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Essential Features

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  • • Adynamic ileus is a functional obstruction due to dysmotility of the bowel

    • Distinguished from postoperative ileus following abdominal surgery (distinction is based on time since operation and clinical circumstances)

    • May present with signs and symptoms of bowel obstruction

    • Must differentiate ileus from mechanical bowel obstruction

    • Thought to occur as a result of dysfunction due to a combination of neural, hormonal, and metabolic factors

    • Occurs with intra-abdominal processes such as pancreatitis, abscess, hemorrhage, peritonitis

    • Sympathetic hyperactivity is thought to be a potential contributing factor

    • Diagnosis of exclusion

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Epidemiology

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  • • Common following abdominal surgery, trauma

    • May be induced by medication:

    • –Narcotics

      –Psychotropic

      –Anticholinergics

    • May result from metabolic/electrolyte abnormalities such as hypokalemia and hypercalcemia or hypocalcemia and hypomagnesemia, uremia, diabetic ketoacidosis

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Clinical Findings

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Symptoms and Signs

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  • • Abdominal tenderness

    • Abdominal distention

    • Hypoactive to absent bowel sounds

    • Absence of flatus or passage of stool

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Laboratory Findings

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  • • Nonspecific

    • May have electrolyte derangements (hypokalemia, hyponatremia)

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Imaging Findings

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  • Abdominal x-ray

    • –Dilated loops of bowel with air throughout the GI tract

      –No transition point suggesting mechanical obstruction

      –Air-fluid levels may or may not be present

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Diagnostic Considerations

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  • • Mechanical bowel obstruction (eg, neoplasm, hernia, adhesions)

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Rule Out

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  • • Mechanical causes of bowel obstruction

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Work-up

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  • • History and physical exam

    • Digital rectal exam

    • History of trauma, recent surgery

    • Review medications

    • Draw serum chemistry, CBC, thyroid function tests

    • Must rule out mechanical obstruction

    • Diagnosis of exclusion

    • Obtain upright abdominal and chest films

    • Obtain contrast enema or CT scan to rule out mechanical etiology as well as evaluate for intra-abdominal pathology contributing to ileus

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When to Admit

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  • • Ileus is a diagnosis of exclusion requiring mechanical sources to be ruled out as a cause of obstruction, which likely requires admission

    • Dehydration

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Treatment and Management

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  • • Treatment is conservative

    • NPO

    • NG decompression

    • IV hydration

    • Correct electrolyte abnormalities

    • Discontinue or substitute for narcotic pain medications or psychotropic medications if possible

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Surgery

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Indications
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  • • Treatment of ileus is nonoperative

    • Conditions contributing to ileus such as abscesses or hemorrhage may require operative intervention

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Medications

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  • • Prokinetic agents such as metoclopramide and erythromycin

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Treatment Monitoring

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  • • Repeat physical exam

    • Failure of ileus to resolve after a prolonged period of time may warrant repeat GI contrast study and/or CT scan

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Complications

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  • • Dehydration

    • Malnutrition

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Prognosis

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