obstruction
(ŏb-strŭk'shŏn 
)
[L. obstructio, blockade]
- Blockage of a structure that prevents it from functioning normally.
SEE: stenosis.
- Something that impedes; an obstacle.
aortic o.Blockage of the aorta, which prevents the flow of blood.
biliary o.Blockage of the flow of bile from the gallbladder. It is typically caused by gallstones but occasionally from other causes, e.g., cancer, cholangitis, cirrhosis, or parasites.
Biliary obstruction may cause right upper quadrant abdominal pain that radiates to the right flank, nausea, vomiting, jaundice, clay-colored stools, and green or dark urine.
ABBR: BOO
The inability to pass urine. BOO is caused by prostatic hyperplasia, drug therapy, or urethral injury and may produce bladder pain, urinary tract infection (esp. in older men), or kidney failure.SEE: benign prostatic hyperplasia .
bowel o.Intestinal obstruction
central airway o.Compression of the upper airways by a tumor, esp. lung cancer, or a goiter; inhalation of a foreign body into the airway; or narrowing of the trachea by a stricture or tracheomalacia or bronchiomalacia. It is a potentially life-threatening condition that in many cases requires bronchoscopy to clear the airway, often followed by placement of a stent.
ABBR: CAO
Chronic obstructive pulmonary disease.foreign body airway o.Blockage of the free passage of air from the mouth and nose to the lungs by any object accidentally inhaled into the trachea, bronchus, or pharynx.
Common causes of this type of obstruction are red meat, hard cand y, hot dogs, coins, and marbles.
Symptoms include inability to inhale or exhale, and shortness of breath. Signs include ineffective coughing, gasping, choking, cyanosis, respiratory distress, and /or stridor.
The diagnosis is often made clinically, as when a patient becomes unable to breathe, cough, or speak during a meal. Partial obstructions can be confirmed with x-rays of the neck or chest.
Patients may be able to expel the foreign object with forceful coughing. Observers may assist some patients by sweeping objects out of the oropharynx with a finger or noninjurious tool. Some objects must be removed after induction of anesthesia, e.g., with forceps, nasopharygoscopy, or bronchoscopy.
The patient is placed in a comfortable position. Supplemental oxygen is provided by blow-by, nasal cannula, or other devices. Oximetry, blood pressure cuffs, and cardiac monitors are applied to the patient so that minute-to-minute assessments may be made of the patient’s hemodynamics and respiratory status. The patient and any supportive family or friends are prepared for required diagnostic or therapeutic procedures. After objects are extracted, follow-up x-ray studies and monitoring are performed as clinically indicated. Parents of small children should be educated regarding risks for recurrent aspirations and obstruction; they should also be given specific instructions on avoiding objects that may be hazardous to children.
SEE: Heimlich maneuver.
ABBR: GOO
Blockage of the flow of food or liquids from the stomach to the duodenum.In young children, the cause is often pyloric stenosis or atresia. In adults, ulcers and cancer are frequent causes.
Symptoms include early satiety, abdominal pain, and nausea or explosive vomiting after meals. After a while, if the disease is untreated, evidence of dehydration or malnutrition may develop. Signs of active obstruction may include visualization of a mass in the upper abdomen just after eating, esp. in thin people or small children.
Obstructions of the stomach may be demonstrated with radiography after barium swallow or with an upper endoscopy.
Children with pyloric stenosis are treated with surgery to divide the excessively enlarged muscle that separates the stomach from the duodenum.
The surgical treatment of pyloric stenosis may be performed through an open incision or by laparoscopy. The operation requires general anesthesia. Patients and their families are prepared for the operation with appropriate education about the procedure and postoperative recovery. After the operation, the incision is kept clean and dry and free from potential contaminants or injury. Oral feeding usually begins shortly after the operation. Patients with outlet obstruction caused by cancer may be treated with more extensive operations that may include tumor debulking and lymph node dissection. Postoperative chemotherapy or radiation therapy may be required. Feeding tubes may need to be placed to supplement patient nutrition, either nasogastrically or percutaneously through the upper abdomen.
ABBR: ILO
SYN: Dysfunction, vocal cord.intestinal o.A partial or complete blockage of the lumen of the large or small intestine.
Patients typically complain of colicky abdominal pain, nausea, vomiting (if the obstruction is in the proximal small intestine), or inability to pass gas or stool. Thirst, dizziness, malaise, and other symptoms of dehydration may be present. The physical examination may show a distended, gas-filled abdomen, which is often tympanitic and diffusely tender. Auscultation reveals bowel sounds, borborygmus, and rushes, which may be loud enough to hear without the stethoscope. The examiner may sometimes find a palpable mass or an incarcerated hernia.
Plain x-rays of the abdomen are used to suggest the diagnosis. Its hallmarks are markedly dilated loops of bowel with edema or effacement of the intestinal valvulae. Computed tomography of the abdomen may identify the precise location of the obstruction, e.g., a hernia or tumor.
The patient is given nothing orally, and when nausea and vomiting are present, a nasogastric (Levin, Salem Sump) or intestinal (Cantor, Miller-Abbott) tube is placed to remove upper intestinal contents and decompress the bowel. Fluids and electrolytes are given intravenously. A large intestinal obstruction due to fecal impaction may be relieved by enemas or disimpaction (manual removal of feces). When obstructions do not resolve with conservative measures and supportive care, surgery may be needed.
In partial obstruction, the patient's condition is monitored closely, including assessment of bowel sounds, vital signs, abdominal girth, fluid and electrolyte balance, and acid-base balance. The patient is assessed for signs of dehydration. Frequent oral hygiene is provided. Prescribed pain medications, antiemetics, and antibiotics are administered. Opioids are sometimes withheld or used sparingly because they may slow peristalsis. Noninvasive pain relief strategies (such as relaxation techniques, imagery, repositioning, massage, and music therapy) may be effective for individual patients. The patient is asked to alert health care providers if pain changes from colicky to constant, because this may signal perforation. Throughout, the patient receives support and encouragement. Ischemia is the most serious consequence of intestinal obstruction, because it leads to peritonitis, perforation, hemorrhage, and gangrene. Ischemia makes the bowel more permeable, allowing normal intestinal flora such as Escherichia coli and Klebsiella to penetrate the bowel wall and enter the peritoneal cavity, potentially leading to peritonitis and /or septic shock. Intravenous fluids are required; blood products and antibiotics may be needed, depending on complications experienced by the patient.
If conservative treatment fails for partial or incomplete mechanical obstruction, or if the obstruction is initially diagnosed as vascular or mechanical and complete, the patient is prepared for nasogastric suctioning, endoscopy, or surgery. If the patient requires a colostomy or ileostomy (which may be a temporary measure or may be permanent, depending on the cause of the obstruction), an enterostomal therapist makes recommendations regarding stoma location and provides further positive reinforcement and emotional support. Postoperative care is explained: if the patient is well enough to understand , he or she is taught exercises to aid ventilation and prevent complications due to immobility. Following surgery, all necessary postoperative care is given, including care of the surgical wound, maintenance of ventilatory status and fluid and electrolyte balance, and relief of pain and discomfort. Vital signs are closely monitored. Oral care is provided, along with misting of mucous membranes while the decompression tube remains in place, and the amount and color of drainage are recorded. Clear fluids may be initiated with the tube clamped to determine toleration. The tube is removed and diet advanced as bowel sounds return. Incentive spirometry, antiembolic or pneumatic hose, and early ambulation help to prevent complications related to immobility. Any necessary postoperative activity limitations are discussed with the patient. Before discharge, any prescribed medications, their proper use, desired responses, and adverse effects are reviewed. Incision and /or colostomy care is taught and signs of infection, activity restrictions, and signs or symptoms for which the surgeon should be called are reviewed with the patient before discharge. The importance of following a structured bowel regimen is emphasized (particularly if the cause of obstruction was a fecal impaction). The patient is encouraged to eat a high-fiber diet, drink plenty of fluids, and exercise daily.SYN: bowel obstruction .
nasal o.Blockage of the nasal passages. Common causes of nasal obstruction in adults are irregular septum, enlarged turbinates, and nasal polyps. In children, a common cause is a foreign body, such as food, buttons, or pins. Complications such as infections, sinusitis, and otitis may develop.
Depending upon the cause of the obstruction, nasal douches, inhalations, or operative care, including resection of septum, turbinectomy, removal of polyp, opening and draining sinuses, or removal of foreign body.
ABBR: UAO
Any potentially life-threatening abnormality in which the flow of air into and out of the lungs is partially or completely blocked by such conditions as laryngeal swelling, foreign bodies, or angioedema.SEE: cardiopulmonary resuscitation; tracheostomy.