ileus obstructive
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Ileus ObstructiveTRANSCRIPT
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Ileus Disusun Oleh :Fini AmaliaKarimah Ihda HusnayainMagista Vivi AnisaStevan Wedi Kurniawan
Pembimbing:dr. Pirma Hutauruk., Sp.B(K)Trauma
ANATOMY & PHYSIOLOGY DIGESTIVE TRACTThe Digestive Organs and the PeritoneumLined with serous membrane consisting ofSuperficial mesothelium covering a layer of areolar tissueSerosa, or visceral peritoneum:covers organs within peritoneal cavityParietal peritoneum:lines inner surfaces of body wallPeritoneal FluidIs produced by serous membrane liningProvides essential lubricationSeparates parietal and visceral surfacesAllows sliding without friction or irritation
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Histological Structure of the Digestive (GI) Tract
The MucosaIs the inner lining of digestive tractIs a mucous membrane consisting ofEpithelium, moistened by glandular secretionsLamina propria of areolar tissueThe Digestive Epithelium Mucosal epithelium is simple or stratifiedDepending on location, function, and stresses: oral cavity, pharynx, and esophagus:mechanical stresseslined by stratified squamous epitheliumstomach, small intestine, and most of large intestine:absorptionsimple columnar epithelium with mucous (goblet) cellsThe Digestive Epithelium Enteroendocrine cellsAre scattered among columnar cells of digestive epitheliumSecrete hormones that:coordinate activities of the digestive tract and accessory glands
5Peristalsis
Peristaltic MotionCircular muscles contract behind bolus:While circular muscles ahead of bolus relaxLongitudinal muscles ahead of bolus contract:Shortening adjacent segmentsWave of contraction in circular muscles:Forces bolus forward
6Small Intestine90% of absorption occurs in the small intestine
ILEUSObstructive ileusClassification Simple mechanical obstruction Bowel lumen is obstructed No vascular compromise Closed loop obstruction Both ends of a bowel loop are obstructed Results in strangulated obstruction if untreated Rapid rise in intraluminal pressure Strangulated obstructionBowel lumen and vascular supply is compromised
Classification Intrinsic bowel lesions Extrinsic bowel lesions Idiopathic bowel lesions Intrinsic bowel lesions Congenital anomalies (Pediatric) Atresia Stenosis Bowel duplicationStrictures
Intrinsic bowel lesions StricturesInflammatory Bowel DiseaseColon CancerIntussusception Gallstones that have entered the bowel lumen BezoarBarium Ascaris infection Tuberculosis Actinomycosis Diverticulitis
Extrinsic bowel lesions Adhesion Abdominal or pelvic surgery Presence of peritonitis or trauma
Hernia (higher risk for strangulation) Inguinal hernia (direct ,indirect) Internal hernias via mesenteric defectsObturator hernia
Small bowel volvulus Rare compared to colon volvulus Occurs in intestinal malrotation or adhesions
Symptoms Frequent and recurrent Generalized Abdominal Pain
Duration: Seconds to minutes Character: Spasms of crampy abdominal painFrequency Intermittent pain initially Every few minutes in proximal obstruction Constant pain suggests ischemia or perforation Symptoms Stool passage Initially may be present despite complete obstruction Later, obstipation (no stool) in complete obstruction
Symptoms more severe in proximal obstruction Severe, colicky abdominal pain Constant pain suggests ischemia or perforation Develops over hours and occurs every few minutes Bilious Emesis Mild abdominal distention
Signs Bowel sounds Initial: High pitched, hyperactive bowel sounds Later: hypoactive or absent bowel sounds
Tender abdominal mass Closed loop Bowel Obstruction may be palpable
Abdominal distention and tympany on percussion Indicates distal obstruction
Rectal examination for blood
Darm contour
Radiology: abdominal X-Ray Bowel distention proximal to obstruction Bowel collapsed distal to obstruction Upright or decubitus view: Air-fluid levels Supine view findings Sharply angulated distended bowel loops Step-ladder arrangement or parallel bowel loopsString of pearls sign (specific for obstruction)Pseudotumor Sign
Small Bowel Gas Pattern Centrally locatedSoft tissue across entire lumen
Colon Gas Pattern Peripheral LocatedMostly not overlappingHaustra markings24
Herring Bone
Coffee Bean
Step Ladder
Dilated Loops of Small Bowel with Air-Fluid levels Area of non-dilated small bowel. Absence of Air in the Colon.30Management: Conservative Therapy Fluid replacement
Bowel decompression Nasogastric TubeLong intestinal tube (eg. Cantor) offers no advantage
Antibiotic Indications (Not for routine use) Surgery planned Bowel ischemia or infarction Bowel perforation Cover Gram Negatives and AnaerobesSecond-generation CephalosporinManagement: surgical interventionSimple correctionBy-passEntero-cutaneus fistuleBowel ressection
OBSTRUCTIVE ILEUSPredictors of resolution without surgery Early postoperative bowel obstructionAdhesive obstruction (prior laparotomy) Crohn's diseaseIndications for surgery Inadequate relief with Nasogastric tube placement Persistant symptoms >48 hours despite treatment (strangulation)Neoplasms
Complications Intestinal Ischemia or infarction Bowel necrosis, perforation and bacterial peritonitis Hypovolemia Complications of surgical intervention if needed
Prognosis: Recurrence of obstruction due to adhesionsRisk after first episode: 53% Risk after more than one episode: 83%
ReferenciesSouba Wiley. ACS Surgery : Principles and practice. 6th EditionGerard M. Doherty: CURRENT DiaGNOSIS & Treatment: Surgery, 13th EditionThank For Your Attentions!!!