Intestinal obstruction

　　During intestinal obstruction of the large intestine, due to the closure of the ileocecal valve, intestinal contents can only enter but not exit, forming a closed-loop intestinal obstruction. Because the blood supply of the colon is not as rich as that of the small intestine, and the wall is thin, even simple obstruction is prone to local necrosis and perforation. The bacterial content in the colon is high, and the growth of bacteria accelerates after obstruction, which is prone to systemic infection, even toxic shock.

　　The severity of cancer obstruction depends on the extent of tumor invasion. When the intestinal lumen is incompletely obstructed, the clinical manifestations and pathophysiological changes are not severe. When completely obstructed, there is severe intestinal distension, and excessive intestinal distension makes the intestinal wall thin, blood supply decreases, so it is prone to necrosis and perforation.

　　Intestinal obstruction caused by volvulus also has complete and incomplete types. In incomplete obstruction, both gas and fluid accumulate in the intestinal loop; in complete obstruction, it is mostly acute volvulus, and the obstruction is of闭袢性. Since the route of swallowing has been blocked, there is a lot of fluid and gas accumulation in the intestinal loop, this segment of the intestinal lumen is highly dilated, much larger than the intestinal lumen above the obstruction. The excessive distension of this segment of the intestinal lumen can cause tensional damage to the intestinal wall, in addition to the blood supply obstruction of the mesenteric vessels, which results in bleeding, necrosis, and exudation of the intestinal loop, even perforation.

　　Intestinal distension

　　In mechanical intestinal obstruction, the intestinal lumen above the obstruction swells due to the accumulation of fluid and gas, and the first reaction of the intestinal segment to obstruction is to enhance peristalsis, which causes intestinal colic. The increased pressure in the intestinal lumen can cause venous return obstruction in the intestinal wall, leading to intestinal wall congestion and edema. Increased permeability. The continued increase in intestinal lumen pressure can block blood flow in the intestinal wall, changing simple intestinal obstruction into strangulated intestinal obstruction. Severe intestinal distension can even raise the diaphragm, affecting the patient's respiratory and circulatory function.

　　Loss of body fluids and electrolytes

　　Intestinal obstruction can cause reflex vomiting due to intestinal distension. In high intestinal obstruction, vomiting is frequent, and a large amount of water and electrolytes are excreted outside the body. If the obstruction is located at the pylorus or the upper part of the duodenum, excessive gastric acid can be vomited, which is prone to produce dehydration and hypochlorhydria and hypokalemia alkalosis. If the obstruction is located at the lower part of the duodenum or the upper part of the jejunum, the loss of bicarbonate is severe. In low intestinal obstruction, although vomiting is not as common as in high intestinal obstruction, due to the decreased absorption function of the intestinal mucosa and the increased secretion of fluid, a large amount of fluid accumulates in the intestinal lumen above the obstruction, sometimes up to 5-10L, containing a large amount of sodium bicarbonate. Although these fluids have not been excreted outside the body, they are sealed in the intestinal lumen and cannot enter the blood, which is equivalent to the loss of body fluids. In addition, excessive intestinal distension affects venous return, leading to intestinal wall edema and plasma extravasation. In strangulated intestinal obstruction, the loss of blood and plasma is particularly severe. Therefore, patients often suffer from dehydration with oliguria, azotemia, and acidosis. If dehydration persists, the blood becomes further concentrated, leading to hypotension and hypovolemic shock. Hypokalemia caused by potassium loss and not eating can lead to intestinal paralysis, which further aggravates the development of intestinal obstruction.

　　The clinical manifestations of large bowel obstruction are basically similar to those of general small bowel obstruction, and the clinical manifestations have the following characteristics:

　　1. All patients have abdominal pain, with right-sided colon obstruction located in the upper right abdomen, and left-sided obstruction located in the lower left abdomen. Chronic obstruction causes mild abdominal pain, while acute obstruction causes severe abdominal pain, but not as severe as intestinal volvulus or intussusception;

　　2. Nausea and vomiting appear late, even absent. Later, the vomit contains yellow fecal-like substances with a foul odor;

　　3. Abdominal distension is less obvious than small bowel obstruction, with prominent bilateral abdominal areas, sometimes in a horseshoe shape;

　　4. Anal cessation of defecation and flatus, but most patients still have a small amount of gas excretion in the early stage of obstruction;

　　5. Abdominal distension is significant, may appear in a horseshoe shape, percussion sounds like a drum, and auscultation may hear water over the sound.

　　1. Patients with abdominal wall hernias should be treated promptly to avoid intestinal obstruction caused by incarceration or strangulation.

　　2. Strengthen health education and publicity, develop good health habits, and prevent and treat enterobiasis.

　　3. Patients with abdominal surgery and peritonitis should have good gastrointestinal decompression, and surgical procedures should be gentle to minimize or avoid peritoneal infection.

　　4. Early detection and treatment of intestinal tumors.

　　5. Early activity after abdominal surgery.

　　1. Imaging examinations

　　Abdominal X-ray, CT, MRI, and other examinations can help clarify the location and cause of the obstruction.

　　2. Blood tests

　　Blood routine and blood biochemistry tests can help understand whether there is strangulated obstruction and whether there is water and electrolyte imbalance.

　　3. Colonoscopy

　　It helps to clarify the nature of the lesion (biopsy can be performed for pathological diagnosis if a tumor is found).

　　1. Foods that are easy to digest and promote defecation. For example, vegetables: kelp, pork blood, carrots, etc.; fruits: hawthorn, pineapple, papaya, etc.; eating foods rich in fiber such as various vegetables, fruits, brown rice, whole grains, and beans can help defecate, prevent constipation, stabilize blood sugar, and lower blood cholesterol;

　　2. It is recommended to eat light and nutritious, fluid foods such as rice porridge, vegetable soup, lotus root starch, egg flower soup, and noodles;

　　3. It is advisable to consume finely processed or cooked foods to facilitate mastication and digestion. One to two whole eggs can be consumed per week. A variety of foods from the six major categories, including dairy products, cereal roots and tubers, meat, fish, beans, eggs, vegetables, fruits, and oils, should be consumed to fully obtain various nutrients;

　　4. Eat foods rich in protein and iron, such as lean meat, fish and shrimp, animal blood, animal liver and kidney, egg yolk, soy products, as well as jujube, green leafy vegetables, sesame paste, etc.

　　5. Choose vegetable oils, which are mostly cooked by boiling, steaming, cold, frying, roasting, braising, and stewing; avoid eating high-cholesterol foods such as fatty meat, offal, fish eggs, butter, etc.

　　Intestinal obstruction is one of the most common acute abdominal emergencies in surgery. According to existing data statistics, the mortality rate of intestinal obstruction can rise to 10% to 20%, which should be paid attention to. During the treatment process, traditional Chinese medicine recommends four treatment methods, as follows:

　　One, blood stasis and qi stagnation

　　Persistent abdominal pain, severe bloating, or fixed pain, pain is resistant to palpation, vomiting, constipation, purple and dark tongue quality, white fur, wiry and fine pulse.

　　Treatment: Activate blood circulation and remove blood stasis, promote qi flow and relieve pain.

　　Prescription: 10 grams of Xiaohuixiang, 5 grams of Xuejie, 10 grams of Yanhusuo, 6 grams of Moyao, 10 grams of Danggui, 10 grams of Chuanxiong, 6 grams of Guanui, 10 grams of Chishao, 10 grams of raw Puhuang, 6 grams of Wulingzi, 10 grams of Muxiang, 10 grams of Xiangfu.

　　Two, heat mass in the bowels

　　Sudden abdominal pain, severe and resistant to palpation, intestinal sounds, vomiting food, dry mouth and bitter taste, constipation, yellow greasy fur, surging or slippery and rapid pulse.

　　Treatment: Relieve heat and dredge the bowels, eliminate mass retention.

　　Prescription: 10 grams of raw Dahuang, 10 grams of Zhishi, 10 grams of Mangxiao, 10 grams of Houpu.

　　Three, direct attack of cold evil

　　Sudden severe abdominal绞痛, palpable mass, pain is resistant to palpation, aversion to cold, pale and cold complexion, pale and dark tongue quality, white and slippery fur, deep and tense pulse.

　　Treatment: Warm the middle and disperse cold, relieve urgency and pain.

　　Prescription: 10 grams of raw Dahuang, 10 grams of Shufu, 3 grams of Xixin, 10 grams of Zhishi, 10 grams of Houpu, 20 grams of Mangxiao.

　　Four, mass obstruction

　　Abdominal pain occurs intermittently, with yellowish skin and emaciation, or white worm spots on the face, sudden severe abdominal pain, pain around the navel, palpable mass, vomiting food or clear fluid, white fur, wiry pulse.

　　Treatment: Expel worms and eliminate mass.

　　Prescription: 6 grams of Leiyao, 10 grams of Kulinpi, 10 grams of Heixiu, 10 grams of Binglang, 10 grams of Zaojiao, 12 grams of Muxiang, 10 grams of Dafupi, 5 grams of Chujiang, 10 grams of Huanglian.