general management of intestinal obstruction arindam roy medical college kolkat

GENERAL MANAGEMENTOF INTESTINAL OBSTRUCTION

- by ARINDAM ROY 8th semester

ALGORITHM FOR MANAGEMENT OF A CASE OF INTESTINAL OBSTRUCTION

LABORATORY INVESTIGATION

• COMPLETE BLOOD COUNT - 1. TLC2. HAEMATOCRIT VALUE • SERUM UREA AND CREATININE• SERUM ELECTROLYTES• LIVER FUNCTION TEST• SERUM AMYLASE

SUPPORTIVE TREATMENT

SUPPORTIVE TREATMENT

1. Nasogastric AspirationS

• Non-vented Ryle’s tube• Vented Salem tube

Role of nasogastric aspiration

• Reduce bowel distension• Improve pulmonary ventilation• Reduce risk of subsequent aspiration during

induction of anesthesia and post extubation

2. Fluid and electrolyte replacement

• I.V. fluid - to correct the fluid loss• Electrolyte solution - to make up electrolyte

deficiency mainly sodium loss• Hartmann’s solution or normal saline used• Volume required to be determined by clinical

hematological and biochemical criteria

3. Parenteral antibiotics

• Broad spectrum antibiotics- Ampicillin, Gentamycin, Metronidazole, Cephalosporins

• To correct bacterial infection• Mandatory for all patients undergoing small

or large bowel resection

4. Blood Transfusion• FFP or platelet transfusions• Often needed in critical patients

5. ICU Critical Care• For systemic management of complications

like ARDS, DIC, SIRS• If hypotension- Dopamine/Dobutamine

6. Indwelling Catheter

• Perurethral• To collect and measure 24 hours urine output• Intake and output chart is made

7. CVP For Fluid And Monitoring

• PCWP (pulmonary capillary wedge pressure) monitoring

• Needed in haemodynamically unstable patients

8. Clinical Follow UpIMPROVEMENT• Conservative treatment

is carried on.

DETERIORATION• Surgery indicated if no

improvement occurs with in 24-48 hours