(1) classification
According to the cause of intestinal obstruction.
① Mechanical intestinal obstruction: more common. It is precisely because of organic lesions that the intestinal cavity becomes smaller and the passage of intestinal contents is blocked. The causes of the disease are insect swarms, fecal lumps, stones and foreign bodies blocking the tube glue, volvulus, incarceration of the neck of hernia sac, compression and involvement of abdominal masses such as adhesion zone and tumor, which makes the lumen compressed; Or intestinal wall lesions caused by tumor, intussusception and inflammation.
② Dynamic intestinal obstruction: due to nerve inhibition or toxin, intestinal peristalsis loss or intestinal spasm, the intestinal contents stop running, and there is no mechanical obstruction.
Blood-borne intestinal obstruction: rare, it is due to mesenteric vascular embolism or thrombosis, which blocks the blood supply to the intestine and loses motivation.
Classification according to whether there is blood supply disorder or not.
① Simple intestinal obstruction: it only blocks the passage of contents, but there is no blood supply obstacle in the intestine.
Pet-name ruby strangulated intestinal obstruction: acute ischemia can occur in the corresponding intestinal segment due to mesenteric vascular thrombosis, embolism or compression; Or simple intestinal obstruction, due to the high expansion of the intestine, oppresses the small blood vessels of the intestine, leading to blood supply disorder of the intestinal wall.
Depending on the location of the obstacle
① High intestinal obstruction-empty intestinal obstruction.
② Low intestinal obstruction-intestinal obstruction.
③ Colon obstruction.
(2) Clinical manifestations
Abdominal pain: Mechanical intestinal obstruction is characterized by paroxysmal abdominal colic, which is aggravated by intestinal peristalsis to overcome obstruction, and abdominal pain may be accompanied by bowel sounds. If the interval of abdominal pain is shortened continuously, or even becomes persistent abdominal pain, it may be the performance of strangulated intestinal obstruction.
Vomiting: in the early stage of intestinal obstruction, vomiting is reflex, and vomit is food or gastric juice; It is generally believed that the higher the obstruction site, the earlier and more frequent vomiting occurs; However, low obstruction and colon obstruction vomiting appeared later and less; Vomiting may be feces.
Abdominal distension: It appears later. Abdominal distension is not obvious in high intestinal obstruction, but obvious in low intestinal obstruction and colon obstruction.
The anus stops exhausting and defecating: after complete intestinal obstruction, patients often do not exhaust and defecate. However, a few patients still have feces and gas residues under the obstruction, which can still be discharged, so the existence of intestinal obstruction cannot be denied.
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.