• 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
• Common following abdominal surgery, trauma
• May be induced by medication:
• May result from metabolic/electrolyte abnormalities such as hypokalemia and hypercalcemia or hypocalcemia and hypomagnesemia, uremia, diabetic ketoacidosis
• 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
• 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
• Treatment is conservative
• NG decompression
• IV hydration
• Correct electrolyte abnormalities
• Discontinue or substitute for narcotic pain medications or psychotropic medications if possible
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