Post op ileus

Question 1

What is POI?

Answer 1

• deceleration or arrest in intestinal motility following surgery
• very common after abdominal surgery or pelvic orthopaedic surgery

Question 2

What are the RF for POI?

Answer 2

Patient Factors

• Increased age
• Electrolyte derangement (e.g. Na+, K+ and Ca2+ derangement)
• Neurological disorders (e.g. Dementia or Parkinson’s Disease)
• Use of anti-cholinergic medication

Surgical Factors

• Use of opioid medication
• Pelvic surgery
• Extensive intra-operative intestinal handling
• Peritoneal contamination (by free pus or faeces)
• Intestinal resection

Question 3

WHat are the clinical features of POI?

Answer 3

• failure to pass flatus or faeces
• bloadting & distension
• N&V
• absent bowel sound

*tinkling bowel sounds in mechanical obstruction

Question 4

What Ix would you order for POI?

Answer 4

• Bloods
  
  • FBC, CRP, U&E, Ca, Phos, Mg
• Imaging
  
  • CT abdo & pelvis c contrast - confirm diagnosis

Question 5

How would you mx POI?

Answer 5

• NBM
• IV fluid
• UC &UO
• Daily bloods
• Encourage mobilisation
• Reduce opiate analgesia

Question 6

What are the prophylatic measures to reduce POI?

Answer 6

• Minimise intra-operative intestinal handling
• Avoid fluid overload (causing intestinal oedema)
• Minimise opiate use
• Encourage early mobilisation