Post-Op Ileus Flashcards
What does a post-op ileum describe?
A deceleration or arrest in intestinal motility following surgery
What is a post-op ileus classified as?
A functional bowel obstruction
Is post-op ileus common?
Yes, very common
When is post-op ileus particularly common?
After abdominal surgery or pelvic orthopaedic surgery
Why is post-op ileus an important condition?
Although innocent in the majority of patients, it can be a sign of other intra-abdominal pathology, in particular a collection or anastomotic leak
Why does an anastomotic leak lead to post-op ileus?
As pus or faeces will irritate the bowel and often cause it to cease functioning
What is the problem with post-op ileus?
Shown to lengthen hospital stay and increased hospital costs
What are the patient risk factors for post-op ileus?
- Increased age
- Electrolyte derangement
- Neurological disorders
- Use of anti-cholinergic medication
What electrolyte derangements can increase the risk of post-op ileus?
Na, K, and Ca derangement
What neurological conditions can increase the risk of post-op ileus?
- Dementia
- Parkinson’s disease
What are the surgical risk factors for post-op ileus?
- Use of opioid medication
- Pelvic surgery
- Extensive intra-operative intestinal handling
- Peritoneal contamination
- Intestinal resection
What are the presenting features of post-op ileus the same as?
Those of mechanical obstruction
What are the presenting features of post-op ileus?
- Failure to pass flatus or faeces
- Sensation of bloating and distention
- Nausea and vomiting / high NG output
What will be found on examination in post-op ileus?
- Abdominal distention
- Absent bowel sounds
What is the aim of investigations in post-op ileus?
To rule out more serious pathologies and determine any underlying cause
What investigations are done in post-op ileus?
- Initial routine bloods
- CT scan, often with oral contrast
What initial routine bloods should be done in post-op ileus?
- FBC
- CRP
- U&Es
- Electrolytes
Why should U&Es be checked in post-op ileus?
Fluid shifts can occur within the dynamic bowel leading to AKI
What electrolytes should be checked in post-op ileus?
- Ca
- Phosphate
- Mg
What is the purpose of CT scan in post-op ileus?
Confirm the diagnosis and rule out any collections/anastomotic leak
What kind of management is used in post-op ileus?
As long as serious pathology, e.g. anastomotic leak, has been excluded, management is conservative
How should any established post-op ileus be managed?
- Daily bloods, including electrolytes
- Encourage mobilisation
- Reduce opiate analgesia and any other bowel mobility reducing medication
What is it important to warn patients with post-op ileus about?
Once it does settle, they will get very watery diarrhoea for first 2-3 bowel movements
What might some cases of post-op ileus warrant?
Insertion of NG tube on free drainage and catheterising with a fluid balance chart
How can the risk of post-op ileus be reduced?
- Minimise intra-operative intestinal handling
- Avoid fluid overload
- Minimise opiate use
- Encourage early mobilisation
