Ileus: Difference between revisions
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**Colonic pseudo-obstruction (aka [[Ogilvie's syndrome]]) | **Colonic pseudo-obstruction (aka [[Ogilvie's syndrome]]) | ||
**Gallstone ileus, [[pancreatitis]] | **Gallstone ileus, [[pancreatitis]] | ||
*Peritonitis (e.g. from infection, malignancy, trauma) | *[[Peritonitis]] (e.g. from infection, malignancy, trauma) | ||
*[[Clostridium difficile]] colitis | *[[Clostridium difficile]] colitis | ||
**[[Burns]], [[acute radiation syndrome]] | **[[Burns]], [[acute radiation syndrome]] | ||
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==Clinical Features== | ==Clinical Features== | ||
*Abdominal pain/distension | *[[Abdominal pain]]/distension | ||
*Nausea/vomiting, inability to tolerate PO/enteral feeding | *[[Nausea/vomiting]], inability to tolerate PO/enteral feeding | ||
*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 | ||
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==Differential Diagnosis== | ==Differential Diagnosis== | ||
*[[Small bowel obstruction]] | *[[Small bowel obstruction]] | ||
*See [[constipation]], [[abdominal pain]] | |||
==Evaluation== | ==Evaluation== | ||
*BMP, Mg | *BMP, Mg | ||
*Abdominal | *[[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 [[SBO]], CT abdomen | ||
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==Management== | ==Management== | ||
*Treat underlying causes | *Treat underlying causes | ||
*Avoid excessive IV fluids (bowel edema worsens ileus) | *Avoid excessive [[IVF|IV fluids]] (bowel edema worsens ileus) | ||
*Avoid opioids | *Avoid [[opioids]] | ||
*Pro-motility agents | *Pro-motility agents | ||
**[[Metoclopramide]], [[erythromycin]] | **[[Metoclopramide]], [[erythromycin]] | ||
*Opioid antagonist: methylnaltrexone | *Opioid antagonist: methylnaltrexone | ||
*Ogilvie's: Neostigmine 2mg IV | *[[Ogilvie's syndrome]]: [[Neostigmine]] 2mg IV | ||
==Disposition== | ==Disposition== | ||
Revision as of 21:31, 29 September 2019
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