Ileus is a disruption of the normal propulsive
gastrointestinalThe human gastrointestinal tract , digestive tract, guts or gut is the system of organs within humans that takes in food, digests it to extract energy and nutrients, and expels the remaining matter...
motor activity due to non-mechanical causes. In contrast, motility disorders that result from structural abnormalities are termed mechanical
bowel obstructionBowel 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. 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 .
Paralytic ileus causes constipation and bloating. On listening to the abdomen with a stethoscope, no bowel sounds are heard because the bowel is inactive.
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 . 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
Symptoms
Symptoms of ileus include, but are not limited to:
- moderate, diffuse abdominal discomfort
- constipation
Constipation, costiveness, or irregularity is a condition of the digestive system in which a person experiences hard feces that are difficult to expel. This usually happens because the colon absorbs too much water from the food...
- abdominal distension
Abdominal distension can be a sign of many other conditions, including:* Coeliac disease* Refractory sprue* Tropical sprue* Small bowel bacterial overgrowth syndrome* Kwashiorkor* Eosinophilic gastroenteritis* Giardiasis...
- nausea
Nausea is the sensation of unease and discomfort in the stomach with an urge to vomit.-Causes:...
/vomitingVomiting 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 is the expulsion through the rectum of a mixture of gases that are byproducts of the digestion process of mammals and other animals. The mixture of gases is known as flatus, fart, or simply gas, and is expelled from the rectum in a process colloquially referred to as "passing gas" or...
- excessive belching
Risk Factors
- gastrointestinal surgery
Lower gastrointestinal surgery refers to a sub-specialisation of medical practise whereby a general surgeon focuses on the lower gastrointestinal tract.A lower GI surgeon might specialise in the following operations:* Colectomy...
or other GI procedures
- electrolyte imbalance
- 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.-Causes:...
- medications (e.g. opiates)
- severe illness
Illness can be defined as a state of poor health. Illness is sometimes considered a synonym for disease. Others maintain that fine distinctions exist...
(Inflammation with peritonitis)
- spinal cord injury (SCI), those with injury above thoracic vertebrae 5 (T5) will have hypomotility problems within the bowel
Treatment
Nil per osNil per os is a medical instruction meaning to withhold oral food and fluids from a patient for various reasons. It is a Latin phrase which translates as "nothing through the mouth". In the UK it is translated as nil by mouth .Typical reasons for NPO instructions are the prevention of aspiration...
(NPO or "Nothing by Mouth") is mandatory in all cases.
Nasogastric suctionNasogastric intubation is a medical process involving the insertion of a plastic tube through the nose, past the throat, and down into the stomach.-Uses:...
and
parenteralParenteral is a route of administration that involves piercing the skin or mucous membrane. Parenteral nutrition refers to providing nutrition via the veins.-Etymology:...
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
lactuloseLactulose 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. The commercial syrup used for treatment of constipation is dyed...
,
erythromycinErythromycin 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. For respiratory tract infections, it has better coverage of atypical organisms, including mycoplasma and...
or, in severe cases (Ogilvie's syndrome),
neostigmineNeostigmine is a parasympathomimetic, specifically, a reversible cholinesterase inhibitor.Neostigmine is available under several trade names such as Prostigmin and Vagostigmin.Neostigmine was first synthesized by Aeschlimann and Reinert in 1931....
.
If possible the underlying cause is corrected (e.g. replace electrolytes).
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