Monday, November 30, 2009

Sakitnya perut..





( PICTURE OF SMALL INTESTINE - USUS KECIL)



"sakitnya perut...ish..!" ..Air mata Rosnah membasahi pipinya..Aku dah tak tahan ni..getus hatinya



"kenapa ni Senah...dari tadi lagi asyik dok mengeluh.." ibunya memandang ke arahnya..Rungsing melihat anak bongsunya menahan kesakitan



"Mak bawak Senah ke hospital sekarang ye..risaulah mak lihat senah , semakin lama makin sakit je nampak.."
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" saya dr. jenab..datang sebab sakit apa ye?"
" anak saya ni...dari semalam lagi sakit perut..tak pernah saya tengok dia sakit macam ni"

seterusnya Dr jenab menemuramah Rosnah:
HISTORY:
1)COLICKY ABDOMINAL PAIN ( SAKIT PERUT YANG DATANG - HILANG
2) NAUSEA ( RASA MUAL)
3) VOMITING ( MUNTAH)
4) NO BOWEL OUTPUT ( TIADA KENTUT ATAU BERAK)


RUPA-RUPANYA ROSNAH PERNAH ADA OPERATION BEBERAPA TAHUN DAHULU UNTUK APPENDICITIS ( UNDERWENT APPENDICECTOMY)





KEMUDIA, ROSNAH DIPERIKSA...
PHYSICAL EXAMINATION:

generally , patient is in pain, dehydrated. Not tachycardic, Blood pressure still within normal range. per abdomen, the abdomen is mildly distended, soft, tender on the Right iliac fosse. no guarding or rigidity. no mass palpable or visualized.


INVESTIGATION:
ABDOMINAL X-RAY AND CHEST ERECT



ABDOMINAL X-RAY:SMALL BOWEL DIILATATION
IMPRESSION: INTESTINAL OBSTRUCTION SECONDARY TO ADHESION

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INTESTINAL OBSTRUCTION:

What is a bowel obstruction?
A bowel obstruction happens when either your small or large intestine is partly or completely blocked. The blockage prevents food, fluids, and gas from moving through the intestines in the normal way. The blockage may cause severe pain that comes and goes.

Pathophysiology
Obstruction of the small bowel leads to proximal dilatation of the intestine due to accumulation of GI secretions and swallowed air.

This bowel dilatation stimulates cell secretory activity resulting in more fluid accumulation. This leads to increased peristalsis both above and below the obstruction with frequent loose stools and flatus early in its course.

Vomiting occurs if the level of obstruction is proximal. Increasing small-bowel distention leads to increased intraluminal pressures. This can cause compression of mucosal lymphatics leading to bowel wall lymphedema. With even higher intraluminal hydrostatic pressures, increased hydrostatic pressure in the capillary beds results in massive third spacing of fluid, electrolytes, and proteins into the intestinal lumen. The fluid loss and dehydration that ensue may be severe and contribute to increased morbidity and mortality.

Strangulated Small bowel Obtructions are most commonly associated with adhesions and occur when a loop of distended bowel twists on its mesenteric pedicle. The arterial occlusion leads to bowel ischemia and necrosis. If left untreated, this progresses to perforation, peritonitis, and death.

Bacteria in the gut proliferate proximal to the obstruction. Microvascular changes in the bowel wall allow translocation to the mesenteric lymph nodes. This is associated with an increase in incidence of bacteremia due to Escherichia coli, but the clinical significance is unclear.


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TREATMENT OF ACUTE INTESTINAL OBSTRUCTION

- GASTROINTESTINAL DRAINAGE
- FLUID AND ELECTROLYTE REPLACEMENT
- RELIEF OF OBSTRUCTION
- SURGICAL TREATMENT IS NECESSARY FOR MOST CASES OF INTESTINAL OBSTRUCTION BUT SHOULD BE DELAYED UNTIL RESUSCITATION IS COMPLETE , PROVIDED THERE IS NO SIGN OF STRANGULATION OR EVIDENCE OF CLOSE LOOOP OBSTRUCTION

sources:

BAILEY & LOVE'S SHORT PRACTICE OF SURGERY

3 comments:

AmberlyThrower said...

good~..................................................

cikgu sharifah said...

nice info, mc baru lepas buat laparoscopic appendictomy...

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