LYCEUM-NORTHWESTERN UNIVERSITY

NANCAYASAN, URDANETA CITY PANGASINAN.

A Case Report

Complex Mass Intestinal Obstruction Right Hemi Abdomen

Presented to the faculty of the College of Nursing

Presented by BSN III Group l Agustin, Dioner P. Ayson, Hazel Q. Esteban, Kristine M. Lazaga, Ma. Theresa R. Morales, Jemalyn S. Ogaco, Crispril O. Paglingayen, Ronnie jr M. Tarangco, Jane V. Tumanda, Ryan Christopher T. Head Nurses Dacanay, Pauline Nicolette R. Licud, Faustino III F. Peralta, Sonia C.

Clinical instructor Mr. Harret Bauzon

I.

Introduction

Complex Mass Intestinal Obstruction Right Hemi Abdomen Complex Mass or a solid mass (having both cystic and solid components) may be cancerous, small masses and can distinguish whether a mass is solid or fluid filled (cystic). Hemi Abdomen refers to the right hemisphere of your abdominal cavity, a midsagittal plane that consists of right upper quadrant and right lower quadrant and the organs within that region.

Anatomy Ascending colon it passes upward, from its commencement at the cecum, opposite the colic valve, to the under surface of the right lobe of the liver, on the right of the gall-bladder, where it is lodged in a shallow depression, the colic impression; here it bends abruptly forward and to the left, forming the right colic flexure (hepatic).

The patients ascending colon is the area where the complex mass occurred and begins to clog the passage of digested food from the cecum trough the hepatic flexure, because the pathway has been obstructed with mass. Physiology The ascending colon is comprised of strong muscles that motor waste products upward and onward out of the body. As part of the larger gastrointestinal tract, the ascending colon connects and continues the work of the small intestine in moving food along on its journey through the body. Intestinal obstruction causes Many conditions can cause intestinal obstruction. Intestinal obstruction can occur as the result of a "mechanical" obstruction when something, such as a hernia or tumor, is physically blocking your intestine. Or intestinal obstruction can occur as the result of a condition in which your intestines don't function properly. Signs and symptoms of intestinal obstruction Intestinal obstruction can result in an array of uncomfortable signs and symptoms, including crampy abdominal pain that comes and goes, abdominal swelling (distention), nausea, and vomiting, diarrhea, constipation, inability to have a bowel movement or pass gas. If left untreated, intestinal obstruction can cause the blocked parts of your intestine to die. This tissue death can lead to perforation of the intestine, severe infection and shock. However, with prompt medical care, intestinal obstruction can often be successfully treated.

Intestinal obstruction treatment A colonoscopy may be performed to decompress the bowel. A cecostomy, in which a surgical opening is made into the cecum, may be performed for patients who are poor surgical risk. The usual treatment, however, is surgical resection to remove the obstructing lesions. A temporary or permanent colostomy may be necessary. An ileoanal anastomosis may be performed if it is necessary to remove the entire large colon.

II. Patients Profile

Pts Name: Mister X Age: 56 y.o Sex: Male Address: Turac, San Carlos City, Pangasinan Civil Status: Married Occupation: Pancit bihon factory worker Religion: Roman catholic Diagnosis: Complex mass intestinal obstruction right hemi abdomen Attending Physician: Dr. Joselito Sison

III. History
History of Past and Present Illness Mister X was confined on 11/15/11 at Pangasinan Provincial Hospital and diagnosed of having Intestinal obstruction, then re-admitted to the same hospital on 12/29/11 complaining of pain in right abdominal hemisphere and 5 days unable to defecate prior to admission. Mister X Claimed that he doesnt smoke but drink alcoholic beverages 4 to 5 times a week for almost 20 years, he also stated that he is physically fit and active.

IV. Laboratory
Hematology Report
Test Hemoglobin Hematocrit Result 83 24 N.V 140-170 g/L 40-50 Vol 1%

12/29/2011
Interpretation. Indicates Bleeding or anemia Implies significant hemorrhage

Hematology Report
Test Hemoglobin Hematology Report Test Hemoglobin WBC Result 130 12.6 x 10 g/l N.V 140-170 g/L 5-10 x 10 g/l Result 72 N.V 140-170 g/L

01/03/2012
Interpretation. Indicates Bleeding or anemia

01/07/2012
Interpretation. Indicates Bleeding or anemia Indicates presence of infection

V. Pathophysiology
There is a blockage in the intestine Accumulated mass on the walls of ascending colon

Impairment of the passage of digested materials due to narrowed pathway

Cessation of passage of flatus and feces trough the ascending colon This results in pain, an increase in abdominal girth, and increased tension in the intestinal wall

Fecal contents being impacted and stored in the ascending colon

The ascending colon begins to stretch and compress nerves and surrounding tissue

Increased tension in the intestinal wall and/or impairment of the blood supply of the intestine

Pressure results in necrosis and perforation of the bowel.

Will result in activation of local and systemic inflammatory responses and translocation of bacteria through the wall of the intestine

Complex Mass Intestinal Obstruction Right Hemi Abdomen