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What is intestinal obstruction? The new condition that Jair Bolsonaro is going through
The 66 -year-old President of Brazil has been admitted to the emergency room due to a peculiar clinical picture. It is an intestinal obstruction, a condition that prevents proper transit and mobility in the digestive system. As a result, it is being subjected to constant monitoring and tests to evaluate the behavior to follow.
What is intestinal obstruction all about? Is it a serious illness?
Intestinal obstruction is one of the pathologies that make up the clinical picture known as “acute obstructive abdomen”. A series of signs and symptoms that have a point in common: the arrest of transit and normal function of the intestine at some of its levels.
Thus, the stool cannot move through the large and small intestine. As a result, the entire mechanism of action of the digestive system is altered, leading to an emergency that is normally resolved surgically.
Today, it is considered that between 20 to 30% of admissions in the surgical hospital emergency suffer from this disease. Consequently, it represents a high figure that determines the health status of a large part of the population.
How does it usually manifest itself?
All acute abdomen syndrome usually begins with the appearance of pain that varies between moderate to strong intensity. In general, it is a symptom that must be studied carefully since it has hundreds of differential diagnoses. In addition to it, the patient can take:
1. Hyperthermia (elevation of the temperature without considering fever).
2. Abdominal distension (if not treated in time, it can be very pronounced).
3. Moderately increased peristalsis (physiological response to obstruction).
4. Imbalance of the water and electrolyte balance.
Peristalsis is understood to be the process of contraction and relaxation by segments that originates in the digestive tract. While the upper portion in one area contracts, the lower portion relaxes pushing the content down.
On the other hand, the hydroelectrolyte imbalance is a situation in which the body fluids are altered. In addition to possible dehydration or difficulty in absorbing water, important electrolytes such as sodium, potassium, calcium, among others, are also out of phase.
Additionally, in the most serious or battered presentations, there is a marked touch of the general state. That is, a patient is prostrate, sleepy or even lethargic due to the progressive progression of the disease.
Other clinical manifestations of care are vomiting and constipation. With respect to the former, they tend to increase in intensity in the first moments of the disease. For its part, constipation is prolonged as the pathology follows its direct course.
The most accepted causes of intestinal obstruction
Etiologically, medical literature speaks of numerous causes and risk factors that promote the onset of the disease. To make the information more dynamic, only the relevant ones have been added:
1. Foreign or obstructive bodies.
2. Lesions of the intestinal wall of congenital, inflammatory or tumor type.
3. Recurrent abdominal trauma.
4. Flanges and adhesions.
5. Volvulus and intussusception.
The presence of a foreign body is nothing more than the ingestion of some object that obstructs the intestine due to its dimensions. In the case of obstructives, they are abnormal formations of the human body that "get stuck" in the digestive system. Some cases are gallstones, "fecal impaction", among others.
On the other hand, flanges and adhesions are the main and confirmed cause of intestinal obstruction. Commonly, they manifest after prolonged abdominal surgery or several of them with defects in healing.
· Flanges are the formation of scar tissue with an intrinsic vascular component. As it expands, it communicates one viscus (organ) with another, promoting the tendency to clog, bend, or rotate on its axis.
· On the contrary, adhesions arise from the same healing process, but without a vascular system present. Another marked difference is that it joins the segment of the intestine with the inner part of the abdominal wall. In most cases, the junction is precipitated in the area of the surgical scar.
What is the medical conduct in these situations?
The medical academy recommends, in every sense, to carry out a surgical procedure to solve the problem. However, on some specific occasions where there is no compromise of the general state, the behavior may be expectant.
1. The patient must enter an absolute diet.
2. Parenteral hydration (intravenous route) is placed for the hydroelectrolyte imbalance.
3. Application of nasogastric or intestinal tube to empty the digestive content.
4. Pharmacology associated with decreased intestinal peristalsis.
Other medical behaviors establish the placement of inhaled oxygen to facilitate the body's physiological gas exchange. In this way, it contributes to the normal functioning of all body systems.
Talking about surgical procedures goes first through the decompression of the intestine. The placement of drainage tubes is vital to "relieve" symptoms and decrease obstruction. Subsequently, the flanges and adhesions that are within the possibilities must be corrected.
Jair Bolsonaro, an account of abdominal surgeries
Secondary to an attack he suffered in 2018 after one of his political rallies, Bolsonaro has been admitted several times for abdominal surgery. The current president of Brazil was unexpectedly stabbed, which shocked not only the local press, but the global one.
The department in charge of communication and messaging of the Republic of Brazil confirmed that Bolsonaro was admitted for intestinal obstruction. After several days suffering from abdominal discomfort such as constipation conjugated to chronic “hiccups”, he was admitted for adequate follow-up.
Given the situation, he was transferred from Brasília to São Paulo where he was finally admitted and evaluated. While waiting for new tests to determine the severity of the matter, it is confirmed that the Brazilian leader's state of consciousness is intact.
The testimony of surgeons Antonio Luiz Macedo and Flávio Quilici
Macedo is a gastric surgery surgeon who has been recognized for intervening in Bolsonaro after his attack. Since then, he became its main trafficker due to the aftermath left by the perpetual accident.
Upon learning of the situation and with the first preliminary examinations, he did not hesitate to diagnose intestinal obstruction. A condition that, previously explained, must be treated in an emergency to decide a specific behavior.
In addition to this, Flavio Quilici, endorsed gastroenterologist surgeon, briefly explains the anatomy that describes the digestive tract. From his words, he seeks to make one understand how one of the most essential systems of the body functions in particular.
“The intestines are like drain hoses that can get clogged under certain conditions. Colloquially speaking, if you step on a hose or cross a stone, the logical thing is that a blockage occurs. The same thing happens with the digestive system, but from a medical point of view”. — Quilici explained.
What is Bolsonaro's forecast?
Both Macedo and Quilici have reserved their prognoses regarding the treatment of the disease pending confirmatory tests. Depending on the results plus the severity of the obstruction, location and causes, the intervention may or may not be possible.
Lúcio Lucas, chief physician of the Syrian-Lebanese Hospital and Surgical Center, also argued about the case. Although he considers abdominal surgeries of this kind to be routine, they require a high degree of physician-patient commitment.
“The intestine is in constant movement to favor the transit of feces in its natural process. When it is subjected to surgical trauma, the stage of inflammation and scarring can alter its mobility”. — Lucas pronounced.
Advantageously, everything seems to indicate that President Jair Bolsonaro's diagnosis was made on time. As part of this procedure, it is not expected to be a complicated clinical picture.
“When the obstruction is not complex, it simply requires surgery to treat the defect. It is not associated with complications and postoperative recovery is quick, without risks”. — Lucas stated. “But, when a good diagnosis is not executed, and it is made to wait, it is possible that a tract of the intestine can be lost due to necrosis. They are the most drastic scenarios where that area must be surgically removed”. — Complements Quilici.
So far, Bolsonaro lies conscious, apparently in good condition on social networks. His latest post on Twitter indicates to be waiting for the aforementioned medical examinations and to keep monitoring them.
