Paralytic Ileus

Question 1

Physiologic processes that inhibit motility

Process

Answer 1

inflamm, inhibitory neural reflexes, neurohormonal peptides

Inflamm (surgery or primary) activates macrophages and cytokine/PG production

PG dec jejunal contractility

Noxious stmul trigger spinal afferents that inc SNS inhib activity

Release of mediation such as sub P, NO, VIP dec GI motility

Question 2

Predispsoing condx to PI

Peritoneal irritation

Severe medical illness

Electrolyte abnromalit

Medications

Postsurgical

Answer 2

Peritonitis, pancreatitis, ruptured viscus/hemorrhage

PNA, sepsis, uremia, DKA

HypoK/Mg/Phos, hyperCa

Opioids, anticholinergics, pheno

SI motility noralizes in hrs, stomach 24-48, colone 48-72 hrs

Question 3

Post operative risk inc w

uncommon in

Answer 3

large incisions and bowel manipulation

laparoscopic procedures w minimal bowel manip (ie cholecystectomy)

Question 4

CM

worsen w

PE

Answer 4

mild dffuse ab discomfort/distension
N/V

oral foods

Bowel sounds dim/absent, ab distension/ central ab tenderness

Question 5

Dx

upright films

Answer 5

Clinical features

Xrays support- multiple distended loops of S/L I

air fluid levels

Question 6

Mx

Most respond w

Restrict

Gradual advance diet when

Answer 6

Depends on underlying illness/surgery

Reviw meds/electrolytes

improvement of underlying cause

oraal intake until ileus improves

bowel function returns