intestinal obstruction by: maj asrar ahmad mbbs, fcps mbbs, fcps (senior registrar paeds surgery)...
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INTESTINAL OBSTRUCTIONINTESTINAL OBSTRUCTION
By: Maj Asrar AhmadBy: Maj Asrar Ahmad MBBS, FCPSMBBS, FCPS (Senior Registrar Paeds Surgery)(Senior Registrar Paeds Surgery)
“Neither sun shall rise nor set on patient of intestinal obstruction”
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SequenceSequence
PathophysiologyPathophysiology PresentationPresentation ManagementManagement CausesCauses Hypertrophic pyloric stenosisHypertrophic pyloric stenosis Intestinal MalrotationIntestinal Malrotation
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PathophysiologyPathophysiology
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PresentationPresentation
PainPain vomitingvomiting Absolute constipationAbsolute constipation Abdominal distentionAbdominal distention
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InvestigationsInvestigations
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ManagementManagement
NPONPO Nasogastric aspirationNasogastric aspiration Intravenous fluidsIntravenous fluids AntibioticsAntibiotics SurgerySurgery
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5’ Hs5’ Hs
HypothermiaHypothermia HypoxiaHypoxia HypovolemiaHypovolemia HypoglycaemiaHypoglycaemia HypoprothrombinaemiaHypoprothrombinaemia
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CausesCauses
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CausesCauses
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Infantile Hypertrophic Pyloric StenosisInfantile Hypertrophic Pyloric Stenosis
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Presentation Presentation
1-4/10001-4/1000 4 weeks4 weeks PolyhydramniosPolyhydramnios Non bilious vomitingNon bilious vomiting DehdrationDehdration Visible peristalsisVisible peristalsis Pyloric Pyloric OLIVEOLIVE
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Metabolic Changes Metabolic Changes
HypokalaemiaHypokalaemia
HypocholraemiaHypocholraemia
AlkalosisAlkalosis
Paradoxical AciduriaParadoxical Aciduria
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InvestigationsInvestigations
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InvestigationsInvestigations
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ManagementManagement
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Intestinal MalrotationIntestinal Malrotation
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EmbryologyEmbryology
5%
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EmbryologyEmbryology
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EmbryologyEmbryology
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Presentation Presentation
1/200 – 1/500 1/200 – 1/500 Male: Female:- 2:1 Male: Female:- 2:1
Age at presentation:Age at presentation: 40-50% 1st month 50-75% 1st year 75-100% >1 year of age
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Presentation Presentation Acute Midgut Volvulus Acute Midgut Volvulus Chronic Midgut volvulusChronic Midgut volvulus Acute duodenal obstructionAcute duodenal obstruction Chronic duodenal obstructionChronic duodenal obstruction Internal herniationInternal herniation Caecal volvulusCaecal volvulus AsymtomaticAsymtomatic
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Presentation Presentation
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Associated AnomaliesAssociated Anomalies Congenital diphragmatic herniaCongenital diphragmatic hernia
Abdominal wall defectsAbdominal wall defects Omphalocele or gastroschisis
Duodenal atresia 50%Duodenal atresia 50%Jejunal atresia 30%Jejunal atresia 30%Meckel’s diverticulumMeckel’s diverticulumHirschsprung’s diseaseHirschsprung’s diseaseImperforate anusImperforate anusEsophageal atresiaEsophageal atresia
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InvestigationsInvestigations
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Ladd’s ProcedureLadd’s Procedure
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Ladd’s ProcedureLadd’s Procedure
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