volvulus
TRANSCRIPT
VOLVULUS
PRESENTATION OUTLINEDefinition CausesIncidencePathophysiologyClinical featuresDiagnostic investigationPredisposing factorsNursing intervention
OUTLINE CONT’Treatment Pre-Operative CarePost Operative CareComplicationsCare plan (Nursing Diagnosis and
outcomes)References
VOLVULUS
It is the term applied to twisting of a loop of bowel so that the mesenteric vessel and the lumen of the bowel become occluded. It therefore is an obstruction of the bowel.
Volvulus
Obstruction caused by twisting of the intestines more than 180 degrees about the axis of the mesentery
1-5% of large bowel obstructions◦ Sigmoid ~ 65%◦ Cecum ~25%◦ Transverse colon ~4%◦ Splenic Flexure
TYPES OF VOLVULUSVolvulus neonatorumVolvulus of the small intestineCeacal volvulus (volvulus of the caecum)Sigmoid volvulus (which is most
common and responsible for most intestinal obstruction)
Gastric volvulus
GASTRIC VOLVULUS (ORGANO-AXIAL)
GASTRIC VOLVULUS (MESENTERO-AXIAL)
GASTRIC VOLVULUS (Combined Volvulus)
Sigmoid Volvulus
CAUSESNo actual cause is known but certain
predisposing conditions which results or complicates into volvulus will be discussed in subsequent slides.
PREDISPOSING FACTORSPerson’s with a redundant colonOne with a normal anatomic variation
resulting in extra colonic loopsPatients with muscular dystrophy due to
the smooth muscle dysfunctionCongenital intestinal malrotationAbnormal intestinal contents e.g.
meconium ileus or adhesions
PREDISPOSING FACTORS TO GASTRIC VOLVULUS CONT’Abnormalities of adjacent organs
like:Diaphragm (hernia, rupture,
nerve palsy)Liver (dislocation)Spleen (splenomegaly, wandering
spleen, polyspenia)
INCIDENCEOccurs commonly in middle aged and
elderly people especially in men.
PATHOPHYSIOLOGYThe sigmoid colon twists upon itself
resulting in the intestinal obstruction (vovulus) which could be:
Acute (total vascular impairment)Sub-acute (without vascular impairment)Chronic (twisting occurs followed by a
correction but twisting reoccurs this time to form a double knot known as ileosigmoid knotting which involves the sigmoid colon and ileum.
CLINICAL FEATURESAbdominal distension and vomiting Ischemia (loss of blood flow) to the
affected portion of intestineAbsolute constipationThere may be visible peristalsis as well as
features of peritonitisSevere pain and progressive injury to the
intestinal wall
CLINICAL FEATURES CONT’Accumulation of gas and fluid in the
portion of the bowelNecrosis of the affected intestinal
DIAGNOSTIC INVESTIGATIONS
This includes:An Upper GI series (the use of barium
meal swallow to perform a GIT radiography)
A Digital rectal examination with rectal tube
And the taking of a straight x-ray film of the abdomen
Barium Enema
NURSING INTERVENTIONAdminister analgesics required to client
to ease off painEncourage client to avoid copious foods
that will induce vomitingGive anti-emetics prescribed.IV fluid administration is done to replace
body fluids and prevent acidosis by maintaining electrolyte balance.
NURSING INTERVENTION CONT’
Examine abdomen for distension and tenderness
Auscultate for bowel sounds and movements
TREATMENTThis is a surgical intervention done by
untwisting the gut in a procedure called sigmoidoscopy (sigmoidoscopic reduction)
Also laparotomy can be done to have a sigmoid resection or untwisting
Incision into the abdomen to untwist the knot (volvulus) and possibly resecting any unsalvageable portion
Operative management for sigmoid volvulus
Elective resection◦ Same admission
Emergent laparotomy◦ Operation depends on
viability of the bowel Resection and
anastomosis Hartmann resection Exteriorization resection Detorsion Detorsion with colopexy Percutaneous colostomy Percutaneous
sigmoidpexy
PRE-OPERATIVE ACTIVITIESExplain procedure to client and relief of
psychological stressSkin preparations e.g. Shaving the abdomenGive patient a low residue diet to have less
stools formedAntibiotic administration 3-5 days before
surgery in an attempt to decrease the bacteria of the bowel content with the aim of decreasing wound infection. E.g. include neomycin, streptomycin, etc
PRE-OPERATIVE ACTIVITIES CONT’A nasogastric or intestinal tube is inserted
before operation and connected to a suction machine to clear the intestinal contents.
POST OPERATIVE ACTIVITIES
Until peristalsis return, anything to be given is introduced parenteral
Moisten mouth with clean water as a result of dryness created by anaesthetic agent
All fluids given as infusions should be recorded
Catheterize patient to ease difficulty in voiding and to prevent urine retention
POST OPERATIVE ACTIVITIES CONT’Give opiod analgesics to relieve painEncourage patient to do deep breathing
and to change position every 1 hourManage rectal tube sutured in the anus to
facilitate the passage of stoolDrugs such as neostigmine is given to
prevent straining the intestine during expulsion
Early ambulation to start peristalsis
COMPLICATIONS
A serious condition that could result in death especially in the acute type of volvulus.
NURSING DIAGNOSISPain in patient related to bowel
obstruction
High risk for fluid volume deficit related to fluid shifts and losses from vomiting.
Fear and anxiety of patient and family related to undergoing invasive procedures
EXPECTED OUTCOMESPain will subside in 3-5 hrs as normal
peristaltic movements returns to normal and allow oral intake of foods
Patient will maintain a normal electrolyte balance and skin turgor within 24 hrs.
Fear and anxiety will be alleviated by making client have the confidence and conviction that all will be well.
REFERENCESColmer. M.R. Moroney’s Surgery for
Nurses, London: Churchil Livingston.Bloom. , A and Bloom, S.R. Toohey’s
Medicine for Nurses, London: churchil Livingstone
Reynolds Watson, J.E., Watson’s Medical-Surgical Nursing and Related Physiology, London: Baillierre Tindall.
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