Clinical identify obstruction

(1) whether there is any obstruction exist under abdominal pain, vomiting, abdominal distension, anal stop defecation and the exhaust, And tone changes and X-ray examination, the diagnosis of intestinal obstruction in general it is not difficult. But there will be in clinical medicine diseases (acute gastroenteritis, the outbreak of food poisoning, angina, allergic Purple Xiao, etc.) as a mechanical intestinal obstruction and an operation led to the death of patients who required attention.
(2) is mechanical obstruction or obstruction former paralytic to be more surgery, which often do not have surgery, so the importance of identification. Diagnosis of the main mechanical intestinal obstruction basis, paroxysmal abdominal pain, accompanied by Music hyperthyroidism, abdominal Perspective see expanded mesocaval with liquid plane; diagnosis paralytic ileus is the main basis for: persistent abdominal distention pain, intestinal Wong Yin disappear, and more are due to the existence of disease, X-ray examination see all the small intestine and colon were evenly Flatulence. But bearing in mind the following two situations: a mechanical obstruction is not a reasonable processing, obstruction of the bowel muscles on excessive expansion, which finally led to the paralysis, expressed as a result of abdominal distention, abdominal pain gradually reduce the increase Music weaken or disappear the other is obstruction, perforation of the bowel necrosis, paroxysmal may alleviate the pain, the formation of secondary peritonitis could cause the intestinal paralysis, and cover up the original mechanical intestinal obstruction. Mechanical obstruction secondary to the primary intestinal paralysis and the identification of paralytic ileus, relying mainly on in detail about history, if patients have early onset of paroxysmal abdominal cramps, abdominal and have very consciously loud Music, after persistent pain to abdominal pain, abdominal beep vanished accordingly, can be diagnosed as mechanical intestinal obstruction secondary to the intestinal paralysis.
(C) is simple obstruction or strangulating obstruction lies in the importance of the two differential, strangulating intestinal obstruction prognosis serious, we must surgical treatment, and simple obstruction can be used to non-surgical treatment. Any of the following clinical features should be suspected strangulating intestinal obstruction: ① severe abdominal pain, seizures of intense, intermittent pain in the paroxysmal stage, there are still persistent abdominal pain; ② a shock early stage disease, and gradually increase, or an anti-shock after treatment, the improvement was not significant. ③ peritoneal irritation sign Obviously, the body temperature, pulse and white blood cell count has increased in the observation of trends; ④ vomiting up blood from the anus or the liquid, or intraperitoneal bleeding puncture aspiration of liquids; ⑤ abdominal distension asymmetry, abdominal tenderness to touch on the intestinal loop. Normally the light of the above characteristics, strangulating intestinal obstruction and simple obstruction of identification not have too much difficulty, but sometimes also cutter clinical intestinal outstanding performance, resulting in their inability to timely surgery, causing intestinal necrosis, peritonitis, most such situations Cable common in adhesions caused by intestinal wall shear zone pressure necrosis, and the only part of strangulating intestinal wall of Richter's incarcerated hernia, intestinal obstruction by the simple non-surgical treatment short period of time, not reduce abdominal pain, should consider implementation laparotomy.
(D) a small bowel obstruction or colonic obstruction because colonic obstruction may be closed loop, the treatment of gastrointestinal decompression more dissatisfied with the result, the need surgery as soon as possible, so identification is important. High small bowel obstruction, vomiting and a frequent earlier, water, acid and alkaline electrolyte imbalance serious abdominal distention not obvious; low of small bowel obstruction, vomiting in the evening, a large amount of vomiting often soiled the smell, abdominal distension significantly. Obstruction is characterized by abdominal pain often not significant, abdominal distension appeared earlier in the abdominal and peripheral, vomiting occurred very late. Colon X-ray examination within Flatulence obvious, and in the sudden suspension of obstruction, obstruction barium enema visible location.
(E) is the complete or partial obstruction of obstruction, slow disease development, defecation, exhaust; complete obstruction, the condition fast and heavy, with more than defecation, exhaust.
(6) What is the reason for obstruction sometimes difficult to determine, based on age, medical history, symptoms, signs, laboratory investigations, and other comprehensive analysis. Neonatal intestinal obstruction, mostly caused by congenital intestinal malformation; 2-year-old following a child, often frequent intestinal obstruction sets of reasons for children Pai insects history, can touch abdominal cord-like mass, and should be considered for roundworm ileus; after young people in vigorous exercise-induced strangulating intestinal obstruction, may be small volvulus; elderly simple obstruction to common colon cancer or plug. In addition, detailed examination of hernia should be a good site to see whether incarcerated hernia was the surgery, trauma or abdominal infection history, mostly caused by the adhesive ileus; heart disease, should consider the superior mesenteric vein thrombosis.