Ileus: Difference between revisions
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==Background== | ==Background== | ||
*Failure or insufficiency in the peristalsis movement of the gastrointestinal tract which normally moves GI contents from mouth to anus. | *Failure or insufficiency in the peristalsis movement of the gastrointestinal tract which normally moves GI contents from mouth to anus. | ||
*Thought to be caused by a disruption in either the neural and/or neuro-hormonal reflexes that normally regulate bowel motility. | *Thought to be caused by a disruption in either the neural and/or neuro-hormonal reflexes that normally regulate bowel motility. | ||
*Multiple causes possible - likely an inflammatory condition | *Multiple causes possible - likely an inflammatory condition | ||
**[[Opioid]]-induced | **[[Special:MyLanguage/Opioid|Opioid]]-induced | ||
**Post-operative (irritation +/- opioids) | **Post-operative (irritation +/- opioids) | ||
**Electrolyte imbalance ([[hypokalemia]], [[hypomagnesemia]]) | **Electrolyte imbalance ([[Special:MyLanguage/hypokalemia|hypokalemia]], [[Special:MyLanguage/hypomagnesemia|hypomagnesemia]]) | ||
**Colonic pseudo-obstruction (aka [[Ogilvie's syndrome]]) | **Colonic pseudo-obstruction (aka [[Special:MyLanguage/Ogilvie's syndrome|Ogilvie's syndrome]]) | ||
**Gallstone ileus, [[pancreatitis]] | **Gallstone ileus, [[Special:MyLanguage/pancreatitis|pancreatitis]] | ||
*[[Peritonitis]] (e.g. from infection, malignancy, trauma) | *[[Special:MyLanguage/Peritonitis|Peritonitis]] (e.g. from infection, malignancy, trauma) | ||
*[[Clostridium difficile]] colitis | *[[Special:MyLanguage/Clostridium difficile|Clostridium difficile]] colitis | ||
**[[Burns]], [[acute radiation syndrome]] | **[[Special:MyLanguage/Burns|Burns]], [[Special:MyLanguage/acute radiation syndrome|acute radiation syndrome]] | ||
**Spastic ileus (rare: porphyria or lead poisoning) | **Spastic ileus (rare: porphyria or lead poisoning) | ||
==Clinical Features== | ==Clinical Features== | ||
*[[Abdominal pain]]/distension | |||
*[[Nausea/vomiting]], inability to tolerate PO/enteral feeding | *[[Special:MyLanguage/Abdominal pain|Abdominal pain]]/distension | ||
*[[Constipation]] | *[[Special:MyLanguage/Nausea/vomiting|Nausea/vomiting]], inability to tolerate PO/enteral feeding | ||
*[[Special:MyLanguage/Constipation|Constipation]] | |||
*Absent or hypoactive bowel sounds | *Absent or hypoactive bowel sounds | ||
*Can produce intestinal ischemia, intestinal perforation, abdominal compartment syndrome | *Can produce intestinal ischemia, intestinal perforation, abdominal compartment syndrome | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
*[[Small bowel obstruction]] | |||
*See [[constipation]], [[abdominal pain]] | *[[Special:MyLanguage/Small bowel obstruction|Small bowel obstruction]] | ||
*See [[Special:MyLanguage/constipation|constipation]], [[Special:MyLanguage/abdominal pain|abdominal pain]] | |||
==Evaluation== | ==Evaluation== | ||
*BMP, Mg | *BMP, Mg | ||
*[[Abdominal X-ray]]: air fluid levels, air in bowel, distended bowel | *[[Special:MyLanguage/Abdominal X-ray|Abdominal X-ray]]: air fluid levels, air in bowel, distended bowel | ||
*Evaluate for underlying causes | *Evaluate for underlying causes | ||
*If concern for [[SBO]], CT abdomen | *If concern for [[Special:MyLanguage/SBO|SBO]], CT abdomen | ||
==Management== | ==Management== | ||
*Treat underlying causes | *Treat underlying causes | ||
*Avoid excessive [[IVF|IV fluids]] (bowel edema worsens ileus) | *Avoid excessive [[Special:MyLanguage/IVF|IV fluids]] (bowel edema worsens ileus) | ||
*Avoid [[opioids]] | *Avoid [[Special:MyLanguage/opioids|opioids]] | ||
*Pro-motility agents | *Pro-motility agents | ||
**[[Metoclopramide]], [[erythromycin]] | **[[Special:MyLanguage/Metoclopramide|Metoclopramide]], [[Special:MyLanguage/erythromycin|erythromycin]] | ||
*Opioid antagonist: methylnaltrexone | *Opioid antagonist: methylnaltrexone | ||
*[[Ogilvie's syndrome]]: [[Neostigmine]] 2mg IV | *[[Special:MyLanguage/Ogilvie's syndrome|Ogilvie's syndrome]]: [[Special:MyLanguage/Neostigmine|Neostigmine]] 2mg IV | ||
==Disposition== | ==Disposition== | ||
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==See Also== | ==See Also== | ||
*[[Small bowel obstruction]] | |||
*[[Toxic megacolon]] | *[[Special:MyLanguage/Small bowel obstruction|Small bowel obstruction]] | ||
*[[Special:MyLanguage/Toxic megacolon|Toxic megacolon]] | |||
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==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:GI]] | [[Category:GI]] | ||
</translate> | |||
Latest revision as of 23:09, 4 January 2026
Background
- Failure or insufficiency in the peristalsis movement of the gastrointestinal tract which normally moves GI contents from mouth to anus.
- Thought to be caused by a disruption in either the neural and/or neuro-hormonal reflexes that normally regulate bowel motility.
- Multiple causes possible - likely an inflammatory condition
- Opioid-induced
- Post-operative (irritation +/- opioids)
- Electrolyte imbalance (hypokalemia, hypomagnesemia)
- Colonic pseudo-obstruction (aka Ogilvie's syndrome)
- Gallstone ileus, pancreatitis
- Peritonitis (e.g. from infection, malignancy, trauma)
- Clostridium difficile colitis
- Burns, acute radiation syndrome
- Spastic ileus (rare: porphyria or lead poisoning)
Clinical Features
- Abdominal pain/distension
- Nausea/vomiting, inability to tolerate PO/enteral feeding
- Constipation
- Absent or hypoactive bowel sounds
- Can produce intestinal ischemia, intestinal perforation, abdominal compartment syndrome
Differential Diagnosis
Evaluation
- BMP, Mg
- Abdominal X-ray: air fluid levels, air in bowel, distended bowel
- Evaluate for underlying causes
- If concern for SBO, CT abdomen
Management
- Treat underlying causes
- Avoid excessive IV fluids (bowel edema worsens ileus)
- Avoid opioids
- Pro-motility agents
- Opioid antagonist: methylnaltrexone
- Ogilvie's syndrome: Neostigmine 2mg IV
Disposition
See Also