic"l bloc"%eo& te intestin"l lu!en. Tis bloc"%e !"(be intrinsic or etrinsic to te w"ll o& teintestine or on occ"sion !"( occursecon$"r( to lu!in"l obstruction "risin%

&ro! te intr"lu!in"l contents.

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Lesions Extrinsic to theIntestinal Wall

Lesions Intrinsic to theIntestinal Wall

AD3ESI45S:

Post-operative, Congenital, Post-infammatory 

C456E5ITA7:

Intestinal atresia, Meckel’sdiverticulum, duplications

3ER5IA:H. External adominal !all, H.Internal, H. Incisional

I587AMMAT4RY:C"ron’s disease, eosinop"ilicgranuloma

C456E5ITA7:

 #nnular pancreas, malrotation,$mp"alomesenteric duct remnant 

I58ECTI45S:

%uerculosis, actinomycosis,complicated diverticulitis

5E497ASTIC:Carcinomatosis, Extraintestinalneoplasm

5E497ASTIC:Primary or metastatic neoplasms,appendicitis

I587AMMAT4RY:

Intra-adominal ascess, &'tarc"( peritonitis

MISCE77A5E4US:

Intussusception, endometriosis,radiation stricture, intramural"ematoma, isc"emic stricture

MISCE77A5E4US:)olvulus, *ossypioma, 'uperiormesentric artery syndrome

I5TRA7UMI5A74BTURAT4R4BSTRUCTI45:*allstone, enterolit", p"ytoe+oar,

 parasite inestaion, s!allo!ed oreignody 

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Wen te obstruction is secon$"r( to&"ctors t"t c"use eiter #"r"l(sis or$(s!otilit( o& intestin"l #erist"lsis t"t#re'ents coor$in"te$ "bor"l tr"nsit o&

lu!in"l contents+ te obstruction is c"lle$ "&unction"l or #seu$o/obstruction. Wit&unction"l obstruction+ no #(sic"l site o&!ec"nic"l obstruction is #resent.

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•  Te !ost co!!on c"use is ; POST-OPERATIVE ILEUSIt is correl"te wit te $e%ree o& sur%ic"l tr"u!" "s well"s te t(#e o& o#er"tion.

• Diferent anatomic segments o thegastrointestinal tract also recover atdiferent rates ater manipulation andtrauma.

•  Te small bowel reco'ers witin se'er"lours #ost/o#er"ti'el(. Stomach witin one$"( l"ter. Colon "bout

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Intra-Abdominal Cases Extra-Abdominal Cases

I!TRAPERITO!EAL

PRO"LE#S: peritonitis, intra-adominalascess, post-operative ,c"emical gastric uice, ile,lood/, #utoimmune 'erositis,vasculitis/ 0 Intestinal isc"emia

arterial or venous, sickle celldisease/

#ETA"OLIC A"!OR#ALITIES:

Electrolyte imalance, sepsis,lead poisoning, porp"yria,"yperglicemia, "ypot"iroidsm,uremia

RETROPERITO!EALPRO"LE#S$1rolit"iasis, pyelonep"ritis,metastasis, pancreatitis,

retroperitoneal trauma

T%ORACIC PRO"LE#S$Myocardial inarction, congestive"eart ailure, pneumonia, t"oracictrauma

#E&ICI!ES$opiates, anti-c"olinergic, alp"a-adrenergik agonists,anti"istamines

#ISCELLA!EOUS$'pinal cord inury, pelvic racture,

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• 7u!in"l obstruction results in #ro!inent"lter"tions o& te nor!"l intestin"l#(siolo%(. Des#ite te !"n( c"n%esnote$+ te #"to#(siolo%( o& bowel

obstruction re!"ins inco!#letel(un$erstoo$. Bowel $istension+ $ecre"se$"bsor#tion+ intr"lu!in"l (#ersecretion+ "n$"lter"tions in !otilit( "re &oun$ uni'ers"ll(+

(et te !ec"nis!s res#onsible &or tese#"to#(siolo%ic $er"n%e!ents "re notcle"r.

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• Intestin"l !otilit( "re disruption o& te normalautonomic parasympat"etic vagal/ andsympat"etic splanc"nic innervation.

Earl' (hase o) bowel obstrction*Intestin"l contr"ctile "cti'it( increases  #ro#elintr"lu!in"l contents #"st te obstruction

Later (hase o) bowel obstrction* Te contr"ctile "cti'it( diminis"es  intestin"l w"ll (#oi" e"%%er"te$ intr"!ur"l in@"!!"tion

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• Distention o& te bowel lu!en wit "conco!it"nt results in increasedtransmural pressure on capillarylood fo! witin te w"ll o& te bowel  risk oisc"emic.

• Intestin"l w"ll isce!i" is re"l concern in LargeBowel Obstruction. Te Ascendin+

Colon  luminal diameter is te %re"test "n$)b( 7"#l"ces l"w* te wall tension )"n$ isce!i"*is "lso te %re"test hi+h ris, to isce!i".

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• U##er s!"ll intestine  %r"!/#ositi'e &"cult"ti'eor%"nis!s in s!"ll concentr"tions+ 1 colonies!7. More $ist"ll(+ in te $ist"l ileu!  teb"cteri"l count incre"ses in concentr"tion to "bout1 colonies!7+ te @or" #ri!"ril( coli&or!s "n$

"n"erobic or%"nis!s

• in te #resence o& obstruction+ " r"#i$ #roli&er"tiono& b"cteri"l or%"nis!s occurs consistin%#re$o!in"ntl( o& ecal-type organisms. re"cin% "#l"te"u o& 1FG11 colonies!7 "&ter 12GH ours o&

"n est"blise$ obstruction.

• B"cteri"l toins "'e "n i!#ort"nt role in te!ucos"l res#onse to bowel obstruction.

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 Te $i"%nosis o& bowel obstruction issus#ecte$ clinic"ll( b"se$ on te #resenceo& cl"ssic si%ns "n$ s(!#to!s "n$ tencon0r!e$ b( so!e &or! o& i!"%in% test+

suc "s "b$o!in"l r"$io%r"#( or !orerecentl( b( co!#ute$ to!o%r"#(. Teetiolo%( c"n o&ten be #in#ointe$ b( c"re&ulistor(/t"in% co!#le!ente$ wit i!"%in%

stu$ies.

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