Chapter 9 - Diseases of the Abdominal Cavity
Introduction to Diseases of the Abdominal Cavity
Acute Inflammation of the Liver
Chronic Inflammation of the Liver
Congestion of the Liver
Passive Congestion of the Liver
Cirrhosis of the Liver
Acute Inflammation of the Spleen
Chronic Inflammation of the Spleen
Gall Stones
Acute Inflammation of the Stomach
Chronic Inflammation of the Stomach
Heart Burn
Cramps in the stomach
Water Brash
Milk Sickness
Acute Inflammation of the Peritoneum
Chronic Inflammation of the Peritoneum
Acute Inflammation of the Bowels
Chronic Inflammation of the Bowels
Cancer of the Intestine
Intestinal Obstruction
Air Swellings
Bilious Colic
Painters' Colic
Chronic Diarrhea
Cholera Morbus
Asiatic Cholera
Chronic Dysentery
Acute Inflamation of the Kidneys
Chronic Inflamation of the Kidneys
Acute Inflammation of the Bladder
Chronic Inflammation of the Bladder
Disease of the Supra Renal Capsules
Bright's Disease
Simple Home Tests for Urine - Diagram
Bleeding from the Kidneys
Suppresion of Urine
Retention of Urine
Inability to Hold Urine
Uric Acid Gravel
Phosphatic Deposits
Oxalic Deposits
Urate of Ammonia Deposits
Hippuric Acid Deposits
Cystine Deposits
Bladder Stones
Dropsy of the Belly
General Dropsy

9.26 Intestinal Obstruction

Intestinal Obstruction.

This is a mechanical interference with the movements of the feces, and is caused either by intussusceptions or invagination, constriction, twists, stricture or hernia. These conditions are frequently produced by irregular movements of the bowels as a whole, and by irregular movements in various parts of the same, there being an increased peristalsis in one part and constipation in an adjacent part. Many cases of intussusceptions occur at the ileocoacal valve, the small bowel entering the large bowel and being driven downward. The circulation of the bowels is naturally interfered with, and intense congestion occurs, with swelling and final obstruction of the caliber of the gut. Pain becomes paroxysmal and peritonitis ensues. Pain increases, with vomiting and the discharge of mucoid stools; finally the patient dies of exhaustion.
Constriction of the bowel forms the larger proportion of cases and is not infrequently caused by fibrous bands which are the result of inflammation. Strangulation may be produced by a loop being held down by such bands or by being twisted about it. Intestinal obstruction, ulceration, and even perforation are common results.
A twist or volvulus is also a cause of obstruction, though less common than the two causes just mentioned, and occurs generally near the sigmoid flexure.
Stricture of the bowel usually occurs at the sigmoid flexure, or in the rectum, and is not usually complete, some small amount of fecal matter still escaping. Tumors, Eke cancer, not infrequently cause stricture by their compression.
Functional obstruction occurs chiefly in hysterical females, but also in disease of the brain and spinal cord, as well as from peritonitis and blows on the abdomen. It is the result of a paralysis of the bowel. impaction of feces is still another frequent cause of obstruction.
The contents of the bowels, especially in the rectum, become hard, blocking the passage till quite a perceptible bunch may be felt externally. The channel is not always blocked completely. Gallstones may become impacted near the ileo caecal valve in their passage downward, and form the starting point of the fecal accumulation.
These various causes produce either acute or chronic obstruction.

Symptoms. In the acute variety, pain, vomiting and constipation are the prominent symptoms. There are at first some digestional disturbances, with moderate pain. Afterwards the pain becomes severe, even intense, and is usually located near the seat of the obstruction. It is at first colicky and intermittent, but finally becomes continuous and severe over the whole abdomen. Vomiting sets in, first of food, then later of bile, and finally stereoraceous if the obstruction becomes complete. Vomiting occurs whether the obstruction is in the large or small bowel. Before the close of the scene this vomiting assumes a rice water like character, perhaps attended with hiccough.
There is an absence of the passage of wind, although at first some small amount of fecal matter may pass. In intussusceptions there are usually bloody discharges in addition to constipation. The abdomen of course soon becomes tympanitic or swollen, and sounds of water and gas may be heard very distinctly.
The general symptoms are those of a very grave disease, restless. ness, cold extremities, pinched features, and cold, clammy skin. The pulse is small, the temperature generally subnormal, tongue dry, and thirst very pronounced.
In the event of chronic obstruction, all these symptoms appear very much more gradually. Pain is less severe, vomiting often absent till the obstruction becomes complete. The fecal matter may often be several feet long before the obstruction becomes severe. Longstanding constipation which does not respond to proper laxatives should arouse suspicion. The stools themselves are often ribbon like in shape and very small, not infrequently resembling the feces of sheep.
The prognosis of obstruction of the bowels is usually very grave, and the duration of life varies from a few hours to ten or twelve days. The higher up the obstruction, the worse the prognosis. Simple fecal impaction perhaps offers the most hope ; next those cases amenable to surgical interference.

Treatment. Opium to relieve pain and to stop the exaggerated peristaltic movement in parts of the bowel above the obstruction is surely indicated; it also relieves the vomiting. Continued, large enemas of suds and oil, and even the addition of turpentine, should be resorted to at once as soon as the trouble has been made out. These are best given with the hips elevated, and should consist of four to six quarts of water; they are to be given slowly and without much force. Oftentimes an anesthetic is needed.
If the obstruction is from fecal impaction, small, repeated doses of some saline should be used; say two ounces of the solution of the citrate of magnesia every two hours. Castor oil in teaspoonful doses hourly till movement occurs is also good. But if the obstruction is from intussusceptions, twist, stricture, etc., all laxatives must be strictly interdicted. Finally, these simple means failing and the case be suspected to be due to impaction by foreign bodies, fibrous bands, etc., the abdomen must be opened and the seat of the obstruction found and if possible removed. The operation in this class of cases is not attended with a great percentage of recoveries, and yet the fatal termination is much surer if left alone ; in many cases it is brilliantly successful.
External methods of treatment by hot fomentations of turpentine, and even of massage, often add greatly to a favorable termination.
The diet must be very light and nutritious, and in case of vomiting must be given by the rectum. After the obstruction has been relieved, one must be very careful about the diet and see that the bowels are open daily.

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