Master Intestinal Obstruction with Picmonic for Nursing RN

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Intestinal Obstruction

Intestinal-guy Obstructed
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An intestinal obstruction occurs when the contents of the gastrointestinal tract cannot pass through the intestines. Signs and symptoms of an obstruction include severe abdominal pain, vomiting, abdominal distension, high-pitched or absent bowel sounds, and increased or absent peristalsis. Fluid and acid-base problems accompany an intestinal obstruction with metabolic alkalosis occurring when an obstruction is high (upper duodenum) due to loss of HCl from vomiting and/or nasogastric suction and dehydration when the obstruction is located in the small intestine. Typically, dehydration and electrolyte imbalance does not usually occur with a large intestine bowel obstruction.
7 KEY FACTS
PARTIAL/EARLY OBSTRUCTION
Severe Abdominal Pain
Severed Abdominal Pain-bolt

Sudden onset of severe abdominal pain may be an early sign of an obstruction. The frequency of abdominal pain can vary depending on the type and location of the obstruction; mechanical obstruction of the bowel typically produces intermittent pain. Guarding and abdominal tenderness may be present upon physical examination. 

Vomiting
Vomit

Gradual onset of vomiting is characteristic of a distal, small bowel obstruction. If the obstruction is located higher in the intestine; however, vomiting may be projectile, containing bile and can result in temporary relief of abdominal pain. 

High Pitched Bowel Sounds
High Pitched Whistle and Bowel-bowl

If bowel sounds are present in a patient with an intestinal obstruction, they will be high-pitched and present above the level of the obstruction. Gurgling bowel sounds called borborygmi may also be audible due to hyperactive intestinal motility.

Abdominal Distention
Abdominal Distention

Though clinical manifestations vary depending on the location and type of obstruction, abdominal distention could be an early sign of an intestinal obstruction. Distention usually precedes the onset of constipation. 

Increased Peristalsis
Up-arrow Pear-on-stilts

Initially, when the bowel becomes obstructed, peristalsis may increase in an attempt to dislodge or resolve the obstruction. 

TOTAL/NEUROGENIC OBSTRUCTION
Absent Bowel Sounds
Silent Bowel-bowl

Bowel sounds may be completely absent in some cases of obstruction. Lack of bowel sounds usually indicates cessation of intestinal activity. A healthcare provider must listen to each abdominal quadrant for five minutes before concluding that bowel sounds are absent.

Paralytic Ileus
Wheelchair Eels

This occurs when intestinal peristalsis is absent; assessment will reveal a lack of bowel sounds. Paralytic ileus is common after surgery. 

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