Rhabdomyolysis

Disease Description (Causes and Symptoms)

• Definition: Intestinal obstruction is a condition in which part of the small or large intestine is partially or completely blocked, preventing intestinal contents (food, digestive fluids, and gas) from passing and causing abdominal distension, pain, vomiting, and difficulty with bowel movements and passing gas.
• Main causes
  • Mechanical obstruction: postoperative adhesions, tumors such as colorectal or small intestinal cancer, strangulated hernia, intussusception, volvulus, etc.
  • Paralytic (functional) obstruction: decreased intestinal motility due to acute peritonitis (e.g., gastroduodenal perforation), acute pancreatitis or cholecystitis, abdominal trauma, or medications and electrolyte abnormalities immediately after surgery, etc.
• Summary of pathophysiology: When intestinal contents accumulate above the site of obstruction, intestinal dilation and increased intraluminal pressure and reduced blood flow can lead to intestinal mucosal ischemia, necrosis, and perforation, as well as systemic dehydration, electrolyte abnormalities, and shock.
• Main symptoms
  • Cramping (paroxysmal) abdominal pain (initially localized, gradually becoming generalized)
  • Vomiting (severe vomiting early in upper obstruction; fecal vomiting may occur over time)
  • Decreased or complete inability to have bowel movements or pass gas (if the obstruction is severe, an enema may be impossible)
  • Abdominal distension, nausea, dehydration, tachycardia, hypotension, and fever (when complications occur)

Treatment Methods

• Initial emergency and conservative treatment (usually first-line treatment)
  • Nil per os (NPO) and intravenous fluids to replace fluids, electrolytes, and nutrition
  • Gastrointestinal decompression: insertion of a nasogastric tube (Levin tube or NG tube) for suction (removal of gas and intestinal contents)
  • Control of pain and vomiting and correction of electrolyte abnormalities; antibiotics if necessary (when perforation or sepsis is suspected)
  • Monitoring: vital signs, urine output, electrolytes, and blood tests (white blood cell count, blood gases, lactate, etc.)
• Imaging and surgical evaluation
  • Plain abdominal X-ray (air-fluid levels when upright) and abdominal CT (identifying the cause, intestinal ischemia, and the site of obstruction) are important for diagnosis and treatment decisions.
• Surgical treatment
  • Emergency or planned surgery is performed when conservative treatment does not improve the condition or when intestinal ischemia, necrosis, or perforation is present, or the cause of the obstruction needs to be removed (such as a tumor, severe adhesions, or hernia).
• Medications and procedures
  • Antimotility drugs (e.g., loperamide) or oral enema agents are contraindicated in mechanical obstruction.
• Precautions, risk of complications, and self-care
  • Situations requiring immediate emergency care: severe persistent abdominal pain, high fever, bloody stool, persistent vomiting (dehydration and impaired absorption), decreased breathing or consciousness, and hypotension or tachycardia (signs of shock)
  • Complications: intestinal ischemia and necrosis, perforation and peritonitis, sepsis, severe electrolyte abnormalities and renal failure, and shock
  • Precautions for self-care: remain NPO before arriving at the hospital (do not eat or drink fluids); if vomiting occurs, do not force the person to eat or use an enema or laxatives; prepare information on medications being taken (such as anticoagulants, antiplatelet drugs, and antihypertensive drugs), surgical history, and allergies

Outpatient Visit Checklist (Items to Prepare and Example Questions)

• Items to prepare (recommended to bring)
  • List of medications currently being taken (including prescription drugs, OTC drugs, and supplements)
  • Records of past surgeries (especially abdominal surgery) and chronic diseases (such as cardiovascular disease and diabetes)
  • Recent test results (if possible, recent abdominal X-ray/CT and blood test results)
  • Symptom records: when symptoms began and how they progressed, the time of the last bowel movement and passage of gas, the contents of vomit (bile, fecal odor, etc.), and whether fever is present
  • Allergies and whether pregnancy is possible
• Examples of questions to check for yourself during the outpatient visit
  • When did the symptoms begin, and how have they changed over time?
  • When was the last bowel movement, and have you been able to pass gas?
  • Have you vomited? What are the color, smell (bile or fecal odor), and amount?
  • Have you recently had abdominal surgery or had a hernia?

Examples of General Questions to Ask the Doctor

• "Given my current condition, do I need emergency surgery, or is there a possibility that I will improve with conservative treatment?"
• "What tests will be used to identify the cause of the obstruction (adhesions, tumor, hernia, etc.) and determine whether intestinal ischemia is present?"
• "What complications or lifestyle factors (diet and medications) should I pay attention to during and after treatment?"
• "What is the prognosis, and what should I do to reduce the risk of recurrence?"

Examples of Disease-Specific Questions

• "In my case (for example, with a history of abdominal surgery), intestinal adhesions are suspected. Can I fully recover with nonsurgical treatment? If surgery is necessary, what type of surgery do you recommend?"
• "If findings suspicious for intestinal ischemia are found on CT, do you recommend immediate surgery? Which test results, such as lactate and white blood cell count, affect the decision to perform emergency surgery?"