VOLVULUS Patho

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VOLVULUS ETIOLOGY: Abnormal rotation of the intestine during embryonic development

y Malrotation of the bowel during fetal development may predispose infants to a volvulus, although a volvulus can occur in the absence of malrotation. y The most common cause of gastric volvulus in adults is diaphragmatic defects.

RISK FACTORS: PORT OF ENTRY: ORGAN INVOLVE:


y y y y stomach small intestine y cecum transverse colon sigmoid colon

CLINICAL MANIFESTATION:

bowel obstruction ( very common in infants) y constipation or difficulty releasing stools


y abdominal pain and distention y shock y nausea and bilious vomiting y bloody or dark red stool

DIAGNOSTIC TEST:
y y y A CBC count, clotting studies, electrolyte level tests, and blood glucose level tests are usually sufficient for preoperative evaluation. Abdominal X-rays may show multiple distended bowel loops and a large bowel without gas. In midgut volvulus, abdominal X-rays may be normal. In cecal volvulus, barium from a barium enema fills the colon distal to the section of cecum; in sigmoid volvulus, barium may twist to a point and, in adults, take on an "ace of spades" configuration. White blood cell count, in strangulation, is greater than 15,000/l. In bowel infarction, it's greater than 20,000/l.

DEATH NURSING INTERVENTIONS:


y y y y y y Moni tor pul se oxi metr y and heart r ate Provi de psychol ogi cal suppo rt. Li sten to th e pati ents concerns and offer reassur ance; take ti me to an sw er hi s questi ons. Admini ster an al gesi cs and broad-spectrum anti bi oti cs as order ed. Admini ster I.V. flui ds as ordered. Obtai n bl ood for typing and cross- matchi ng. Con ti nuousl y moni to r vi tal si gns, respi ratory status,ci rcul atory status,neurol ogi c status, i n take and ou tput, becau se i nfants wi th vo l vulu s can rapi dl y decomp ensate

y y y

Insert a n asogastri c tube, and conn ect to lo w-pressu re i ntermi tten t sucti on , i f ordered, to reli eve abdomi nal di stenti on . Prepar e th e pati ent for proctoscopy as i ndi cated. If th e pati ent i s sch edul ed for deto rsi on surgery, provi de appropri ate preo per ati ve and posto per ati v e care, as fo r any pati ent undergoin g abdomi nal surgery

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