Bowel obstruction

Bowel obstruction is an outcome of the passage of intestinal contents due to mechanical obstruction or by functional impairment. Depending on the reasons distinguish mechanical (tumor or cicatricial stenosis of the intestine, compression from the outside, etc.) and dynamic (innervation disorders, paralysis, complications of drug therapy, etc.), intestinal obstruction, high (impede the level of the small intestine) and low (lesions of the colon). The main symptoms of intestinal obstruction: long delay emptying (in some cases there may be diarrhea), flatulence in the absence of a discharge gas, abdominal pain (prystupovydni, spastic character), violent peristalsis (in later stages - intestinal atony), nausea and vomiting (in later stages with high obstruction - vomiting stagnant contents of the stomach, low - intestinal contents with fecal odor).

The degree of expression of obstruction can be compensated, and decompensated subcompensated.

When compensated (chronic) occlusion clinical manifestations are mild, detention stools and bloating occur periodically over time. With dynamic obstruction symptomatic therapy (antispasmodics, enemas, laxatives) and prescriptions that increase motility of the gastrointestinal tract (koordynaks, peristyle, ubretyd, galantamine, metoclopramide, Reglan, Reglan) take effect.

Development of decompensation means that violation of the passage of intestinal contents shall neobotniy nature, often due to mechanical obstruction, at least - on the background of progressive intestinal atony. Severity of clinical grows: nausea and vomiting, increased flatulence, develops intoxication. In such cases, appointed intensive infusion therapy and urgently (within 2-3 hours) decision about the need for emergency intervention hirurihchnoho. This is a very important decision taken collectively, with mandatory participation surgeon, with the following points: the denial of emergency operations will lead to the development of fatal complications, surgery can take really extend the life of the patient, without deepening his suffering, the risk of surgery is much less risk of serious complications, the patient and his relatives fully informed about the possible risks and their choice is deliberate.

It may happen that the severity of the general condition of the patient makes any surgery too dangerous and hopeless in terms of prolongation of life (the patient would still die in the near future due to disease progression). In such cases, the consent of the family and the patient made ​​an informed decision to refuse surgery, in terms of the contraindications to it. In case of cancellation transactions must be documented appointment necessary symptomatic therapy in full, to the maximum possible withdrawal of the patient from suffering.

Ascites

Ascites - abnormal accumulation of free fluid in the abdomen (often) occurs as a result of the following reasons: kantseromatoz peritoneum, retroperitoneal lymph node metastatic lesions, accompanied by violation of lymph, hypoalbuminemia, profound violation salt obinu (as a consequence of high levels of aldosterone) supporting cardiogenic pathology.

Clinical manifestations of ascites depends on the amount of free fluid: increased abdominal discomfort in the abdomen, feeling of fullness, indigestion, belching, reflux, nausea and vomiting, shortness of breath, swelling of the lower extremities.

Conservative treatment of ascites include application specific anticancer chemotherapy (including intravenous, intraperitoneal or endolymphatic) treatment of accompanying diseases, if it is the cause of fluid accumulation, use of diuretics. Diuretics are used long-term, controlled performance of potassium in the blood, with hypokalemia and prophylactically prescribe potassium (asparcam, Panangin). Furosemide is prescribed individually, starting dose 20 80 mg. Lazilakton (furosemide + spironolactone) has a less pronounced effect on mineral metabolism, the initial dose to 4 tablets. Spironolactone (veroshpiron), potassium and mahniyzberezhuyuchyy diuretic, taking a daily dose of 100-200 mg 1 per day. After a week, if necessary, the dose is doubled and, subsequently adjusted depending on the achieved effect. Bumetanide assigned to 0.5-2 mg 1 time per day.

In cases when conservative therapy is ineffective, requires evacuation of fluid through celiocentesis. This surgical manipulation should be carried out in strict accordance with the principles of asepsis and antisepsis, medicinal rem, which has relevant experience. After manipulation morning nakladuyetsya bandage and, in most cases, to prevent leakage of ascitic fluid - seam. The bandage should be kept until they are healed. In principle, it is possible and permanent drainage of the abdominal cavity, but in practice it is rarely used, often performing repeated puncture of the abdominal cavity. Treatment of ascites does not require adherence to a special diet, with some restrictions salty foods. No need to control and fluid intake. Eating should be smaller portions, but more often.