Small Bowel ObstructionLyudmyla WhiteAnoka Ramsey Community CollegeSmall Bowel ObstructionSmall Bowel Obstruction is a condition caused by a blockage in the small intestines. After an operation, the bowel typically forms scar tissues called adhesions which can obstruct the small intestines. In other case s, 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). Causes and risk factorsMany factors can cause SBO. 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 et al., 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 (SBOs) may occur as a result of post-surgical adhesion. SBO may occur when 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 et al., 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 increase the risks of inadvertent attachment of the suture to the small bowel or the bowel’s mesentery. This may, in turn, cause SBO during the early postoperative period.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 a 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. 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 (Ramnarine & Dronen, 2017). According to (Gore B , . et al., 2015), a hernia is the second most common factor that causes SBO in the U.S; it accounts for approximately twenty-five percent of all cases. Protective FactorsSeveral protective factors may be used in the treatment of SBO 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 SBO may include, medication such as laxatives or stool softeners and intravenous hydration. Therapeutic enema to relieve stool impaction during severe constipation In the most severe cases a nasogastric tube to relieve pressure and gas trapped in the stomach or surgery to remove damaged or blocked bowel sections. Environmental factorsThe common causes of SBO differ widely with geographic regions, the age group of patients, socioeconomic status, and the accessibility to medical services. For instance, in developing nations, an 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 SBO Should be Primarily Managed by a Surgical Team,’ researchers (Aquina et al., 2016)aimed to compare the outcomes of patients with SBO when they are handled by primary medical teams versus surgical service teams during admissions(Aquina et al., 2016). According to the study, adhesive SBO usually requires the patient to be admitted in the hospital. 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 SBO admissions (Aquina et al., 2016)The results showed that among the 107,603 adhesive SBO admissions, 57% were managed by surgical attending teams, while 43% were managed by primary medical attending teams (Aquina et al., 2015). Similarly, the SBO patients managed by medicine service after surgery experienced delays in surgical interventions, greater readmissions, extended stay periods, higher in-patient healthcare costs (Aquina et al., 2016).The study concludes that the management of patients with adhesive SBO by surgical attending teams is associated with lower healthcare costs and utilization, as well as positive perioperative patient outcomes(Aquina et al., 2016) Study SignificanceThe study mentioned above is significant in nursing practice. SBOs 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 SBO.The study goes a long way to help nurses and medical practitioners to evaluate the best strategies to handle patients with SBO. The research shows that Adhesive SBO patients handled by the surgical team experience better outcomes as well as lower healthcare costs. Pros and Cons of the StudyFirst off, the study utilized a large sample size 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. 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. Conclusion Acute bowel obstruction occurs in instances where an interruption exists in the forward flow of the contents of the intestines. The clinical symptoms associated with bowel obstruction typically differ depending on the obstruction level. Researchers have conducted numerous studies involving SBO. However, there is a need for more research. ReferencesAquina , C. T., Becerra, A. C., Probst, C. P., Xu, Z., Iannuzz, J. C., Hensley,, B. J., & Fleming, F. J. ( 2016, ). Patients with adhesive SBO should be primarily managed by a surgical team. Annals of Surgery. Annals of Surgery,, (), 264(3), 437-447.Baiu , I., & Hawn, M. T. (2018). Small Bowel Obstruction. Jama, 319(20), 2146-2146.Gore B , ., 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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