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Ileus is a disruption of the normal propulsive gastrointestinal
Gastrointestinal tract

The digestive tract is the system of Organ s within multicellular animals that takes in food, digestion it to extract energy and nutrients, and expels the remaining waste....
 motor activity from non-mechanical mechanisms. Motility disorders that result from structural abnormalities are termed mechanical bowel obstruction
Bowel obstruction

Bowel obstruction is a mechanical or functional obstruction of the intestines, preventing the normal transit of the products of digestion. It can occur at any level distal to the duodenum of the small intestine and is a medical emergency....
. Some mechanical obstructions are misnomers, such as gallstone ileus and meconium ileus, and are not true examples of ileus by the classic definition .

Postoperative Ileus
It is a temporary paralysis of a portion of the intestines typically after an abdominal surgery.






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Ileus is a disruption of the normal propulsive gastrointestinal
Gastrointestinal tract

The digestive tract is the system of Organ s within multicellular animals that takes in food, digestion it to extract energy and nutrients, and expels the remaining waste....
 motor activity from non-mechanical mechanisms. Motility disorders that result from structural abnormalities are termed mechanical bowel obstruction
Bowel obstruction

Bowel obstruction is a mechanical or functional obstruction of the intestines, preventing the normal transit of the products of digestion. It can occur at any level distal to the duodenum of the small intestine and is a medical emergency....
. Some mechanical obstructions are misnomers, such as gallstone ileus and meconium ileus, and are not true examples of ileus by the classic definition .

Types


Postoperative Ileus


It is a temporary paralysis of a portion of the intestines typically after an abdominal surgery. Since the intestinal content of this portion is unable to move forward, food or drink should be avoided until peristaltic sound is heard from auscultation of the area where this portion lies.

Paralytic Ileus

Paralysis of the intestine. To be termed "paralytic ileus," the intestinal paralysis need not be complete, but it must be sufficient to prohibit the passage of food through the intestine and lead to intestinal blockage.

Paralytic ileus is a common aftermath of some types of surgery. It can also result from certain drugs and from various injuries and illnesses such as Fibromyalgia
Fibromyalgia

Fibromyalgia , meaning muscle and connective tissue pain , is a disorder classified by the presence of chronic widespread pain and a heightened and painful response to gentle Somatosensory system ....
. Paralytic ileus causes constipation and bloating. On listening to the abdomen with a stethoscope, no bowel sounds are heard because the bowel is inactive.

Acute colonic pseudoobstruction


Also known as Ogilvie's syndrome

Pathogenesis


Inhibitory neural reflexes


Inflammation

Ileus may increase adhesion formation, because intestinal segments have more prolonged contact, allowing fibrous adhesions to form, and intestinal distention causes serosal injury and ischemia. Intestinal distention has been shown to cause adhesions in foals . In a recent survey of ACVS diplomates on drugs to prevent ileus and therefore prevent adhesions (unpublished data). The drug used in this survey was lidocaine, erythromycin, and cisapride . Some respondents also mentioned the importance of walking horses postoperatively to stimulate motility. Repeat celiotomy to decompress chronically distended small intestine and remove fibrinous adhesions is also a useful method of treating ileus and reducting adhesions, and it has been associated with a good outcome

Neurohumoral peptides


Symptoms

Symptoms of ileus include, but are not limited to:
  • moderate, diffuse abdominal discomfort
  • constipation
    Constipation

    Constipation, costiveness, or irregularity, is a condition of the digestive system in which a person experiences hard feces that are difficult to expel....
  • abdominal distension
    Abdominal distension

    Abdominal distension can be a sign of many other conditions, including:* diverticulitis* lactose intolerance* obstructed bowel* Polycystic Liver Disease...
  • nausea
    Nausea

    Nausea is the sensation of unease and discomfort in the stomach with an urge to vomit....
    /vomiting
    Vomiting

    Vomiting is the forceful expulsion of the contents of one's stomach through the mouth and sometimes the nose. Undesired vomiting may result from many causes, ranging from gastritis or poisoning to brain tumors, or elevated intracranial pressure....
    , especially after meals
  • lack of bowel movement and/or flatulence
    Flatulence

    Flatulence is the production of a mixture of gases in the gastrointestinal tract of mammals or other animals that are byproducts of the digestion process....
  • excessive belching


Risk Factors

  • gastrointestinal surgery
    Lower gastrointestinal surgery

    Lower gastrointestinal surgery refers to a sub-specialisation of medical practise whereby a general surgeon focuses on the lower gastrointestinal tract....
     or other GI procedures
  • electrolyte imbalance
  • hypothyroidism
    Hypothyroidism

    Hypothyroidism is the disease state in humans and in animals caused by insufficient production of thyroid hormone by the thyroid gland. Cretinism is a form of hypothyroidism found in infants....
  • medications (e.g. opiates)
  • severe illness
    Illness

    Illness can be defined as a state of poor health.It is sometimes considered a synonym for disease. Others maintain that fine distinctions exist....


Treatment

Nihil per os (NPO or "Nothing by Mouth") is mandatory in all cases. Nasogastric suction
Nasogastric intubation

Nasogastric intubation is a medical process involving the insertion of a plastic tube through the nose, past the throat, and down into the stomach....
 and parenteral
Parenteral

Parenteral refers to a route of administration that involves piercing the skin or mucous membrane.Total parenteral nutrition refers to providing nutrition via the veins....
 feeds may be required until passage is restored.

There are several options in the case of paralytic ileus. Most treatment is supportive. If caused by medication, the offending agent is discontinued or reduced. Bowel movements may be stimulated by prescribing lactulose
Lactulose

Lactulose is a synthetic sugar used in the treatment of constipation and hepatic encephalopathy, a complication of liver disease. It is a disaccharide formed from one molecule each of the simple sugars fructose and galactose....
, erythromycin
Erythromycin

Erythromycin is a macrolide antibiotic that has an antimicrobial spectrum similar to or slightly wider than that of penicillin, and is often used for people who have an allergy to penicillins....
 or, in severe cases (Ogilvie's syndrome), neostigmine
Neostigmine

Neostigmine is a Parasympathomimetic drug, specifically, a reversible cholinesterase inhibitor.Neostigmine is available under several trade names such as Prostigmin and Vagostigmin....
.

If possible the underlying cause is corrected (e.g. replace electrolytes).

External links



See also

  • Bowel obstruction
    Bowel obstruction

    Bowel obstruction is a mechanical or functional obstruction of the intestines, preventing the normal transit of the products of digestion. It can occur at any level distal to the duodenum of the small intestine and is a medical emergency....