Intestinal obstruction is the obstruction of intestinal contents in the intestinal tract. In fact, intestinal obstruction is the result of disruption of the balance of fluid secretion and absorption in the intestine, forming a vicious cycle of “secretion-dilation-secretion”.
Patients with gastrointestinal tumors such as gastric cancer and colorectal cancer are the most frequently affected by intestinal obstruction, among which colorectal cancer is the most common, and intestinal obstruction caused by peritoneal metastasis of gastric cancer is also very common in China. Some of the causes of intestinal obstruction (3%-48%) are non-cancerous and also common causes of functional intestinal obstruction, such as intestinal adhesions after surgery or radiotherapy, hypokalemia, and fecal impaction due to weakness.
Once intestinal obstruction occurs, patients not only have to suffer from vomiting, abdominal pain, abdominal distension, inability to eat, but also may have to suffer from mental pain caused by giving up treatment or having a negative attitude. However, some intestinal obstruction can be prevented and avoided, such as some food-induced intestinal obstruction mentioned at the beginning of this article; even some intestinal obstruction caused by cancerous factors can also be prevented and avoided. Most of the intestinal obstruction has a slow onset, and the initial stage is often incomplete intestinal obstruction, so timely detection can gain time for treatment. If effective prevention and timely detection can be achieved, some intestinal obstruction can be avoided and timely treatment can be carried out to reduce the pain caused by intestinal obstruction and avoid delaying the anti-tumor treatment.
I. High-risk groups of intestinal obstruction 1. Patients who have received abdominal surgery, radiotherapy or intraperitoneal drug infusion: intestinal adhesions and anastomotic stenosis that may be caused by surgery; fibrosis caused by radiotherapy, resulting in intestinal stenosis; intraperitoneal drug infusion may also lead to the occurrence of intestinal obstruction; 2. Sometimes there is no obvious mass, but diffuse peritoneal metastasis may also lead to intestinal obstruction; 3, patients who have had intestinal obstruction before: intestinal obstruction has occurred in the past, indicating that there are changes such as poor operation of the intestinal canal and luminal narrowing; 4, old and frail, long-term bedridden patients: the elderly have reduced secretion of intestinal digestive juices, coupled with weak intestinal peristalsis, often habitual constipation, resulting in slowing down the operation of intestinal contents and even causing stool impaction. 5, electrolyte disorders, or even hyperhydrosis patients: in addition to similar to the fourth reason, poor nutritional status, electrolyte disorders exacerbate the obstruction of intestinal tube operation, often leading to paralytic intestinal obstruction; 6, acute intestinal infections, such as acute gastroenteritis serious, repeated diarrhea will also cause “paralytic intestinal obstruction “.
Second, what are the precursors or early manifestations of intestinal obstruction?
The most common symptoms of intestinal obstruction include nausea, vomiting, abdominal pain, abdominal distension, loss of bowel movements and exhaustion. At first, these symptoms usually appear intermittently and can be relieved by themselves. These symptoms gradually deteriorate with the aggravation of intestinal obstruction and become persistent.
1, abdominal pain: intestinal obstruction is often manifested as paroxysmal colic: mostly located in the middle abdomen, sudden onset, gradually intensified, lasting for several minutes and then relieved, intermittent period can be completely painless, after a period of time can be again. Acute jejunal obstruction, colic is more intense, usually one attack in 2-5 minutes, less incomplete, relieved by a burst of bowel sounds or exhaustion. Colonic obstruction, occurring mostly in the lower abdomen, is generally milder than the small intestine.
2.Vomiting: In the early stage of intestinal obstruction, vomiting is reflexive, and the vomit is food or gastric juice; it is generally believed that the higher the obstruction site is, the earlier and more frequent vomiting appears; while in low obstruction and colonic obstruction, vomiting appears late and less; the vomit can be fecal-like.
3. Abdominal distension: appears later. Abdominal distension is not obvious in high intestinal obstruction, but is obvious in low intestinal obstruction and colonic obstruction.
4.Anal stop venting and defecation: after the occurrence of complete intestinal obstruction, patients mostly do not vent and defecate. Some patients think that as long as there is farting (anal exhaust) and stool, intestinal obstruction will not occur, but the first 2-3 days of high small intestinal obstruction, there is still defecation and exhaust; incomplete intestinal obstruction also has anal exhaust and defecation. Therefore, even if there is anal discharge and defecation, it should not be taken lightly and carelessly.
Third, for the high-risk groups how to prevent intestinal obstruction 1, dietary adjustment: should choose more easily digestible, plant foods containing more fiber, less animal food. Food processing or cooking should be finer, in order to facilitate chewing. Animal food should be cooked and rotten, in order to facilitate digestion and absorption. Pay attention to dietary hygiene, unclean diet will not only cause acute gastroenteritis, but also cause intestinal obstruction. Be sure to pay attention to drink more water.
Some foods that are not easy to chew and easily form lumps, such as glutinous rice, rice cakes, animal sinew, tendons, etc., and lotus root powder, should be eaten sparingly. Eat more foods that are easy to digest and promote defecation, such as vegetables: seaweed, pig’s blood, carrots, etc., fruits: hawthorn, pineapple, papaya, etc.; eat more fiber-rich foods, such as various vegetables, fruits, brown rice, whole grains and beans, which can help defecate, prevent constipation, stabilize blood sugar and lower blood cholesterol; it is appropriate to eat light and nutritious, liquid foods, such as rice soup, vegetable soup, egg flower soup, noodle flakes, etc.
2, moderate exercise: gastrointestinal tumor patients are generally resting in their daily life, bed-ridden and less active, therefore, the intestinal peristalsis is slow and the function is weakened. There are more elderly people suffering from habitual constipation. Therefore, they should pay attention to more activities, and if necessary, they can choose some drugs to regulate intestinal secretion function, promote intestinal peristalsis, help to soften stool and prevent intestinal obstruction.
3, self-examination: family members of patients or themselves must pay attention to abdominal symptoms, signs, if abdominal pain, bloating and other discomfort, although the degree may be mild, or even self-relieving, do not take it lightly, strengthen observation, if necessary, timely medical treatment, so as not to delay the best time for diagnosis and treatment. If there are suspicious symptoms or signs, in addition to seeking medical attention, it is possible to reduce food intake, or enter fluid and semi-liquid and other easily digestible food, and take oral laxatives to keep the stool open, etc., which have certain preventive and curative effects on early intestinal obstruction.
4, oral vitamin E, chewing gum to prevent intestinal adhesions: some studies have shown that oral chewing gum after surgery can prevent the occurrence of intestinal adhesions after surgery. The possible mechanism is that by constantly chewing gum, it promotes the secretion of digestive juices and intestinal peristalsis, which can reduce the occurrence of intestinal obstruction to a certain extent.
Through the above prevention, we hope that all patients with GI tumors can enjoy good food and avoid the occurrence of intestinal obstruction smoothly at the same time.