Intestinal obstruction refers to the obstruction of intestinal passage caused by any reason, which leads to pathological changes in the intestine and the whole body. Intestinal obstruction is a common acute abdomen in children.
Etiological intestinal obstruction can be roughly divided into two categories: mechanical (organic) and dynamic (functional).
1. Mechanical intestinal obstruction is caused by intestinal or parenteral organic lesions. The etiology can be congenital developmental malformation such as intestinal atresia, intestinal stenosis, intestinal malrotation, annular pancreas, hernia incarceration and so on. Acquired causes include intussusception, ascaris obstruction, volvulus, tumor compression, inflammation or postoperative intestinal adhesion.
2. Functional intestinal obstruction is due to poor intestinal peristalsis, so that intestinal contents can not be transported normally. It is common in toxic intestinal paralysis caused by severe pneumonia, septicemia and enteritis or paralytic intestinal obstruction caused by hypokalemia. Or hypertrophic pyloric obstruction caused by Hirschsprung's disease and intestinal nerve dysplasia.
Symptoms: In addition to the unique manifestations of the primary disease, the common manifestations of intestinal obstruction are paroxysmal abdominal cramps, vomiting and abdominal distension, and no exhaust during defecation.
1. Paroxysmal abdominal pain often occurs suddenly, and mechanical intestinal obstruction has severe colic. The abdominal wall of children is thin, and intestinal lines and peristalsis waves are often seen in the abdomen when abdominal pain occurs. There is no colic in paralytic intestinal obstruction. Only when there is high abdominal distension can there be persistent distension pain, no intestinal pattern can be seen and no bowel sounds can be heard.
2. Vomiting and bloating; If the obstruction is high, vomiting occurs early and frequently, and gastric juice and yellow bile are spit out, with only upper abdominal distension or no abdominal distension. If the obstruction position is low, vomiting occurs later, and fecal juice-like liquid is spit out, and abdominal distension is obvious. Most of the paralytic intestinal infarction do not vomit in the early stage, but can vomit fecal matter in the late stage, with obvious abdominal distension.
3. The anus does not defecate or exhaust, which is a manifestation of complete intestinal obstruction. However, in the early stage of obstruction, the feces and gas remaining in the distal intestinal tract of obstruction can still be discharged, so don't mistake it for no obstruction. When the intestine is strangulated, bloody liquid can be discharged. In addition to the above manifestations, there are symptoms of systemic poisoning, such as drowsiness, pallor and dehydration. Intestinal strangulation usually occurs within 6-8 hours, often accompanied by toxic shock, and the condition is very dangerous.
Treatment: X-ray abdominal fluoroscopy, photos and barium enema can assist diagnosis and treatment; mechanical intestinal obstruction must be treated surgically. Functional intestinal obstruction such as Hirschsprung's disease and hypertrophic pyloric obstruction also need surgical treatment. In addition to treating the primary disease, intestinal obstruction is mainly treated conservatively, including fasting, gastrointestinal decompression, anti-infection, intravenous infusion to supplement nutrition and water, multivitamins and so on. Can be combined with traditional Chinese medicine, acupuncture and other treatments.
The prognosis of intestinal obstruction depends on the causes and types of obstruction, and is closely related to diagnosis and treatment. General simple intestinal obstruction, no serious systemic poisoning symptoms. The prognosis of operation is good. If there is intestinal necrosis, it depends on the length of necrotic intestine. Range. Generally, timely rescue is effective. Excessive intestinal resection will make it difficult to maintain the normal function of the intestine, hinder the absorption of nutrients and have a poor prognosis.
Physical examination generally presents acute pain in the face, and early vital signs generally do not change much. In the late stage, there may be manifestations such as increased body temperature, shortness of breath, decreased blood pressure and accelerated pulse.
Abdominal signs can be intestinal type, peristalsis wave, abdominal tenderness, rebound pain and muscle tension after strangulation. Some patients can feel a lump in their abdomen. Ascites can appear in strangulated intestinal obstruction, and moving dullness can be heard on percussion. Auscultation: Mechanical intestinal obstruction may lead to hyperactivity of bowel sounds and excessive water sounds. The bowel sounds of strangulated intestinal obstruction are weakened or disappeared.
(3) Physical and chemical inspection
Blood routine: the increase of white blood cell count is generally above 10× 109/L, strangulated intestinal obstruction is often above 15× 109/L, and neutrophils increase.
Determination of serum carbon dioxide binding capacity: when metabolic acidosis occurs, the carbon dioxide binding capacity can be reduced.
Serum electrolyte determination: Hypokalemia, hypochloremia and hyponatremia may occur.
X-ray examination: multiple liquid-gas planes and flatulent intestinal loops can be seen in standing perspective.
(4) treatment
Western medicine treatment
① Non-surgical treatment: solving the imbalance of water and electrolyte and acid-base imbalance.
Gastrointestinal decompression is one of the important methods to treat intestinal obstruction. It can relieve abdominal distension, reduce intestinal pressure, reduce bacteria and toxins, and help improve local and systemic conditions.
Prevention and treatment of infection: the application of antibiotics is of great significance to the prevention and treatment of bacterial infection.
② Surgical treatment: All kinds of strangulated intestinal obstruction, intestinal obstruction caused by tumor and congenital malformation, and patients who are ineffective in non-surgical treatment should be treated surgically. The specific surgical method should be based on the etiology, nature, location and general situation of obstruction.
Traditional therapy in China
Single prescription
Raw vegetable oil: raw soybean oil, sesame oil or peanut oil, 200-250ml for adults and 80- 150ml for children, taken orally or by gastric tube injection.
(5) Nursing care
Fasting water, gastrointestinal decompression, reducing abdominal distension. Choose a semi-supine position to reduce the pressure on the diaphragm. Keep a close eye on the changes of the disease, if it gets worse. Be alert to strangulated intestinal obstruction and treat it in time.
(6) Prevention
Pay attention to the diet of adhesive intestinal obstruction in remission period, don't eat hard food, and the diet is mainly thin and soft food. After the intestinal obstruction caused by ascaris lumbricoides is relieved, anthelmintic treatment should be carried out. In addition to drugs, oxygen therapy can also be used to drive away intestinal ascaris. Don't do strenuous exercise after a full meal to prevent volvulus.