Surg - Viva - Pseudo obstruction and ileus

Question 1

What is ileus

Answer 1

Marked intestinal dilation from partial or complete NON-mechanical obstruction of the small and or large intestine

Question 2

What is pseudo-obstruction

Answer 2

AKA paralytic ileus. More specific term dscribing clinical picture of mechanical obstruction of colon, in the absence of evidence of bowel obstruction

Question 3

Features of ileus

Answer 3

Abdomina distention
Pain
Constipation
N&V
Scanty/absent BS

X-ray - gaseous distention of isolated segment of intestine

Question 4

Differential of pseudo obstruction

Answer 4

Mechanical obstruction

Megacolon from c.diff

Question 5

Risk factors for ileus

Answer 5

Most common - abdo surgery with transient inhibition of small bowl movement

Stomach recovery 24-48 hours
Colon 48-72

Risk - opiate use
Intra op blood loss
Prolonged operation time
Intestinal resection

Other
Ventilation
Electrolytes
Intra-ab pressure
Sedaton
Sepsis
Volume overload
Hypotension

Question 6

Early preventative strategies to prevent ileus?

Answer 6

Early mobilsiation
Minimise opiate use, sedative, atecholamins

Correct hypokalaemia, hyperglycaemia
Reduce bowel handing

?chewing gum???

Question 7

Management principles of ileus?

Answer 7

Exclude precipatatining pathology (CT, collection, haematoma)

Resus and optimise physiology - minimise vasopressors and excess iv, correct electrolytes

Question 8

Specific management of Ileus

Answer 8

NG - in nausea and vomiting

Prokinetics do not reduce ileus
Neostimgine - dramatic effect

Avoid starvation, low rate trophic feed
PN when note tolerating oral

Wean opiates

Decompress in the context of compartment syndrome

Question 9

Specific pseudo obstruction Tx

Answer 9

Colonoscopic decompression, flatus tube

Neostgimine

Surgery in actual or imminent perf