Ogilvie’s Syndrome Flashcards
definition
Gradual or sudden onset associated with an acute dilation of the colon with no evidence of mechanical obstruction.
Pathogenesis
impairment of the autonomic nervous system leading to an atonic distal colon and functional obstruction.
At what day Risk of Ischemia +- perforation increase
particularly if the duration of distention exceeds 6 days.
Rf
hospitalized or institutionalized patients
severe comorbid illness
infection
cardiac disease
inoperative trauma
orthopedic procedures including hip and spine surgery
after pelvic surgery.
CT of the abdomen and pelvis
- proximal colon dilation with an intermediate transition zone near the splenic flexure
- Occasional dilation may extend to the rectum.
- This will exclude a mechanical obstruction.
Something You Shouldnt Do, increase risk for Perf
Contrast enemas can be hazardous and may increase the risk of perforation.
Initial Tx
- NPO
- decompression with nasogastric and rectal tube suction,
avoiding medications such as
opioids, anticholinergics, antipsychotics, cytotoxic drugs, calcium channel blockers, and clonidine - Fluid and electrolyte corrected.
- Serial labs , lactate, rule out C.Diff
- Mobilizing the patient
- Position (prone position with hips elevated)
- considered for 24 to 48 hours as long as the patient is undergoing frequent physical examinations and abdominal films at 12-hour intervals.
Algorithmic approach to stepwise therapy in acute colonic pseudo-obstruction.
see
What is Conservative Tx not effective
- Neostigmine, an anticholinesterase parasympathomimetic agent
- Indicated in patients with a cecal diameter of 12 cm who have failed conservative management.
- (2 mg) is given intravenously over a 5-minute period
- monitoring of vital signs and electrocardiography.
- Patients should be supine
- response will generally occur within 30 minutes.
- Glycopyrrolate should be available to treat bradycardia.
- A second dose can be given no sooner than 8 hours but up to 24 hours later
Neostigmine Therapy
see
Risk factors for neostigmine failure
male gender
younger age
electrolyte imbalance
postsurgical status.
What may increase the effectiveness of neostigmine
- regular administration of polyethylene glycol via nasogastric tube
Role of infusion
Continuous infusion of neostigmine was associated with greater bowel diameter reduction in 24 hours, and adverse events may also be diminished by continuous infusion.
SE of the Drug
Bradyarrhythmias
bronchoconstriction
hypotension
agitation
abdominal cramps
nausea and vomiting
salivation
diaphoresis.
How to Tx SE
Glycopyrrolate 0.4 mg
Endoscopic Decompression
see
