general management of intestinal obstruction arindam roy medical college kolkat
DESCRIPTION
Arindam Roy Medical College KolkatTRANSCRIPT
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