pertaining to the intestine.
a surgical procedure in which all but a short section of the proximal jejunum and terminal ileum is bypassed in order to bring about malabsorption of digested food. The procedure is done for the purpose of correcting obesity
. Patients having this type of surgery must be meticulously managed so that severe nutritional cirrhosis
and serious loss of water and electrolytes are avoided. Called also jejunoileal bypass
and jejunoileal shunt
intestinal flu a popular term for what may be any of several disorders of the stomach and intestinal tract. The symptoms are nausea, diarrhea, abdominal cramps, and fever. During the acute stage all foods should be avoided. Carbonated soft drinks such as ginger ale or cola can be taken in moderation to relieve the nausea. When the symptoms subside, the diet should at first be confined to liquids and soft, bland foods. Milk and dairy products, butter and fats generally, fruits, and greens should be avoided completely until the patient is free of all symptoms.
any hindrance to the passage of the intestinal contents. Causes may be mechanical or neural or both. Some of the more common mechanical causes are hernia
of the peritoneum, volvulus
, malignant or benign tumor, congenital defect, and local inflammation, as in diverticulitis
. Failure of peristalsis (adynamic ileus
) is frequently associated with peritonitis
; it also may occur with gallstones
, heavy metal poisoning
, infection, and spinal injury.
. The most characteristic symptoms are abdominal pain, vomiting, and distention. The symptoms may be mild at first and in its early stages the condition can be confused with less serious disorders of the intestinal tract. Under no circumstances should the patient be given a cathartic
or other laxative
, because that will aggravate the situation. If the obstruction continues the patient suffers from dehydration and shock because of inadequate absorption of fluids, electrolytes, and nutrients from the intestinal tract. If the bowel becomes strangulated and circulation to the bowel wall is obstructed, the patient shows signs of peritonitis with extreme tenderness and rigidity of the abdomen.
Diagnosis. The diagnosis of obstruction can usually, but not always, be made from plain abdominal radiographs. If there is a question, a gastrointestinal series with barium will usually resolve the issue quickly.
. The basic steps of treatment are decompression of the intestine, replacement of fluids and electrolytes, and removal of the cause of the obstruction. Decompression is accomplished by intubation with a special tube (usually the miller-abbott tube
) designed to reach past the pyloric sphincter and into the intestine. Constant suction is then applied to remove accumulations of gas and liquids. Fluids, sodium chloride, and glucose are administered intravenously at a specific rate as prescribed. Transfusions of whole blood plasma may be given as necessary to restore normal blood values.
Surgical removal of the cause of obstruction is necessary in cases of complete obstruction. If there is no evidence of strangulation of the bowel, the surgeon may choose to postpone surgery until dehydration and shock have been overcome and a normal electrolyte balance is restored. The type of surgical procedure performed depends on the cause of the obstruction and whether or not the intestine is gangrenous. In some cases a colostomy may be necessary along with removal of the damaged portion of the bowel. A surgical incision into the cecum with insertion of a drainage tube (cecostomy
) may be done when intestinal intubation is not successful in relieving distention.
. Assessment of the patient with intestinal obstruction includes noting the location and character of abdominal pain, degree of distention, character of the bowel sounds, and occurrence or absence of bowel movements or passing of flatus. Should defecation occur, a specimen is saved for examination and laboratory analysis. If there is vomiting, the amount and special characteristics of the vomitus should be noted and recorded. In severe cases of obstruction of the small bowel the vomitus may contain fecal material because of the reversal of peristalsis and forcing of the intestinal contents backward into the stomach. Foods and fluids by mouth are restricted. Frequent mouth care is necessary to relieve the dryness and foul taste that accompanies intestinal obstruction and vomiting. Urinary output is measured and recorded because of the possibility of decreased urinary output related to dehydration.
Preoperative Care. If conservative measures fail to relieve the obstruction, or if the bowel has become strangulated, surgery is indicated. Suction siphonage, once initiated, is continued and the intestinal tube is left in place when the patient goes to the operating room.
Routine postoperative care of the patient with abdominal surgery is indicated. Specific measures depend on the type of surgical procedure done. Suction siphonage is usually continued until peristalsis resumes. Results of the assessment of bowel sounds and the passing of flatus or feces should be noted on the patient's chart because they indicate a return of normal peristaltic movements of the bowel. In some cases a cecostomy tube or rectal tube is inserted during surgery; the tube is attached to a drainage system and the amount and type of material collected in the system are recorded. If there is evidence that the tube has become obstructed the surgeon should be notified. The skin around the site of insertion of a cecostomy tube should be protected with a skin barrier. The area must be washed frequently to avoid erosion of the skin by intestinal contents leaking around the tube. (See colostomy
for patient care after that procedure.)
the small and large intestines in continuity; this long, coiled tube is the part of the digestive system
where most of the digestion of food takes place. (See color plates.) The small intestine
has three parts: the duodenum
(connected to the stomach), the jejunum
, and the ileum
. The small intestine is small in diameter but very long (about 6.1 m). The large intestine,
which starts just below the ileum, is about 1.5 m long. It is made up of the cecum
(to which the appendix
is attached), the colon
(comprising the ascending, transverse, and descending colon and the sigmoid), and the rectum
The digestion of food is completed in the small intestine. The digested food is absorbed through the walls of the small intestine into the blood. Indigestible parts of the food pass into the large intestine. Here the liquid from the wastes is gradually absorbed back into the body through the intestinal walls. The waste itself is formed into fairly solid feces and pushed down into the rectum for evacuation.
Among the disorders of the intestinal tract are the disturbances of function, such as diarrhea
, and irritable bowel syndrome
; the organic diseases, ulcerative colitis
, and ileitis
; and communicable diseases, such as dysentery
. Irritable bowel syndrome is characterized by constipation, sometimes alternating with diarrhea. Ulcerative colitis is a disorder in which ulcers may appear in the wall of the large intestine. Ileitis is a disorder of the ileum, or lower portion of the small intestine. A symptom of both is diarrhea. Dysentery, which is characterized by diarrhea, is the result of infection by bacteria, viruses, or various parasites.
pertaining to the intestine.
sudden change in normal intestinal structure or disposition, e.g. intestinal volvulus
relics of inflammatory incidents binding loops of intestine together or to peritoneum; have the effect of obstruction or luminal constriction.
see colonic aganglionosis.
intestinal amphistomiasis intestinal arterial thromboembolism intestinal atony
occurs reflexly as a result of peritonitis, of severe inflammation or distention in other parts of the alimentary tract and abdominal viscera, or directly as a result of severe inflammation, as distinct from the early excitation or movement that occurs with mild or early inflammation. See also paralytic
a rare disease of the horse manifested by an acute, highly fatal diarrhea associated with the presence in the gut of large numbers of Clostridium perfringens type A.
by a tissue mass, e.g. tumor, organ enlargement, causing partial or complete obstruction.
by adhesion, local blood clot causing partial or complete obstruction.
simple, branched, tubular invaginations of mucosa at the base of the villi.
the causes of the dilatation are fluid, feces or flatus (gas). All cause pain of varying degree, and initially an increase in motility, followed by atony. In distention of long duration, e.g. with feces, the distended bowels are easily palpable and are usually the cause of some abdominal distention. In acute dilatation the distention and palpability of the loops of intestine are less obvious and later in their appearance than other signs.
causing partial or complete obstruction, e.g. displacement of the colon in horses.
may cause intestinal compression and obstruction, e.g. Meckel's diverticulum.
intestinal fibrinous casts
gelatinous, sausage-shaped masses, like casts of the intestinal lumen, resulting from severe inflammation and protein loss from the bowel wall.
fluids in the lumen of the intestine; the balance between intake and absorption of these fluids determines the form of the feces; disruption can cause diarrhea or constipation.
intestinal foreign body
has most importance as a cause of intestinal obstruction. It may also cause laceration and intestinal hemorrhage or penetration of the intestinal wall and the development of peritonitis.
resulting from chronic local inflammation; cause constriction of the intestinal lumen.
into the small intestine causes the appearance of red-black feces (melena); from the large intestine the appearance is typical of whole blood, which may be mixed homogeneously with feces or be scattered through them as clots.
intestinal hemorrhage syndrome intestinal hypermotility
causes abdominal pain, increased gut sounds, diarrhea and decreased opportunity for the absorption of nutrients. It occurs as a result of irritation to the intestinal lining, as in enteritis, to stimulation of the parasympathetic nervous system by the use of parasympathomimetic drugs, or to changes in the composition of the gut contents such as occurs when there is a malabsorption problem.
occurs as a result of distention and as a major part of the response to enterotoxic Escherichia coli toxin. The effect is to increase the fluidity of the gut contents; diarrhea results.
intestinal idiopathic muscular hypertrophy
ileal muscular hypertrophy.
intestinal ileocecal valve impaction
see intestinal obstruction colic
passage of a loop of intestine through a small orifice, e.g. inguinal canal, with resulting swelling, obstruction and occlusion of blood supply.
may be nonstrangulating, presenting a clinical picture of subacute but still fatal colic, or strangulating, e.g. when torsion precedes the development of the infarct, a much more acute and potentially fatal situation; see thromboembolic colic
, intestinal infarction
intestinal intramural hematoma
causes a swelling in the bowel wall and partial obstruction of the lumen.
intestinal linear foreign body intestinal lipofuscinosis
brown discoloration of the intestinal muscularis, especially the terminal small intestine.
any hindrance to the passage of the intestinal contents. Causes may be acute
, such as those caused by foreign body, phytobezoar, intussusception, volvulus and strangulation. There is sudden onset of abdominal pain, cessation of feces evacuation, vomiting in dogs and cats, gastric distention in horses, rumen distention in ruminants, loops of intestine distended with fluid and gas palpable per rectum or visible radiographically, shock and dehydration. Obstruction may also be chronic
and manifested by intermittent vomiting and abdominal pain, chronic intestinal distention, loud intestinal sounds, and palpable distended loops of intestine. See also intestinal obstruction colic
infestation of the intestinal lumen and wall by nematodes, cestodes and immature trematodes.
; may cause intermittent bowel obstruction or erratic passage of feces.
porcine intestinal hemorrhagic syndrome intestinal portals
openings to the closed foregut and hindgut of the embryo.
the patient presents a clinical picture of intestinal obstruction with no surgically correctable lesion, e.g. paralytic ileus.
is part of the reaction to increased gut motility resulting in gastric dilatation and the vomiting of intestinal contents, even feces.
can occur as a result of extreme distention. More commonly it follows compromise to a section of gut, e.g. strangulation, in which a necrotic section of gut wall collapses. The effects of perforation of the gut wall through a deep ulcer are similar but not so sudden. The result of a rupture is sudden death due to shock and endotoxemia. With a slower leak the result is an initial stage of acute peritonitis accompanied by fever and abdominal pain.
mild to obvious bowel dilation with mononuclear inflammatory infiltrate in the smooth muscle fibers plus interstitial fibrosis and atrophy of smooth muscle cells.
intestinal secretory-absorptive imbalance
includes excessive absorptive function, e.g. thrifty bowel syndrome, or over-secretion, the classical malabsorption syndrome, e.g. in enteric colibacillosis.
intestinal segmental ischemic necrosis of mares
occurs spontaneously in the small colon of pregnant or postpartum mares; intestinal rupture and death follow quickly.
intestinal smooth muscle intrinsic disease
see intestinal sclerosis (above).
constriction of the bowel lumen, as a result of incomplete aplasia, cicatricial contraction after injury or infection, leads to a syndrome of chronic or intermittent subacute abdominal pain.
occurs in an incarcerated hernia, umbilical, inguinal, mesenteric tear, uterine ligament, or a volvulus. There may be a double problem of acute intestinal obstruction plus an intestinal infarction characterized by profound shock and toxemia, paralytic ileus and a blood-stained paracentesis specimen. Less severe but still lethal strangulations occur as a result of tightening of a lipoma pedicle, displacement of dorsal colon in the horse over the gastrosplenic ligament.
is a common cause of acute intestinal obstruction. There is an obstruction to the movements of contents and compromise to the circulation of the twisted segment.
the small and large intestines in continuity. The long, coiled tube of the intestine is the part of the digestive system where most of the digestion of food takes place. The small intestine has three parts: the duodenum, jejunum and ileum; the large intestine, the cecum, colon and rectum.
is part of most cases of intestinal obstruction. Primary cases of intestinal tympany are rare and confined in their occurrence to the horse. See also flatulent colic
Patient discussion about intestinal
Q. I recently had my surgery for bowel obstruction? I recently had my surgery for bowel obstruction? None of the diet was restricted for me by doctor but should I go for any special diet.
A. I had surgery in 08/08 during having a c-section and hernia repair, and I'm having diarrhea all the time. I don't know what to eat nor what medicines to take. Only Immodium AD helps temporary. If I have an appointment, I don't eat breakfast or lunch. I come home and eat dinner. About 30 minutes after eating, I'm in the bathroom. Can someone help me please? I have to return back to work next month, and I don't want to be in the bathroom more than I am at my desk.
Q. Can Alcoholism makes you vulnerable to intestine infections? A friend of mine is a heavy drinker, he had something like 5 infections in the past year. Is it connected?
Q. What is the connection between bowel disease and arthritis? My son suffers from ulcerative colitis, and the doctor said that his recent joint pain can be as a result of the colitis. Why is that?
A. Although ulcerative colitis happens mainly in the colon, it is a systemic disease, and patients may present with symptoms and complications outside the colon. These include musculoskeletal complications such as arthritis (for instance- ankylosing spondylitis). The exact mechanism of this injury is unknown. More discussions about intestinal