'Nil By Mouth' Surgical Tradition Slowly Gives Way

The problem is, the misery of thirst and not choosing what and when to start eating doesn't contribute to safer recovery after most operations. A long fasting period is more likely to slow recovery down. Restrictive "nil by mouth" policies are being challenged by research on early fluids, food...and chewing gum. . .

Constipation and ileus in the critically ill

Ileus (or "paralytic ileus", or "pseudo-obstruction", as separate from "post-operative ileus" and actual bowel obstruction) is the occurrence of intestinal blockage in the absence of an actual physical obstruction.

Difference between Ileus vs Small bowel obstruction

Abdominal x-ray showing both small and large bowel loops dilatation till rectum is diagnostic of paralytic ileus. It can’t be always feasible to distinguish ileus from mechanical small bowel obstruction on frontal views. A lateral radiograph may help in this condition by showing air in rectum; however, ultrasound or contrast study may be required in equivocal cases.

Gallstone Ileus

With occurrence in less than 0.5% of patients, Gallstone ileus is an uncommon complication of cholelithiasis. The typical route of gallstone passage into the bowel lumen is through a biliary-enteric fistula, which results in mechanical obstruction in about 1 to 4 percent of cases.

Ileus

Ileus (also called adynamic ileus) is defined as the functional inhibition of propulsive bowel activity, irrespective of pathogenic mechanism. This differs from other gastrointestinal motility disorders resulting from structural abnormalities—for example, small bowel obstruction. Postoperative ileus is the uncomplicated ileus that follows surgery and usually resolves spontaneously within 2 to 3 days. Prolonged postoperative ileus lasts longer than 3 days. Ileus of the colon with sudden massive dilatation is called acute colonic pseudo-obstruction or Ogilvie syndrome. Toxic megacolon is another form of colonic ileus in which inflammation involves all colonic tissue layers and that results in systemic toxicity.

Ileus in Adults

By definition, ileus is an occlusion or paralysis of the bowel preventing the forward passage of the intestinal contents, causing their accumulation proximal to the site of the blockage. A key distinction is drawn between mechanical and functional ileus.

Illustration

ileus is defined as the absence of physiological motility of the bowel leading to a disturbance in the progression of bowel contents.

Listening to Bowel Sounds: An Outdated Practice?

Medical programs teach us that listening to bowel sounds is an essential part of the physical examination of the abdomen, especially when the differential includes ileus, small bowel obstruction, diarrhea or constipation. Woe betide the student who fails to auscultate the abdomen of patients with these presentations. Yet firstly there’s little supporting evidence for this maneuver, […]

Management of Paralytic Ileus

Gastrointestinal symptoms, particularly paralytic ileus, are not only found in primary gastrointestinal tract diseases, but also as a manifestation of other systemic ailments. In the field of internal medicine, in addition to peritonitis, many conditions could cause cessation of smooth muscle motor activity in the small intestines and colon, such as sepsis, as a side effect of certain medications, hormonal imbalance, electrolyte imbalance, and bowel ischemia.

Management of Postoperative Ileus

A patient with ileus after surgery typically complains of bloating, increasing abdominal pain, nausea, vomiting, intolerance of oral diet, and absent or minimal flatus. The differential diagnosis for these symptoms includes ileus, small bowel obstruction, bowel injury, intra-abdominal or retroperitoneal bleeding, and intra-abdominal abscess.

Mechanisms and Treatment of Postoperative Ileus

Paralytic postoperative ileus continues to be a significant clinical problem. The etiology of this process can best be described as multifactorial.

Neostigmine Treatment of Paralytic Ileus in Critically Ill Patients

Neostigmine is an acetylcholinesterase inhibitor that increases cholinergic (parasympathetic) activity in the intestinal wall, which in turn stimulates colonic motility. Nevertheless, the clinical utility of neostigmine may be limited by its adverse effects, which include abdominal cramps, excessive salivation, vomiting, and bradycardia.

Paralytic ileus

Opioids and antidiarrheals (e.g., loperamide), Calcium channel blockers, Clonidine, Alpha-adrenergic medications, Medications with anticholinergic properties, for example: Antipsychotics, tricyclics, Antihistamines, Muscle relaxants (e.g., baclofen, cyclobenzaprine, tizanidine), Parkinson's disease medications.

Postoperative Ileus

Management of postoperative ileus revolves around supportive care. After excluding serious or treatable conditions, supportive treatment and optimizing care almost always resolve the ileus.

Postoperative ileus: A pharmacological perspective

Postoperative ileus (POI) is a frequent complication after abdominal surgery. The consequences of postoperative ileus can be potentially serious such as bronchial inhalation or acute functional renal failure. Numerous advances in peri-operative management, particularly early rehabilitation, have made it possible to decrease postoperative ileus.

The search for a therapy to prevent and treat postoperative ileus

The major challenge of treating postoperative ileus is simple: There is no therapy that has been proven to prevent or treat the problem. It’s one reason that surgeons often take a passive view of the condition.

What Is It, Types, Causes, Diagnosis, Treatment, and More

With paralytic ileus, peristalsis is significantly reduced or stopped, leading to a functional intestinal obstruction and consequent buildup of stomach contents in part of the intestine. Another type of ileus is meconium ileus, commonly seen in newborns with cystic fibrosis, in which thick, sticky stool (meconium) sticks to the intestinal wall and becomes trapped in the small intestine. Gallstone ileus (more accurately known as a mechanical intestinal obstruction) refers to a large gallstone creating a blockage in a portion of the small intestine. Abdominal or pelvic surgery are the most common causes of an ileus.