Physiological Role of Intestine The intestines are a part of the gastrointestinal-intestinal tract and play an important role in the distension and absorption of the ingested nutrients like carbohydrates, fats, proteins, vitamins, and minerals. They also help in excretion of waste and provide protection from micro-organisms like bacteria and other pathogens.
Definition and Types A condition where the digested food is unable to pass normally through the bowel is known as bowel or intestinal obstruction. This obstruction can be dynamic (mechanical or physical) or adynamic (impaired peristalsis). It can also be acute, common in the small intestine, chronic or even acute on chronic, often seen in the large bowel.(Image: Canva)
Dynamic Obstruction Causes Twenty five percent of dynamic intestinal obstructions are due to hernias, and about forty percent are due to the formation of adhesions, common after surgical intervention. Neoplastic or malignant conditions like cancers can also cause obstruction. Inflammatory bowel disease is also implicated as an etiological factor.(Image: Canva)
Adynamic Obstruction Causes Adynamic causes of bowel obstruction include the presence of gall bladder stones and infection by organisms like the roundworm. Alongside, thickened stools, electrolyte imbalances, diabetes mellitus and renal surgeries can also lead to obstruction. Any underlying reason that causes a reduction or a cessation of the intestinal propulsive forces can lead to this condition.(Image: Canva)
Pathophysiology When there is obstruction in the intestinal pathway for the digested food, the wall turns to vigorous peristalsis so as to overcome it. If the obstruction is not relieved, peristalsis ceases and the bowel becomes flaccid and dilated. The fluid from saliva and pancreas starts to get collected proximal to the obstruction, and can lead to severe dehydration.(Image: Canva)
Pain and Location A person who has intestinal obstruction will experience intermittent colicky pain that becomes continuous and severe in the later stages. In case of an obstruction in the small intestine, pain may predominantly begin near the belly button. Small episodes of crescendo/decrescendo type of pain are common.(Image: Canva)
Constipation and Systemic Effects The affected individual may also feel constipated, where neither stools nor flatus can be passed. Because of the dehydration the person faces in case of intestinal obstruction, the amount of urine may be reduced, predisposing to renal failure. Other symptoms and signs include increased heart rate, elevated respiratory rate, fever, and sunken eyes.(Image: Canva)
Vomiting and Distension Depending on the location of the obstruction, vomiting may either present in the earlier stages and be persistent, or may recur in small intervals. The abdomen may also become distended, abnormally so in case of a large bowel obstruction, and peristalsis may be visible. Rumbling sounds from the intestine can be heard as well.(Image: Canva)
Severe Signs and Diagnosis The abdomen may become tender to touch, and in severe cases, the person may experience extreme pain and features of shock, along with a loss of the bowel sounds so clearly heard in the initial stages. A number of investigations are done to diagnose an intestinal obstruction, like plain X-ray (abdomen), CT Scan and Barium enema.(Image: Canva)
Treatment and Urgency If you are experiencing such symptoms, you must visit your healthcare provider to confirm the cause. The treatment often involves replacement of fluids and electrolytes, antibiotic regimes and blood transfusions and ICU care for critical patients. Immediate surgery is required to relieve the obstruction.(Image: Canva)
