Difference between revisions of "Intestinal Obstruction"
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==Signalment== | ==Signalment== | ||
*No breed predisposition | *No breed predisposition | ||
*No sex predilection | *No sex predilection | ||
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==Description== | ==Description== | ||
| − | '''Intestinal obstruction''' can be classified as acute or chronic, partial or complete, simple or incarcerated. The cause of the obstruction can be intraluminal, extraluminal or intramural. Most common causes of intestinal obstruction include [[Intussusception|intussusception]], neoplasia and foreign body. [[Intussusception|Intussusception]] is more likely in young animals with a history of gastroenteritis or intestinal surgery. Cats frequently present with linear foreign bodies. Other less common causes include intestinal torsion/volvulus and incarcerated intestinal obstruction. Neoplasia is more commonly present in middle-aged to older animals. | + | '''Intestinal obstruction''' can be classified as acute or chronic, partial or complete, simple or incarcerated. The cause of the obstruction can be intraluminal, extraluminal or intramural. Most common causes of intestinal obstruction include [[Intussusception - WikiClinical|intussusception]], neoplasia and foreign body. [[Intussusception - WikiClinical|Intussusception]] is more likely in young animals with a history of gastroenteritis or intestinal surgery. Cats frequently present with linear foreign bodies. Other less common causes include intestinal torsion/volvulus and incarcerated intestinal obstruction. Neoplasia is more commonly present in middle-aged to older animals. |
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==Diagnosis== | ==Diagnosis== | ||
===Clinical Signs=== | ===Clinical Signs=== | ||
| − | The clinical presentation depends on the cause, severity, and the site of obstruction. Upper small intestinal obstruction causes a net fluid secretion whereas lower small intestinal obstruction causes a net fluid resorption. [[Antibiotic Responsive Diarrhoea|Antibiotic responsive diarrhoea]] is more likely to occur in distal small intestinal obstruction. | + | The clinical presentation depends on the cause, severity, and the site of obstruction. Upper small intestinal obstruction causes a net fluid secretion whereas lower small intestinal obstruction causes a net fluid resorption. [[Small Intestinal Bacterial Overgrowth and Antibiotic Responsive Diarrhoea - WikiClinical|Antibiotic responsive diarrhoea]] is more likely to occur in distal small intestinal obstruction. |
====Simple obstruction==== | ====Simple obstruction==== | ||
| − | *[[ | + | *[[Stomach and Abomasum Consequences of Gastric Disease - Pathology|Vomiting]]; the further the obstruction is towards the mouth, the frequency and the volume is higher |
*Moribund or in septic shock; in cases where part of the intestine becomes devitalised, resulting in septic peritonitis | *Moribund or in septic shock; in cases where part of the intestine becomes devitalised, resulting in septic peritonitis | ||
*Abdominal foreign body, mass or obstructive ileus may be palpable | *Abdominal foreign body, mass or obstructive ileus may be palpable | ||
====Incarcerated intestinal obstruction==== | ====Incarcerated intestinal obstruction==== | ||
| − | *Acute [[ | + | *Acute [[Stomach and Abomasum Consequences of Gastric Disease - Pathology|vomiting]] |
*Abdominal pain | *Abdominal pain | ||
*Depression | *Depression | ||
| − | *[[Shock#Endotoxic shock|Endotoxic shock]] with toxic mucous membranes and tachycardia | + | *[[Shock - Pathology #Endotoxic shock|Endotoxic shock]] with toxic mucous membranes and tachycardia |
====Intestinal torsion/volvulus==== | ====Intestinal torsion/volvulus==== | ||
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*nausea | *nausea | ||
*retching | *retching | ||
| − | *[[ | + | *[[Stomach and Abomasum Consequences of Gastric Disease - Pathology|vomiting]] ± bloody diarrhoea |
*acute abdomen | *acute abdomen | ||
*abdominal fluid accumulation | *abdominal fluid accumulation | ||
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====Linear foreign body==== | ====Linear foreign body==== | ||
| − | *[[ | + | *[[Stomach and Abomasum Consequences of Gastric Disease - Pathology|Vomiting]]; food, bile and/or phlegm |
*Anorexia, depression | *Anorexia, depression | ||
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===Laboratory Tests=== | ===Laboratory Tests=== | ||
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*Hypochloraemia and hypokalaemia acid-base derangement is common in animals with intestinal obstruction. | *Hypochloraemia and hypokalaemia acid-base derangement is common in animals with intestinal obstruction. | ||
*Metabolic alkalosis ± aciduria may occur with upper duodenal obstruction. | *Metabolic alkalosis ± aciduria may occur with upper duodenal obstruction. | ||
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===Diagnostic Imaging=== | ===Diagnostic Imaging=== | ||
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====Ultrasonography==== | ====Ultrasonography==== | ||
Most of the time, this is a more sensitive technique in revealing the cause of the obstruction compared to radiography. Dilation and thickening of the wall of the intestine may be revealed. | Most of the time, this is a more sensitive technique in revealing the cause of the obstruction compared to radiography. Dilation and thickening of the wall of the intestine may be revealed. | ||
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===Histopathology=== | ===Histopathology=== | ||
*Fine needle aspirate may be warranted before surgery if a mass is suspected, such as lymphoma. | *Fine needle aspirate may be warranted before surgery if a mass is suspected, such as lymphoma. | ||
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==Treatment== | ==Treatment== | ||
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==Prognosis== | ==Prognosis== | ||
This depends on type and severity of obstruction. A simple obstruction with no signs of septic peritonitis has a good prognosis. The prognosis is better in cases where there is no large resection of the intestines. On the other hand, the prognosis is grave if there are signs of [[Neoplasia - Pathology #The Process of Metastasis|metastatic]] neoplasia. | This depends on type and severity of obstruction. A simple obstruction with no signs of septic peritonitis has a good prognosis. The prognosis is better in cases where there is no large resection of the intestines. On the other hand, the prognosis is grave if there are signs of [[Neoplasia - Pathology #The Process of Metastasis|metastatic]] neoplasia. | ||
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==References== | ==References== | ||
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*Hall, E.J, Simpson, J.W. and Williams, D.A. (2005) '''BSAVA Manual of Canine and Feline Gastroenterology (2nd Edition)''' ''BSAVA'' | *Hall, E.J, Simpson, J.W. and Williams, D.A. (2005) '''BSAVA Manual of Canine and Feline Gastroenterology (2nd Edition)''' ''BSAVA'' | ||
*Nelson, R.W. and Couto, C.G. (2009) '''Small Animal Internal Medicine (Fourth Edition)''' ''Mosby Elsevier''. | *Nelson, R.W. and Couto, C.G. (2009) '''Small Animal Internal Medicine (Fourth Edition)''' ''Mosby Elsevier''. | ||
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[[Category:Intestine_-_Mechanical_Obstruction]] | [[Category:Intestine_-_Mechanical_Obstruction]] | ||
[[Category:To_Do_-_Clinical]] | [[Category:To_Do_-_Clinical]] | ||
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Revision as of 12:16, 28 June 2010
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This article has been peer reviewed but is awaiting expert review. If you would like to help with this, please see more information about expert reviewing. |
Signalment
- No breed predisposition
- No sex predilection
Description
Intestinal obstruction can be classified as acute or chronic, partial or complete, simple or incarcerated. The cause of the obstruction can be intraluminal, extraluminal or intramural. Most common causes of intestinal obstruction include intussusception, neoplasia and foreign body. Intussusception is more likely in young animals with a history of gastroenteritis or intestinal surgery. Cats frequently present with linear foreign bodies. Other less common causes include intestinal torsion/volvulus and incarcerated intestinal obstruction. Neoplasia is more commonly present in middle-aged to older animals.
Diagnosis
Clinical Signs
The clinical presentation depends on the cause, severity, and the site of obstruction. Upper small intestinal obstruction causes a net fluid secretion whereas lower small intestinal obstruction causes a net fluid resorption. Antibiotic responsive diarrhoea is more likely to occur in distal small intestinal obstruction.
Simple obstruction
- Vomiting; the further the obstruction is towards the mouth, the frequency and the volume is higher
- Moribund or in septic shock; in cases where part of the intestine becomes devitalised, resulting in septic peritonitis
- Abdominal foreign body, mass or obstructive ileus may be palpable
Incarcerated intestinal obstruction
- Acute vomiting
- Abdominal pain
- Depression
- Endotoxic shock with toxic mucous membranes and tachycardia
Intestinal torsion/volvulus
Acute and severe onset of:
- nausea
- retching
- vomiting ± bloody diarrhoea
- acute abdomen
- abdominal fluid accumulation
- depression
Linear foreign body
- Vomiting; food, bile and/or phlegm
- Anorexia, depression
Laboratory Tests
Haematology
- Mild dehydration to septic shock
Biochemistry
- Hypochloraemia and hypokalaemia acid-base derangement is common in animals with intestinal obstruction.
- Metabolic alkalosis ± aciduria may occur with upper duodenal obstruction.
Diagnostic Imaging
Radiography
- Plain abdominal radiography may be all that is needed to reveal the cause of the obstruction. Gas and fluid accumulation may be visible due to intestinal dilation. Decreased serosal detail indicates peritoneal fluid accumulation and free gas in the abdomen suggests perforated intestines. Gravel sign due to food particle accumulation may be present. Displacement, bunching or plication may also be seen.
- Contrast radiography may be needed if ileus and obstruction cannot easily be distinguished. However, this may not always be feasible in an emergency situation.
Ultrasonography
Most of the time, this is a more sensitive technique in revealing the cause of the obstruction compared to radiography. Dilation and thickening of the wall of the intestine may be revealed.
Histopathology
- Fine needle aspirate may be warranted before surgery if a mass is suspected, such as lymphoma.
Treatment
Stabilisation
Fluid balance, electrolyte and acid-base derangements are common in a vomiting animal. These need to be addressed prior to anaesthesia.
Antimicrbial
Broad spectrum antimicrobials, such as ampicillin or cephalosporin combined with metronidazole, are usually given prophylactically prior to surgery. This is vital if there are signs of sepsis or intestinal compromise.
Surgery
Once stabilised, the animal can be taken to surgery. Removal or resection of the obstruction is required.
Prognosis
This depends on type and severity of obstruction. A simple obstruction with no signs of septic peritonitis has a good prognosis. The prognosis is better in cases where there is no large resection of the intestines. On the other hand, the prognosis is grave if there are signs of metastatic neoplasia.
References
- Ettinger, S.J. and Feldman, E. C. (2000) Textbook of Veterinary Internal Medicine Diseases of the Dog and Cat Volume 2 (Fifth Edition) W.B. Saunders Company.
- Hall, E.J, Simpson, J.W. and Williams, D.A. (2005) BSAVA Manual of Canine and Feline Gastroenterology (2nd Edition) BSAVA
- Nelson, R.W. and Couto, C.G. (2009) Small Animal Internal Medicine (Fourth Edition) Mosby Elsevier.