文档介绍：Intestinal obstruction
Anatomy
The jejunal mucosa is relatively thick with prominent plicae circulares; the mesenteric vessels form only one or two arcades with long vasa recta. The ileum is smaller in circumference and has thinner walls; the mesenteric vessels form multiple vascular arcades with short vasa recta.
Blood supply to the jejunoileum and distal duodenum is entirely from the superior mesenteric artery, which courses anterior to the third portion of the duodenum. The celiac artery supplies the proximal duodenum.
Physiology
Motility:
Peristalsis consists of intestinal contractions passing aborally at a rate of 1 to 2 cm/sec
contractions initiated by the migrating plex (MMC)
under the control of both neural and humoral pathways
ENDOCRINE FUNCTION
Obstruction
Etiology:
Common causes of small bowel obstruction in industrialized countries:
Clinical Manifestations and Diagnosis
Cardinal symptoms:
colicky abdominal pain
nausea
vomiting
abdominal distention
failure to pass flatus and feces
Physical Exam
distended abdomen
peristaltic waves
minimal or no bowel sounds
Mild abdominal tenderness with / without a palpable mass
Exam to rule out incarcerated hernias
Rectal exam
Radiologic and Laboratory Examinations
Plain abdominal radiographs: accuracy≈60%
-dilated loops of small intestine without evidence of colonic distention
-multiple air-fluid levels, often in a stepwise pattern
-demonstrate the cause of the obstruction
CT: for plex cases