Small Bowel ObstructionNameInstitutionDateSmall Bowel ObstructionIntroductionSmall Bowel Obstruction is a condition caused by a blockage in the small intestines. These obstructions are often caused by cancer, scar tissue, or hernia. In the US, most reported cases of Small Bowel Obstruction are as a result of previously conducted surgeries. After an operation, the bowel typically forms scar tissues called adhesions which can obstruct the small intestines (Baiu & Hawn, 2018). A patient risks developing Small Bowel Obstruction when they have had multiple surgeries that involve the bowel. When the bowel gets trapped in the operated adhesions, the patient may suffer from small bowel obstruction. In other cases, it becomes severe when the blood supply gets compromised; leading to the bowel tissues dying. When this happens, it may pose a threat to the patient’s life (Baiu & Hawn, 2018). A patient with severe obstruction may find it difficult or impossible to pass gas or stool, while a patient with partial obstruction may suffer from diarrhea.Causes and risk factorsMany factors can cause Small Bowel Obstruction. These causes may either be mechanical or non-mechanical. Mechanical obstructions refer to physical blockages that may restrict or prevent the flow of bowel matter through the system.. Some non-mechanical obstructions may include ileus or paralytic ileus which may occur when a foreign body interferes with the functioning of the digestive system. Other causes of non-mechanical obstruction may consist of diabetes, abdominal surgery, hypothyroidism, opioid medications, muscle disorders such as Parkinson’s disease, or infections. Mechanical obstructions may include adhesion tissue from adhesions, foreign bodies, volvulus, barbed sutures, hernias, pseudo-obstruction, intestinal atresia, tumors, and intussusceptions (Roses, Folkert, & Krouse, 2018).Adhesions refer to fibrous brands which form amid organs and tissues typically as the effect of injury particularly, during surgery (Roses, Folkert, & Krouse, 2018). Adhesions normally form naturally as part of the healing process of the body after surgery. Abdominal adhesions typically result from abdominal surgical procedures; they start forming within hours after surgery and may trigger the attachment of internal organs to other organs located in the abdominal cavity or to the surgical site. Adhesion-related pulling and twisting of internal organs may cause complications such as intestinal obstruction or abdominal pain. SBO (Small bowel obstructions) may occur as a result of post-surgical adhesion. Small bowel obstruction may occur when an adhesion kinks or pulls the small intestines and prevents content flow via the digestive tract. A barbed suture relates to a form of knotless surgical suture typified by barbs on the surface (Roses, Folkert, & Krouse, 2018). Conventional sutures depend on the ability of the surgeon to tie safe or secure knots. The improper cutting and burying of the suture’s end increases the risks of inadvertent attachment of the suture to the small bowel or the bowel’s mesentery. This, may, in turn, cause small bowel obstruction during the early postoperative period.Intussusception refers to a medical condition whereby an intestine’s section folds into the section directly ahead of it. Intussesception commonly occurs in the small bowel as opposed to the large bowel. Some of the symptoms of intussesception include bloody stool, abdominal boating, vomiting, and recurring abdominal pains; it typically causes small bowel obstruction. Other complications associated with intussesception include bowel perforation or peritonitis. Risk factors associated with intussesception in adults include intestinal tumors, bowel adhesions, and endometriosis (Gore et al., 2015). Intestinal atresia refers to any congenital intestinal malformation that causes bowel obstruction. The congenital malformation may be a rotation, absence, or stenosis (narrowing) of a section of the intestine. The defects mentioned above can occur in the large or small intestine. A volvulus occurs in instances where an intestine’s loop twists around its supporting mesentery and itself; this results in small bowel obstruction. Symptoms include bloody stool, constipation, vomiting, abdominal bloating, and abdominal pain. The risk factors associated volvulus include intestinal mal-rotation (a birth defect), abdominal adhesions, pregnancy, and hirschprung disorder. Cancerous tumors are likely to trigger small bowel obstruction by either developing within the intestinal wall, thereby blocking the intestines’ inner passageway, or by pressing the bowel’s outer side and pinching it closed (Gore et al., 2015).Pseudo-obstruction refers to a clinical disorder triggered by the acute impairment in the intestine’s capacity to push food through it. Pseudo-obstruction often presents the symptoms and signs of intestinal obstruction without the presence of lesion in the lumen of the intestines. Pseudo-obstruction’s clinical features include constipation, diarrhea, dysphagia, vomiting, severe distension, nausea, abdominal pain, and appetite loss (Ramnarine & Dronen, 2017). Pseudo-obstruction triggered by the mutation of the FLNA gene is typically inherited in a recessive pattern (X-linked). Pseudo-obstruction triggered by the mutation of the ACTG2 gene is inherited or passed on to the offspring in an autosomal dominant pattern. The inheritance of other pseudo-obstruction cases occurs in autosomal recessive patterns. A hernia relates to the abnormal exit of an organ, for instance, the bowel, or tissue through the cavity wall in its location. The bowel’s section that becomes a hernia can be obstructive in instances where it is tightly pinched or trapped at the region where it pokes through the wall of the abdomen. In extreme instances, the hernia may ‘strangulate’ (cut off blood supply) (Ramnarine & Dronen, 2017). According to Gore et al., (2015), hernia is the second most common factor that causes small bowel obstruction in the U.S; it accounts for approximately twenty-five percent of all cases.Various pathologic processes and risk factors also cause small Bowel Obstruction. In developed countries, the most common cause of Small Bowel Obstruction is intra-abdominal adhesions which account for about 75% of the cases (Gore et al., 2015). Other leading causes of Small Bowel Obstruction in developed countries include Crohn Disease, Hernia, volvulus, and malignancy. On the contrary, in developing countries, the primary causes of Small Bowel Obstruction are hernias which account for 40% of the cases, adhesions 30%, tuberculosis 10%, and others such as Crohn’s diseases, parasitic infections, and volvulus (Gore et al., 2015). Another common risk factor for Small Bowel Obstruction is prior pelvic or abdominal surgery, previous radiation therapy, and or both.Protective FactorsSeveral protective factors may be used in the treatment of Small Bowel Obstruction depending on the cause and severity of the blockage. A full mechanical obstruction often requires surgery, while partial obstructions often require some form of medication to get treated (Ramnarine & Dronen, 2017). Protective factors or interventions for Small Bowel Obstruction may include:Medication such as laxatives or stool softenersIntravenous hydrationNasogastric tube to relieve pressure and gas trapped in the stomachSurgery to remove damaged or blocked bowel sectionsTherapeutic enema to relieve stool impaction during severe constipationEnvironmental factorsThe common causes of small bowel obstruction differ widely with geographic regions, the age group of patients, socio economic status, and the accessibility to medical services. For instance, in developing nations, inguinal hernia is among the most common risk factor for bowel strangulation; this is mainly due to ignorance or the lack or minimal access to surgery (elective hernia repair).Study on SBOIn a study titled ‘Patients with Adhesive Small Bowel Obstruction Should be Primarily Managed by a Surgical Team,’ researchers Aquina et al. (2015) aimed to compare the outcomes of patients with Small Bowel Obstruction when they are handled by primary medical teams versus surgical service teams during admissions (Aquina et al., 2015). According to the study, adhesive Small Bowel Obstruction usually requires the patient to be admitted in the hospital. This admission is associated with high healthcare costs and utilization. However, many patients are often handled non-operatively and are, therefore, admitted to medical institutions. The researchers hypothesized that patient outcomes and healthcare costs would greatly be improved if surgical teams manage these patients as compared to primary medical teams. The researchers utilized bivariate and mixed-effects regression analyses to assess the factors that are associated with healthcare costs, utilization, and outcomes for Small Bowel Obstruction admissions (Aquina et al., 2015). The results showed that among the 107,603 adhesive Small Bowel Obstruction admissions (78% non-operative, 22% operative), 57% were managed by surgical attending teams, while 43% were managed by primary medical attending teams (Aquina et al., 2015). According to the results, Adhesive Small Bowel Obstruction admissions that were managed by primary medical attending were associated with longer hospital stays, lower patient confidence, greater healthcare costs, and higher readmission rates following non-operative management. Similarly, the Small Bowel Obstruction patients managed by medicine service after surgery experienced delays in surgical interventions, greater readmissions (30 days), extended stay periods, higher in-patient healthcare costs (Aquina et al., 2015).The study concludes that management of patients with adhesive Small Bowel Obstruction by surgical attending teams is associated with lower healthcare costs and utilization, as well as positive perioperative patient outcomes (Aquina et al., 2015). The study also suggests that policies that favor primary management of patients with adhesive Small Bowel Obstruction by surgical teams may be effective in improving patient outcomes, and reducing healthcare costs and utilization.Study SignificanceThe study mentioned above is significant in nursing practice. Small Bowel Obstructions are responsible for over 15% of hospital admissions in the United States, with about 20% of the cases needing surgical intervention (Baiu & Hawn, 2018). The above study analyzes this common medical problem and offers a guide to caring physicians. It guides caregivers on how to manage patients who initially present with acute abdominal pain that may exhibit signs and symptoms of Small Bowel Obstruction. The study goes a long way to help nurses and medical practitioners to evaluate best strategies to handle patients with Small Bowel Obstruction. The research shows that Adhesive Small Bowel Obstruction patients handled by the surgical team experience better outcomes as well as lower healthcare costs. Therefore, nurses can use this evidence-based information to provide quality and best care for patients with Small Bowel Obstruction Physicians can also use information from this study to better advise their subordinates about the care of patients with Small Bowel Obstruction.Pros and Cons of the StudyThe study has many advantages, especially when it comes to the management of patients with SBO. First off, the study utilized a large sample size (107, 603) which is significant in generalizing to an entire population (Baiu & Hawn, 2018). The review also uses comparative analysis to compare the primary care team with the surgical team. Using this method is helpful to get an accurate conclusion with regards to the two teams. However, the study has a demerit because it excludes the efforts of the primary medical team in the care of SBO patients. This team is also crucial in other areas of the care of SBO patients, and therefore the study should include their role.The gap in this study involves the inclusion and exclusion criteria. The study only concentrated on patients with Adhesive SBO. The study would have been more effective if it included patients with other forms of SBO, such as those experiencing SBO due to hernia, diabetes, volvulus, and cancer. Including all these patients would lead to more conclusive results and generalization. Future research should aim to focus on even larger sample sizes. The samples can include SBO patients whose symptoms are caused by other factors other than just adhesion.ConclusionAcute bowel obstruction occurs in instances where an interruption exists in the forward flow of the contents of the intestines. The interruption can take place at any point or region along the gastrointestinal tract’s length. The clinical symptoms associated with bowel obstruction typically differ depending on the obstruction level. The most common causes of small bowel obstruction include intestinal herniation, malignancy, and intra-abdominal adhesions. Researchers have conducted numerous studies involving small bowel obstruction. However, there is need for more research.ReferencesAquina, C. T., Becerra, A. Z., Probst, C. P., Xu, Z., Hensley, B. J., Iannuzzi, J. C., … & Fleming, F. J. (2016). Patients with adhesive small bowel obstruction should be primarily managed by a surgical team. Annals of Surgery, 264(3), 437-447.Baiu, I., & Hawn, M. T. (2018). Small Bowel Obstruction. Jama, 319(20), 2146-2146.Gore, R. M., Silvers, R. I., Thakrar, K. H., Wenzke, D. R., Mehta, U. K., Newmark, G. M., & Berlin, J. W. (2015). Bowel obstruction. Radiologic Clinics, 53(6), 1225-1240.Ramnarine, M., & Dronen, S. (2017). Small-Bowel Obstruction. Medscape. Retrieved, 2(24), 2018.Roses, R. E., Folkert, I. W., & Krouse, R. S. (2018). Malignant Bowel Obstruction: Reappraising the Value of Surgery. Surgical oncology clinics of North America, 27(4), 705-715.
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