2. DEFINITION :
Ileus is a condition in which there is
neurogenic failure or loss of peristalsis in
the intestine in the absence of
mechanical obstruction.
3. PERCIPITATING FACTORS :
It is commonly seen in hospitalized pts as a
result of :
1- intra-abdominal processes such as recent gi
or abd surgery or peritoneal
irritation(peritonitis,pancreatitis,ruptured
viscus,hemorrhage)
2- severe medical illness such as pneumonia,
respiratory failure requiring intubation,sepsis or
severe infection,uremia, dka and
4. .
Electrolyte imbalance such as
hypokalemia,hypophosphatemia,hypomag
nesemia and hypercalcemia.
3-medications that effect intestinal motility
such as opoids,anticholinergics and
phenothiazines.
5. .
After the surgery motility usually
normalizes first in small intestine (often
within hours), followed by stomach(24-48
hours) and the colon (48-72 hours).
Postoperative ileus can be reduced by the
use of pt controlled or epidural analgesia
and avoidance of i/v opoids as well as early
ambulation,gum chewing and initiation of
clear liquid diet.
6. CLINICAL FEATURES :
SYMPTOMS-
Mild diffuse,continuous abd discomfort with
nausea and vomiting.
SIGNS-
Generalized abd distension with minimal abd
tenderness but no signs of peritoneal irritation(unless
due to pri peritoneal disease).
Bowel sounds are diminished to absent.
7. LABORATORY FINDINGS :
The lab findings are attributable to the
underlying condition.
Serum electrolytes, including
potassium,magnesium,phosphorous and
calcium,should be obtained to exclude
abnormalities as contributing factors.
8. IMAGINGS :
Plan film radiography of the abdomen
demonstrates gas filled loops of small and large
intestine.
Air-fluid levels may be seen.
9. Differential diagnosis :
Ileus must be distinguished from mechanical
obstruction of small intestine or proximal colon.
Pain from small bowel obstruction is usually
intermittent,cramping and associated initially with
profuse vomiting.
AGE, acute appendicitis and acute pancreatitis may
all present with ileus.
10. TREATMENT :
The pri medical and surgical illness that has
precipitated adyanamic ileus should be treated.
Most cases of ileus respond to restriction of oral
intake with gradual liberalization of diet as bowel
function returns.
Severe or prolonged ileus requires nasogastric
suction and parentral administration of fluids and
electrolytes.
11. .
Alvimopan is a peripherally acting mu-opoid
receptor antagonist with limited absorption or
systemic activity that reverses opoid induced
inhibition of intestinal motility.
Alvimopan 12 mg orally twice daily for short
term(no longer then 15 days),may be
considered in pts undergoing partial large or
small bowel resection when postop opoid
theraoy is anticipated.
