GI Section 1: Luminal (Ileus)

Question 1

Ileus is best thought about as?

Answer 1

Ileus is best thought about as paralyzed or “sleepy” bowel

Question 2

basically the electrical system of the bowel.

Answer 2

migrating myoelectric complex - keeping the poop train running

Question 3

Classic offender of the normal electrical system in bowel peristalsis?

Answer 3

Surgery

Question 4

Ileus comes in two flavors

Answer 4

1. Generalized
2. Reactive

Question 5

Supine: Dilated loops arranged in “stepladder” fashion. Orderly. A bag of sausages.

Upright: Many dilated air-fluid levels in both limbs of a given loop, at different heights (candy canes).

Answer 5

Obstruction

Question 6

Supine: Disorderly loops scattered throughout the abdomen. A bag of popcorn.

Upright: Fewer and/or
smaller (less dilated) air-fluid levels scattered throughout the abdomen.

Answer 6

Ileus

Question 7

If the process is local - the “canceling” of bowel movement will also be local

Answer 7

Reactive (Focal Ileus)

i.e.

Appendicitis
Pancreatitis
Diverticulitis

Question 8

a segment of bowel that it dilated —in response to some adjacent infection or inflammatory process.

Answer 8

Sentinel loop

In this case (black arrow) the dilated loop is in the central abdomen - so you’d think pancreatitis.

Question 9

This is a scenario where there is basically no bowel gas. It is non-specific and can be the result of fluid filled bowel in the setting of diarrhea or the result of fluid filled bowel in the setting of obstruction.

Answer 9

Gasless abdomen