Ileus
| Ileus | |
|---|---|
 | |
| Gangreneof the bowel causing gangrenous ileus | |
| Pronunciation | |
| Specialty | Gastroenterology,general surgery |
Ileusis a disruption of the normalpropulsiveability of theintestine.It can be caused by lack ofperistalsisor bymechanical obstruction.[1] The word 'ileus' derives fromAncient Greekεἰλεός(eileós)'intestinal obstruction'. The term 'subileus' refers to a partial obstruction.[2]
Signs and symptoms
[edit]Symptoms of ileus include, but are not limited to:[citation needed]
- moderate to severe, diffuseabdominal pain
- constipation
- abdominal distension
- nausea/vomiting,especially after meals
- vomiting ofbilious fluid(green or yellowish-green in colour)
- flatulenceand/or lack ofbowel movement
- excessivebelching
Cause
[edit]Decreased propulsive ability may be broadly classified as caused either by bowel obstruction or by intestinalatonyor paralysis. However, instances with symptoms and signs of a bowel obstruction occur, but with the absence of a mechanical obstruction, mainly in acute colonicpseudo-obstruction,Ogilvie's syndrome.[3]In 2023 the USFDAreported gastrointestinal ileus as anadverse effectof the medicationsemaglutide,with frequency and causal relationship unknown.[4]
Bowel obstruction
[edit]A bowel obstruction is generally a mechanical obstruction of the gastrointestinal tract and can occur anywhere from the Ligament of Treitz to the anus. When the obstruction affects only the small intestine, it is generally referred to as a small bowel obstruction to distinguish it from a colonic obstruction, which may or may not affect the small intestine. The distinction helps to narrow the possible causes and treatment.
Common causes of small bowel obstruction include post-operative adhesions, hernias, intussusception, and intraabdominal tumors. Common causes of colonic obstruction include primary colon cancer,volvulusand post-operative adhesions. When the ileocecal valve is competent, colonic obstruction may manifest as gaseous distention of the colon, but not the small intestine; when the ileocecal valve is incompetent, it does not prevent retrograde passage of air and stool and a colonic obstruction will cause dilation of both large and small bowel.
Bowel obstructions can be partial or complete. They can be differentiated on imaging by the intestinal gas pattern. Partial obstructions will have gas distal to the obstruction, whereas a complete obstruction will not. Sounds of "rushes and tinkles" are associated with partial obstructions[5]and represent brief passages of fluid and gas (respectively) through the partial obstruction. Complete obstructions do not make these sounds.
Intestinal paralysis
[edit]Paralytic ileus is paralysis of the intestine, whether or not complete, sufficient to prohibit the passage of food through the intestine and lead to intestinal blockage. It causes constipation and bloating. On listening to the abdomen with a stethoscope, no bowel sounds are heard because the bowel is inactive.[citation needed]It is a common side effect of some types of surgery, termed postsurgical ileus. It can also result from certain drugs and from various injuries and illnesses, such asacute pancreatitis.
A temporary paralysis of a portion of the intestines occurs typically after abdominal surgery. Since the intestinal content of this portion is unable to move forward, food or drink should be avoided untilperistalticsound is heard, byauscultation(use of a stethoscope) of the area where this portion lies. Intestinal atony or paralysis may be caused by inhibitory neural reflexes, inflammation or other implication of neurohumoral peptides.[citation needed]
Risk factors
[edit]- gastrointestinal surgeryor other GI procedures
- electrolyte imbalance(Namelyhypokalemiaandhypercalcemia)
- diabetic ketoacidosis(DKA),[6]and other causes ofmetabolic acidosis
- hypothyroidism
- diabetes
- medications(e.g.opioidsorantimuscarinics)
- severeillness(inflammation with peritonitis)
- spinal cord injury, those with injury abovethoracic vertebra 5(T5) will have hypomotility problems within the bowel
- acute intermittent porphyria
Treatment
[edit]Traditionally,nothing by mouthwas considered to be mandatory in all cases, but gentle feeding by enteralfeeding tubemay help to restore motility by triggering the gut's normal feedback signals, so this is the recommended management initially.[7]When the patient has severe, persistent signs that motility is completely disrupted,nasogastric suctionandparenteral nutritionmay be required until passage is restored. In such cases, continuing aggressive enteral feeding causes a risk of perforating the gut.
Several options are available 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 prescribinglactulose,erythromycinor, in severe cases that are thought to have a neurological component (such asOgilvie's syndrome),neostigmine.There is also evidence from a systematic review ofrandomized controlled trialsthat chewing gum, as a form of 'sham feeding', may stimulate gastrointestinal motility in the post-operative period and reduce the duration of postoperative ileus.[8]
If possible the underlying cause is corrected (e.g. replace electrolytes).
Other animals
[edit]Ileus is a cause ofcolicin horses due to functional obstruction of the intestines. It is most commonly seen in horses postoperatively, especially following colic surgery.[9]Horses experiencing ileus are at risk for gastric rupture due to rapid reflux build-up, and require intense medical management with frequent nasogastric intubation.[9]Ileus may increaseadhesionformation, because intestinal segments have more prolonged contact and intestinal distention causes serosal injury andischemia.It is usually treated with aggressive fluid support,prokinetics,and anti-inflammatories.[9]
Terminology
[edit]ICD-10coding reflects both impaired-peristalsis senses and mechanical-obstruction senses of the term as modified by various adjectives.[1]Some authors have argued for trying to reserve the term for the impaired-peristalsis senses,[10][11]under whichprescriptioncertain older terms such as "gallstoneileus "and"meconiumileus ", although now technicallymisnomers,are still accepted as correct owing to their long-established usage.[12]
References
[edit]- ^abWorld Health Organization (WHO),ICD-10 coding. K56.x series.,archivedfrom the original on 2018-12-04,retrieved2021-07-28.
- ^"Ileus Intestinal Obstruction".baermed.ch.Archivedfrom the original on 2020-08-21.Retrieved2019-10-05.
- ^Ponec RJ, Saunders MD, Kimmey MB (1999). "Neostigmine for the treatment of acute colonic pseudo-obstruction".N. Engl. J. Med.341(3): 137–41.doi:10.1056/NEJM199907153410301.PMID10403850.
- ^Zoler, Mitchel L. (28 September 2023)."FDA Gives Ozempic Two Drug Safety–Related Label Changes".Medscape.Archivedfrom the original on 5 October 2023.Retrieved3 October2023.
- ^Suneja, Manish (2020).DeGowin's diagnostic examination(11th ed.). New York, NY: McGraw-Hill. pp. Chapter 9.
{{cite book}}:CS1 maint: date and year (link) - ^Kitabchi AE, Umpierrez GE, Murphy MB, et al. (January 2001)."Management of hyperglycemic crises in patients with diabetes".Diabetes Care.24(1): 131–53.doi:10.2337/diacare.24.1.131.PMID11194218.Archivedfrom the original on 2012-07-07.Retrieved2012-01-05.
- ^McClave SA, Martindale RG, Vanek VW, et al. (2009)."Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.)".JPEN J Parenter Enteral Nutr.33(3): 277–316.doi:10.1177/0148607109335234.PMID19398613.
- ^Fitzgerald JE, Ahmed I (December 2009). "Systematic review and meta-analysis of chewing-gum therapy in the reduction of postoperative paralytic ileus following gastrointestinal surgery".World J Surg.33(12): 2557–66.doi:10.1007/s00268-009-0104-5.PMID19763686.
- ^abcLarson, Erica (22 July 2013)."Equine Postoperative Ileus Insights".thehorse.The Horse.Archivedfrom the original on 15 July 2014.Retrieved4 July2014.
- ^Townsend CM, Beauchamp RD, Evers BM, Mattox KL (2004). "The biological basis of modern surgical practice".Sabiston Textbook of Surgery(17th ed.). Elsevier Saunders.
- ^Livingston EH, Passaro EP (January 1990). "Postoperative ileus".Dig. Dis. Sci.35(1): 121–32.doi:10.1007/bf01537233.PMID2403907.
- ^Feldman M, Friedman LS, Brandt LJ, Sleisenger MH (2006). "Intestinal obstruction and ileus".Sleisenger & Fordtran's Gastrointestinal and Liver Disease(8th ed.). Elsevier Saunders.