Intestinal Obstruction - Small Bowel Obstruction vs Large Bowel Obstruction

00:07:09
https://www.youtube.com/watch?v=rJw26uA-F9M

摘要

TLDRThe video explains intestinal or bowel obstruction, which can arise from mechanical blockages or functional issues affecting the gastrointestinal tract. It details the differences between small and large bowel obstructions, with small bowel obstructions being more prevalent, often due to post-surgical adhesions, hernias, or inflammatory conditions. Symptoms include abdominal pain, vomiting, and constipation, with diagnosis involving physical exams and imaging techniques. Treatment options range from conservative management to surgical interventions, depending on the obstruction's cause and severity.

心得

  • 🩺 Intestinal obstruction can be mechanical or functional.
  • 🔍 Small bowel obstructions are more common than large bowel obstructions.
  • 🧵 Post-surgical adhesions are a leading cause of small bowel obstruction.
  • ⚠️ Symptoms include abdominal pain, vomiting, and constipation.
  • 🩸 Diagnosis involves physical exams and imaging studies.
  • 💉 Treatment may be conservative or surgical based on the cause.
  • 🔧 Surgery can involve resection or anastomosis of the bowel.
  • 🚑 Complications include dehydration and electrolyte imbalances.
  • 🧪 Blood tests can indicate underlying issues like cancer or ischemia.
  • 🛠️ A stoma may be necessary in severe cases.

时间轴

  • 00:00:00 - 00:07:09

    Intestinal or bowel obstruction can arise from mechanical blockages or functional issues affecting the propulsion of digested contents. Mechanical obstructions are categorized into small and large bowel obstructions, each with distinct causes: extramural (outside the bowel wall), mural (within the wall), and intraluminal (inside the bowel lumen). Small bowel obstructions are more prevalent, often due to post-surgical adhesions, hernias, or neoplasms. Mural causes include inflammatory strictures and intussusception, while intraluminal causes can involve gallstone ileus or foreign bodies. Large bowel obstructions, accounting for 20% of cases, are frequently caused by colorectal adenocarcinoma, diverticular disease, or volvulus.

思维导图

视频问答

  • What is intestinal obstruction?

    Intestinal obstruction is a condition caused by a mechanical blockage or a functional issue that prevents the proper movement of digested contents through the gastrointestinal tract.

  • What are the common causes of small bowel obstruction?

    Common causes include post-surgical adhesions, hernias, neoplasms, inflammatory strictures, and intraluminal causes like gallstone ileus.

  • How is large bowel obstruction typically caused?

    The most common cause of large bowel obstruction is colorectal adenocarcinoma, accounting for about 60% of cases.

  • What symptoms are associated with bowel obstruction?

    Symptoms include abdominal pain, vomiting, constipation, and abdominal distension.

  • How is bowel obstruction diagnosed?

    Diagnosis involves physical examination, blood tests, and imaging studies like CT scans or abdominal X-rays.

  • What are the treatment options for bowel obstruction?

    Treatment can be conservative with IV fluids and monitoring, or surgical, depending on the cause and severity of the obstruction.

  • What is the role of surgery in bowel obstruction?

    Surgery may involve repairing hernias, removing tumors, or resecting blocked regions, often with anastomosis.

  • What complications can arise from bowel obstruction?

    Complications include electrolyte imbalances, dehydration, aspiration pneumonia, and acute kidney injury.

  • What is the significance of post-surgical adhesions?

    Post-surgical adhesions are bands of scar tissue that can cause intestines to kink or twist, leading to obstruction.

  • What is a stoma?

    A stoma is an opening created in the abdomen for waste to exit the body, often needed in severe cases of bowel obstruction.

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  • 00:00:00
    intestinal or bowel obstruction is a
  • 00:00:02
    condition that comes
  • 00:00:04
    from either a mechanical blockage of the
  • 00:00:06
    bowels or
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    a functional issue where the bowels no
  • 00:00:09
    longer propel
  • 00:00:10
    digested contents properly through the
  • 00:00:14
    gastrointestinal tract
  • 00:00:15
    mechanical bowel obstruction can be
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    divided
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    into small bowel or large bowel
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    obstructions
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    and generally each have different causes
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    which are mostly divided
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    into extramural meaning outside the wall
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    of the bowel
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    mural meaning within the wall of the
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    bowel and intraluminal
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    meaning inside the bowel lumen small
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    bowel obstruction
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    is more common than large bowel
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    obstruction with around 80 percent
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    being small bowel the most common cause
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    for small bowel obstruction
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    are post-surgical adhesions they are
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    bands of scar tissue
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    that form as a result of the surgery and
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    can cause the affected tissue
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    to stick together which in the case of
  • 00:00:56
    the intestines can
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    make them kink or twist leading to an
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    obstruction
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    around sixty six percent of people will
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    have post operations
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    with ten to twenty five percent of these
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    patients
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    going on to develop an obstruction
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    adhesions can
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    also occur in some instances without
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    surgery
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    hernias are another common cause in
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    particular
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    inguinal hernias neoplasm can also cause
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    small bowel obstruction
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    but this is typically due to external
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    compression
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    rather than a cancer of the small bowel
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    itself
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    mural causes include inflammatory
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    strictures such as in crohn's disease
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    and we may also see interception which
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    is where part of the bowel
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    passes into a contiguous piece like a
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    telescope
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    another is meccal's diverticulum and
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    these two
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    are more common in children intraluminal
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    causes
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    include a gallstone ileus where a larger
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    gallstone
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    may pass into the intestine via a
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    fistula between the gallbladder
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    and the intestine ingested foreign
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    bodies may also cause an intraluminal
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    small bowel obstruction large bowel
  • 00:02:03
    obstructions
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    make up around 20 of mechanical
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    obstructions
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    extramural causes include diverticular
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    disease
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    involving strictures usually at the
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    sigmoid colon
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    and also volvulus which is a twisting of
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    the bowel
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    again in this instance it's most
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    commonly seen
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    at the sigmoid colon however the most
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    common cause overall
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    for a large bowel obstruction is
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    colorectal adenocarcinoma
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    which is responsible for around 60
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    percent of cases
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    an intraluminal cause could be fecal
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    impaction
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    patients with intestinal obstruction
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    will typically manifest an abdominal
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    pain
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    which in small bowel obstruction is
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    usually a cramping
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    or colicky pain in the center of the
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    abdomen
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    due to peristalsis that may be working
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    against the obstruction
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    while in large bowel obstructions the
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    spasms typically last longer
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    or is continuous and is felt lower in
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    the abdomen
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    this pain is often accompanied with
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    abdominal distension
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    vomiting is also likely with proximal
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    obstructions
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    suffering from vomiting earlier than
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    more distal obstructions
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    also obstructions that are in the small
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    bowel are more likely to vomit
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    bilious material or even undigested food
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    contents
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    while in large bowel obstructions
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    vomiting may be fecular
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    constipation may also be seen but in
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    this case
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    it is the opposite in that it happens
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    sooner in distal obstructions
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    while it is a late finding in proximal
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    obstructions
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    as a result of the obstruction the
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    patient may have electrolyte imbalances
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    and dehydration due to the vomiting as
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    well as therefore
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    a risk for aspiration pneumonia in terms
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    of the diagnosis
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    the physical exam will typically show
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    tenderness on palpation
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    but signs such as guarding or rebound
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    tenderness
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    may suggest the perforation or ischemia
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    of the bowel
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    bowel sounds are characteristically
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    tinkly sounding like
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    bubbles rising blood tests are done as
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    the full blood count
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    may show a microcytic anemia which would
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    be consistent with a colorectal cancer
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    while leukocytosis may suggest ischemia
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    or perforation
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    especially if combined with a raised
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    lactate
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    as mentioned we may also see electrolyte
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    imbalances
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    with hypokalemia being frequent and a
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    high creatinine
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    may indicate an acute kidney injury
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    which is a common complication
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    due to the vomiting and dehydration the
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    preferred imaging modality
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    is a ct scan of the abdomen and pelvis
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    with contrast
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    especially as it can help in
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    pre-operative planning
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    another imaging modality is an abdominal
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    x-ray
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    where you may see dilated gas-filled
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    loops
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    or air fluid levels which can indicate
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    obstruction
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    in some instances it's possible to
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    determine if a small or large bowel
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    obstruction is present
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    based on the bands on the bowels these
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    are known as the horse straw
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    of the large bowel which do not go all
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    the way across the bowel
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    while the valvulate convents in the
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    small bowel do
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    however this may vary with position and
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    exposure
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    therefore it is not perfectly reliable
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    there is also a rule of sizes
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    where the small bowel is normally
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    smaller than three centimeters
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    the large bowel less than six
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    centimeters unless they're at the cecum
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    which is less than nine centimeters some
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    patients
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    may require surgery while others can be
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    managed conservatively
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    conservative management is selected when
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    there is no suspicion of ischemia
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    or perforation and the management will
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    include iv
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    fluids as well as monitoring the urine
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    output
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    usually using a catheter the urine
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    output should be above
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    0.5 milliliters per kilogram per hour
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    and the patient will likely be made nail
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    by mouth and a nasogastric tube placed
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    in order to decompress the bowel as the
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    ng tube can drain
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    the gi contents however in obstructions
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    where no previous surgery has taken
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    place
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    and therefore is unlikely to have
  • 00:06:15
    adhesions
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    surgery is more likely to be required
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    the type of surgery is dependent on the
  • 00:06:21
    cause
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    therefore may involve a reparation of a
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    hernia or a section of a tumor
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    there may also be a resection of the
  • 00:06:28
    blocked region
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    with a rejoining of the newly formed two
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    ends
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    this is termed an anastomosis this is
  • 00:06:36
    particularly true
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    in patients with colorectal cancer who
  • 00:06:39
    may undergo a hemicolectomy
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    where half of the colon is removed in
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    some instances
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    a stoma may be needed which is an
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    opening of the bowels onto the skin
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    stenting is another possibility which is
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    seen often in palliative cases
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    in order to reduce symptoms however this
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    is also sometimes done
  • 00:06:59
    as a bridge to surgery
标签
  • intestinal obstruction
  • bowel obstruction
  • mechanical blockage
  • small bowel
  • large bowel
  • adhesions
  • hernia
  • colorectal cancer
  • diagnosis
  • treatment