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Introduction

Intestinal obstruction is significant mechanical impairment or complete arrest of


the passage of contents through the intestine due to pathology that causes blockage of
the bowel. Symptoms include cramping pain, vomiting, obstipation, and lack of flatus.
Diagnosis is clinical, confirmed by abdominal x-rays. Treatment is fluid resuscitation,
nasogastric suction, and, in most cases of complete obstruction, surgery.

Mechanical obstruction is divided into obstruction of the small bowel (including


the duodenum) and obstruction of the large bowel. Obstruction may be partial or
complete. About 85% of partial small-bowel obstructions resolve with non-operative
treatment, whereas about 85% of complete small-bowel obstructions require surgery.

Overall, the most common causes of mechanical obstruction are adhesions,


hernias, and tumors. Other general causes are diverticulitis, foreign bodies (including
gallstones), volvulus (twisting of bowel on its mesentery), intussusception (telescoping
of one segment of bowel into another), and fecal impaction. Specific segments of the
intestine are affected differently

Obstruction of the small bowel causes symptoms shortly after onset: abdominal
cramps centered around the umbilicus or in the epigastrium, vomiting, and—in patients
with complete obstruction—obstipation. Patients with partial obstruction may develop
diarrhea. Severe, steady pain suggests that strangulation has occurred. In the absence of
strangulation, the abdomen is not tender. Hyperactive, high-pitched peristalsis with
rushes coinciding with cramps is typical. Sometimes, dilated loops of bowel are
palpable. With infarction, the abdomen becomes tender and auscultation reveals a
silent abdomen or minimal peristalsis. Shock and oliguria are serious signs that indicate
either late simple obstruction or strangulation.

Obstruction of the large bowel usually causes milder symptoms that develop
more gradually than those caused by small-bowel obstruction. Increasing constipation
leads to obstipation and abdominal distention. Vomiting may occur (usually several
hours after onset of other symptoms) but is not common. Lower abdominal cramps
unproductive of feces occur. Physical examination typically shows a distended abdomen
with loud borborygmi. There is no tenderness, and the rectum is usually empty. A mass
corresponding to the site of an obstructing tumor may be palpable. Systemic symptoms
are relatively mild and fluid and electrolyte deficits are uncommon.
Volvulus often has an abrupt onset. Pain is continuous, sometimes with
superimposed waves of colicky pain.
Anatomy and Physiology

The GI System

The gastro-intestinal system is essentially a long tube running right through the
body, with specialized sections that are capable of digesting material put in at the top
end and extracting any useful components from it, then expelling the waste products at
the bottom end. The whole system is under hormonal control, with the presence of food
in the mouth triggering off a cascade of hormonal actions; when there is food in the
stomach, different hormones activate acid secretion, increased gut motility, enzyme
release etc. etc. Nutrients from the GI tract are not processed on-site; they are taken to
the liver to be broken down further, stored, or distributed. The digestive system is made
up of the alimentary canal (also called the digestive tract) and the other abdominal
organs that play a part in digestion, such as the liver and pancreas. The alimentary canal
is the long tube of organs — including the esophagus, stomach, and intestines — that
runs from the mouth to the anus. An adult's digestive tract is about 30 feet (about 9
meters) long.
The Large Intestine

By the time digestive products reach the large intestine, almost all of the
nutritionally useful products have been removed. The large intestine removes water
from the remainder, passing semi-solid feces into the rectum to be expelled from the
body through the anus. The mucosa (M) is arranged into tightly-packed straight tubular
glands (G) which consist of cells specialized for water absorption and mucus-secreting
goblet cells to aid the passage of feces. The large intestine also contains areas of
lymphoid tissue (L); these can be found in the ileum too (called Peyer's patches), and
they provide local immunological protection of potential weak-spots in the body's
defenses. As the gut is teeming with bacteria, reinforcement of the standard surface
defenses seems only sensible...From the small intestine, undigested food (and some
water) travels to the large intestine through a muscular ring or valve that prevents food
from returning to the small intestine. By the time food reaches the large intestine, the
work of absorbing nutrients is nearly finished. The large intestine's main function is to
remove water from the undigested matter and form solid waste that can be excreted.
The large intestine is made up of three parts:

1. The cecum is a pouch at the beginning of the large intestine that joins the small
intestine to the large intestine. This transition area expands in diameter, allowing
food to travel from the small intestine to the large. The appendix, a small,
hollow, finger-like pouch, hangs at the end of the cecum. Doctors believe the
appendix is left over from a previous time in human evolution. It no longer
appears to be useful to the digestive process.

2. The colon extends from the cecum up the right side of the abdomen, across the
upper abdomen, and then down the left side of the abdomen, finally connecting
to the rectum. The colon has three parts: the ascending colon; the transverse
colon, which absorb fluids and salts; and the descending colon, which holds the
resulting waste. Bacteria in the colon help to digest the remaining food products.

3. The rectum is where feces are stored until they leave the digestive system
through the anus as a bowel movement.