Bowel Obstruction - Causes and Pathophysiology

00:13:10
https://www.youtube.com/watch?v=sBm12CkNtAo

Resumen

TLDRThe video offers a comprehensive understanding of bowel obstruction with a focus on the small intestine. It identifies symptoms like nausea and stomach pain, and explains the different causes of mechanical obstructions - adhesions, tumors, intussusception, hernia, and volvulus. It also covers pseudo obstructions stemming from muscle or nerve problems. Potential complications include bowel ischemia, perforation, and sepsis. It describes how obstructions disrupt bowel functionality by blocking food passage, leading to various health issues. Understanding these conditions is crucial as they can escalate to severe situations if not properly managed.

Para llevar

  • 🚨 Bowel obstruction symptoms: nausea, vomiting, cramping pain, distended abdomen.
  • 🔍 Focus on small intestine obstruction, applicable to large intestine too.
  • 🔗 Adhesions: fibrous bridges causing bowel obstruction.
  • 🎭 Tumors can block bowels leading to obstruction.
  • 🔄 Intussusception: bowel invaginates into itself.
  • 🌟 Hernia: intestine protrudes through abdominal wall.
  • 🔧 Volvulus: twisting of bowels causing blockage.
  • 🧠 Pseudo obstruction involves muscle or nerve issues.
  • 👶 Hirschsprung disease: congenital, affects bowel movement.
  • ⚠️ Complications: bowel ischemia, perforation, sepsis.

Cronología

  • 00:00:00 - 00:05:00

    This video begins by discussing bowel obstruction, focusing on the signs and symptoms such as nausea, vomiting, abdominal pain, and fever. The explanation highlights that bowel obstruction, a blockage in the small or large intestine, leads to food piling up, fostering bacterial growth due to accumulated nutrition, which can cause serious problems. The categorization of bowel obstruction into mechanical and pseudo-obstruction is introduced, with a primary focus on mechanical obstruction. The five main types of mechanical obstructions—adhesions, tumors, intussusception, hernia, and volvulus—are briefly defined. Adhesions, often post-operative, involve fibrous bridges between bowel segments, while tumors can grow large enough to cause obstructions. The terms intussusception and volvulus are defined, with intussusception being a rare occurrence where part of the bowel invaginates, often seen at the ileocecal valve, and volvulus involving the twisting of the bowel.

  • 00:05:00 - 00:13:10

    The explanation continues with further elaboration on mechanical bowel obstruction types and introduces pseudo-obstruction. Hernias are defined as bulges through body walls that can protrude both internally and externally, potentially leading to bowel obstruction. The discussion then turns to pseudo-obstruction, described as false blockages affecting bowel movement due to muscular or neural issues, and conditions like Hirschsprung's disease, a congenital issue with missing neural connections in the colon, are highlighted. The pathophysiology of bowel obstruction shows its progression from bacterial metabolism of piled-up food, leading to gas production and distention, to complications like ischemia from oxygen deprivation, tissue necrosis, and potential sepsis. Shock can arise from both hypotension due to fluid loss and systemic bacteria circulation. Lastly, complications such as bowel ischemia, perforation, and sepsis are summarized, emphasizing the serious impacts of untreated bowel obstructions.

Mapa mental

Vídeo de preguntas y respuestas

  • What are common symptoms of bowel obstruction?

    Symptoms include nausea, vomiting, cramping abdominal pain, distended abdomen, and fever.

  • What is an adhesion in bowel obstruction?

    Adhesion is when two parts of the bowel are connected by fibrous tissue, causing obstruction.

  • How does a tumor cause bowel obstruction?

    A tumor can grow within the bowel, leading to blockage as it constricts passage.

  • What is intussusception?

    Intussusception is a condition where a part of the bowel folds into another section, causing obstruction.

  • What is a volvulus?

    A volvulus is a bowel obstruction caused by twisting of a segment of the intestine around a fixed point.

  • What are the complications of bowel obstruction?

    Complications can include bowel ischemia, perforation, and sepsis.

  • How can bowel obstructions be categorized?

    Bowel obstructions can be categorized as mechanical or pseudo-obstructions.

  • What is Hirschsprung disease?

    Hirschsprung disease is a congenital condition where nerves are missing in the lower bowel, affecting movement.

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Subtítulos
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Desplazamiento automático:
  • 00:00:04
    in this video we're going to look at
  • 00:00:06
    bowel obstruction let's first begin with
  • 00:00:10
    the signs and symptoms and how a person
  • 00:00:12
    can present so the signs and symptoms of
  • 00:00:15
    a bowel obstruction include nausea
  • 00:00:18
    vomiting cramping abdominal pain ABS the
  • 00:00:22
    patient an inability to basically do a
  • 00:00:26
    poo diarrhea possibly there can be a
  • 00:00:30
    distended abdomen fever as well as
  • 00:00:33
    tachycardia
  • 00:00:35
    so bowel obstruction as the name
  • 00:00:38
    suggests is obstruction of the bowel it
  • 00:00:41
    can be of the small intestine or it can
  • 00:00:44
    be of the large intestine in this video
  • 00:00:47
    we're going to mainly focus on the small
  • 00:00:49
    intestine but it it applies for the
  • 00:00:52
    large as well so let's first draw an
  • 00:00:56
    obstructed bowel here I'm going to draw
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    a sphincter like thing in red just to
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    represent the obstruction and the
  • 00:01:11
    obstruction can be can be caused by many
  • 00:01:13
    things which we'll look at but
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    essentially if you have an obstruction
  • 00:01:16
    the food that we eat will pile up of
  • 00:01:20
    course and this can cause some serious
  • 00:01:23
    problems because you know normally in
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    the intestine we actually find bacteria
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    commensal organisms that live within our
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    intestine and when the bacteria is
  • 00:01:34
    exposed to all this nutrition it will
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    begin to grow essentially but before
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    looking at you know the pathophysiology
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    structuring can be categorized and it
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    can be categorized into a mechanical
  • 00:01:50
    obstruction or a pseudo obstruction let
  • 00:01:55
    us first focus on mechanical obstruction
  • 00:01:58
    and there are five main types of
  • 00:02:01
    mechanical obstruction the first type of
  • 00:02:04
    mechanical obstruction the most common
  • 00:02:06
    is what's known as an adhesion and it's
  • 00:02:09
    essentially where two two parts of the
  • 00:02:14
    bowel are basically are connected with
  • 00:02:16
    each other by a sort of fibrous
  • 00:02:18
    and so this is referred to as adhesion
  • 00:02:20
    and this can cause an obstruction the
  • 00:02:23
    other most common type of obstruction is
  • 00:02:25
    where we have essentially a tumor a
  • 00:02:28
    cancer growth within the bowel itself
  • 00:02:30
    and this can lead to an obstruction
  • 00:02:33
    another type of mechanical obstruction
  • 00:02:35
    is known as a interception interception
  • 00:02:41
    is essentially when up the part of the
  • 00:02:43
    bowel invaginate itself so there's some
  • 00:02:47
    terminal terminology we have to know
  • 00:02:49
    about interception and the first one is
  • 00:02:53
    the part of the bowel that goes into the
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    other part of the bowel this is known as
  • 00:03:01
    the into the septum and the part of the
  • 00:03:05
    bowel that is on the outside surrounding
  • 00:03:08
    it is now known as the into Sisyphean
  • 00:03:12
    another cause of a mechanical
  • 00:03:16
    obstruction a type of mechanical
  • 00:03:18
    obstruction is a hernia and a hernia is
  • 00:03:21
    essentially a protrusion of the part of
  • 00:03:24
    the intestine through the abdominal wall
  • 00:03:27
    because of because the up to the
  • 00:03:29
    abdominal wall can be weak for example
  • 00:03:31
    and this can sort of strangulate the
  • 00:03:33
    part of the intestine causing
  • 00:03:36
    obstruction finally the last type of
  • 00:03:39
    mechanical obstruction is referred to as
  • 00:03:42
    known as a volvulus and this is
  • 00:03:44
    essentially where we get twisting of the
  • 00:03:45
    bowel so now let us look at each of
  • 00:03:53
    these five types and sort of describe it
  • 00:03:57
    in a bit more detail the most common
  • 00:04:00
    cause of mechanical obstruction is
  • 00:04:03
    post-operative adhesion so this is
  • 00:04:06
    essentially when you have a surgery of
  • 00:04:09
    the of the abdominal cavity and opening
  • 00:04:13
    the abdominal cavity
  • 00:04:14
    it can cause fibrous and adhesions to
  • 00:04:17
    cause between segments of the bowel so
  • 00:04:21
    adhesions are fibrous bridges between
  • 00:04:23
    bowel segments adhesions cause extrinsic
  • 00:04:28
    compression of the bowel which thus can
  • 00:04:30
    lead to a
  • 00:04:31
    destruction now the cancer so colorectal
  • 00:04:37
    cancer is a common and lethal disease
  • 00:04:42
    and risk factors for cancer of the bowel
  • 00:04:46
    include age family obesity inflammatory
  • 00:04:51
    bowel disease and certain diets so this
  • 00:04:56
    is self-explanatory a tumor can grow so
  • 00:04:59
    large that it can cause an obstruction
  • 00:05:01
    now interest is a interoception
  • 00:05:04
    intussusception is rare in adults
  • 00:05:07
    between about one to five percent of
  • 00:05:10
    mechanical bowel obstruction is a result
  • 00:05:12
    of intussusception common sight of
  • 00:05:15
    intussusception is the ileocecal valve
  • 00:05:18
    so this is essentially when the the
  • 00:05:22
    valve the ileocecal valve just basically
  • 00:05:24
    goes invaginate into the cecum resulting
  • 00:05:29
    in an interception the next type of
  • 00:05:32
    mechanical obstruction is hernia which
  • 00:05:34
    is defined as a protrusion bulge or
  • 00:05:37
    projection of an organ or a part of an
  • 00:05:41
    organ through the body wall that
  • 00:05:43
    normally contains it hernias can be
  • 00:05:47
    internal or external so in the diagram
  • 00:05:49
    above we have a example of a hernia that
  • 00:05:52
    is bulging out the intestine that is
  • 00:05:55
    bulging out of the abdominal cavity
  • 00:05:57
    which is the wall that normally contains
  • 00:05:59
    it the last type of mechanical
  • 00:06:01
    obstruction we'll talk about is the
  • 00:06:02
    volvulus which is twisting other
  • 00:06:04
    segments of the intestine around a fixed
  • 00:06:06
    point common sites of our volvulus
  • 00:06:10
    include the cecum and sigmoid area of
  • 00:06:13
    the colon I'm a small bowel adhesion
  • 00:06:17
    adhesion the small bowel can lead to a
  • 00:06:20
    volvulus so those are examples of
  • 00:06:25
    mechanical obstruction adhesions cancer
  • 00:06:28
    intussusception hernia and volvulus now
  • 00:06:31
    let's look at pseudo obstruction suit
  • 00:06:34
    obstruction as the name implies is
  • 00:06:36
    pseudo false obstruction false
  • 00:06:38
    obstruction but regardless it does
  • 00:06:41
    result in an obstruction of the bow
  • 00:06:43
    so the main examples we look at our
  • 00:06:46
    myopathy problems with the muscle and
  • 00:06:48
    neuropathy problems with the innervation
  • 00:06:52
    of the bowel and then we'll look at a
  • 00:06:56
    specific type of condition known as
  • 00:06:58
    hirschsprung disease hirschsprung
  • 00:07:01
    disease affects the distal part of the
  • 00:07:04
    colon so am i Appa fee problem with the
  • 00:07:08
    muscles result in no movement no
  • 00:07:11
    peristaltic contraction and thus this
  • 00:07:15
    can lead to an obstruction because the
  • 00:07:17
    food just doesn't go through a
  • 00:07:20
    neuropathy problems the nerve
  • 00:07:22
    innervation of the bowel means that we
  • 00:07:26
    can have no innervation of the smooth
  • 00:07:27
    muscles which means we we have abnormal
  • 00:07:30
    movement so we get an obstruction
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    finally hirschsprung disease is a
  • 00:07:36
    congenital condition so it's present in
  • 00:07:40
    the baby
  • 00:07:41
    and this is where we have nerves that
  • 00:07:43
    are missing at the distal end of the
  • 00:07:45
    colon which means that we have no - no
  • 00:07:50
    or abnormal peristaltic contractions so
  • 00:07:53
    movement and this can mean that we can
  • 00:07:58
    have a obstruction our surgery can
  • 00:08:02
    correct this so regardless of the cause
  • 00:08:07
    you know pseudo obstruction or
  • 00:08:09
    mechanical obstruction it results in
  • 00:08:11
    obstruction and an obstruction means
  • 00:08:13
    that the material the substance that we
  • 00:08:16
    eat cannot pass through our bowels
  • 00:08:17
    smoothly it accumulates in the area and
  • 00:08:20
    this can result in a few things so let's
  • 00:08:22
    just go back to the diagram here and
  • 00:08:24
    look at what what it can cause so food
  • 00:08:28
    that pileups here can be metabolized by
  • 00:08:31
    the bacteria that are normally residing
  • 00:08:33
    in the area to produce gas gas
  • 00:08:35
    accumulates causing a bowel causing
  • 00:08:39
    bowel distension bowel distension you
  • 00:08:43
    know it can compress the vessels that
  • 00:08:44
    supply the bowel so we can have venous
  • 00:08:46
    compression when we have venous
  • 00:08:49
    compression this means that we have
  • 00:08:51
    decrease in oxygen supply to the area to
  • 00:08:54
    the bowel and thus we have the
  • 00:08:57
    increase in oxygenation decrease in
  • 00:08:59
    oxygenation results in a few things
  • 00:09:01
    firstly because we have no oxygen supply
  • 00:09:04
    to the bow the cells of the intestine
  • 00:09:07
    die second no oxygen supply decreases
  • 00:09:11
    peristalsis further aggravating the
  • 00:09:13
    bowel distension so essentially we have
  • 00:09:16
    more distension decrease in oxygenation
  • 00:09:19
    also promotes the bacteria in the area
  • 00:09:22
    to enter circulation because they are
  • 00:09:24
    anaerobic they can enter circulation so
  • 00:09:27
    when the bacteria enter the circulation
  • 00:09:29
    and when we have the intestinal cells
  • 00:09:31
    dying all this essentially are toxic and
  • 00:09:35
    they all these are these are toxins that
  • 00:09:37
    can enter the circulation resulting in
  • 00:09:40
    some form of sepsis septic reaction so
  • 00:09:44
    that was one aspect of of it further
  • 00:09:48
    when we breathe air goes down you know
  • 00:09:51
    our intestine is normal but this
  • 00:09:55
    realistically aggravates the bowel
  • 00:09:57
    distension it promotes the distinction
  • 00:09:59
    of the bowel so again we have you know
  • 00:10:02
    bowel distension and it's compresses the
  • 00:10:05
    vessels we get venous compression and
  • 00:10:07
    when we have venous compression which we
  • 00:10:10
    haven't looked at it can actually result
  • 00:10:12
    in fluid being secreted because of all
  • 00:10:15
    the fluid piling up in this area
  • 00:10:17
    it just gets secreted out into the bowel
  • 00:10:21
    when fluid is being secreted into the
  • 00:10:24
    bowel we lose water and when we lose
  • 00:10:27
    water we lose electrolytes and when we
  • 00:10:31
    lose electrolytes and water
  • 00:10:33
    this results in hypotension so we
  • 00:10:36
    actually get shock so bowel distension
  • 00:10:39
    simply results in hypotension also when
  • 00:10:44
    we get a distinction of the bowel this
  • 00:10:47
    sort of triggers some nerves in the
  • 00:10:49
    bowel which sends signals up to the
  • 00:10:51
    brain to trigger the vomiting response
  • 00:10:56
    because the brain thinks that there's
  • 00:10:58
    something wrong in this area and it
  • 00:11:00
    wants to get rid of it so vomiting is
  • 00:11:02
    triggered
  • 00:11:03
    but vomiting doesn't really help this
  • 00:11:05
    the killer scenario because when we
  • 00:11:08
    vomit we lose water and we also lose
  • 00:11:11
    electrolyte which result in hypertension
  • 00:11:14
    again so we get shock hypovolemic shock
  • 00:11:18
    so shock can result from hypotension or
  • 00:11:21
    shock can result from sepsis which is
  • 00:11:23
    when we get you know the bacteria
  • 00:11:25
    entering the circulation so I hope that
  • 00:11:28
    all made sense but the complications of
  • 00:11:31
    bowel obstruction can be three main
  • 00:11:33
    things one bowel ischemia which we just
  • 00:11:36
    means that we have decreased supply of
  • 00:11:38
    oxygen to the bowel to perforation
  • 00:11:41
    if the bowel is distended first you know
  • 00:11:44
    so much it can perforate three sepsis
  • 00:11:48
    when the toxins of the bacteria enters
  • 00:11:50
    circulation due to the necrosis of the
  • 00:11:53
    area etc necrosis of tissue of the area
  • 00:11:56
    so again when we have venous compression
  • 00:12:01
    I mean this means that a healthy liver
  • 00:12:03
    doesn't get a blood supply to it and
  • 00:12:06
    though and thus it dies and when it dies
  • 00:12:09
    this releases toxins to circulation it
  • 00:12:11
    also allows the bacteria to move from
  • 00:12:13
    the bowel into circulation
  • 00:12:16
    number two the complication perforation
  • 00:12:19
    so here we have the lumen of the bowel
  • 00:12:21
    if it if the bowel grows distends due to
  • 00:12:24
    the gas buildup and the air and whatnot
  • 00:12:26
    it essentially perforates releasing gut
  • 00:12:29
    content into the peritoneum
  • 00:12:32
    this can cause peritonitis causing a
  • 00:12:34
    massive problem next sepsis sepsis is
  • 00:12:38
    due can be due to the perforation and
  • 00:12:40
    due to the systemic dissemination due to
  • 00:12:43
    the death the dying cells in the area so
  • 00:12:47
    that was a sort of an overview of bowel
  • 00:12:50
    obstruction the different types of bowel
  • 00:12:52
    obstruction which is mechanical and
  • 00:12:54
    pseudo obstruction as well as we looked
  • 00:12:56
    at the pathophysiology and the
  • 00:12:57
    complications associated with bowel
  • 00:12:59
    obstruction I hope you enjoyed this
  • 00:13:01
    video thank you for watching
  • 00:13:09
    you
Etiquetas
  • bowel obstruction
  • adhesion
  • tumor
  • intussusception
  • hernia
  • volvulus
  • mechanical obstruction
  • pseudo obstruction
  • complications
  • Hirschsprung disease