GI - Paralytic Ileus And Colonic Pseudo-obstruction

Question 1

What is the presentation of a paralytic ileus?

Answer 1

• Adynamic bowel secondary to absence of normal peristalsis
• Usually SBO affected
• Reduced or absent bowel sounds
• Mild abdominal pain: not colicky
• Nausea and vomiting

Question 2

Paralytic ileus: causes

Answer 2

• post op
• peritonitis
• pancreatic/localised inflammation
• Poisons/drugs: anti-AChM (eg TCAs)
• pseudo-obstruction
• Metabolic disturbance: hypo K+, Na+, Mg+, uraemia
• mesenterio ischaemia

Question 3

Paralytic ileus: Ix

Answer 3

• Bloods: FBC and CRB, U&Es and calcium levels

- CT scan (with oral contrast): usually confirms Dx and helps rule out anastomotic leak and any collection

Question 4

Paralytic ileus: prevention

Answer 4

• Decreased bowel handling
• laparoscopic approach
• peritoneal lavage after peritonitis
• unstarched gloves

Question 5

Paralytic ileus: Mx

Answer 5

• Conservative: drip and suck
• Correct any underlying causes (eg drugs/metabolic abnormalities)
• Consider need for parenteral nutrition
• Encourage mobilisation
• Reduce opiate analgesia
• May need insertion of NG tube

Question 6

Colonic pseudo-obstruction: presentation

Answer 6

• Clinical signs of mechanical obstruction but not obstructing lesion
• usually distension only: no colic

Question 7

Paralytic ileus: cause

Answer 7

• aetiology unknown

- Associated with: elderly pets, cardio-reps disorders, pelvic surgery (eg hip arthroplasty), trauma

Question 8

Paralytic ileus: Ix

Answer 8

• Usual set of bloods and imaging

- Gastrograffin enema: to exclude a mechanical cause

Question 9

Paralytic ileus: Mx

Answer 9

• Neostigmine: anti-cholinesterase

- colonoscopic decompression: 80% succcessful