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🌱來自: Intestinal Pseudo-obstruction

Evaluation of Intestinal Pseudo-obstruction

• A plain [abdominal x-ray][6] will usually show colonic and small bowel dilation and air-fluid levels.
• Exclude mechanical obstruction with either:
  • abdominal [computed tomography (CT)][7]
  • water-soluble or barium [contrast enema][8] of the rectum and colon
• Consider performing abdominal CT, MRI, or ultrasound to evaluate the degree of colonic dilation, diverticulosis, and [complications][9] such as perforation.
• If toxic megacolon is diagnosed through abdominal imaging and clinical presentation, begin supportive therapy and medical management of toxic megacolon, obtain immediate specialist consultation, and perform [stool test][10] to rule out Clostridium difficile infection as a potential etiology.
• [Blood tests][11] should include a basic metabolic panel, complete blood count, thyroid studies, and calcium, magnesium, and phosphate tests.
• Consider arterial blood gas (ABG) sampling to assess for development of metabolic acidosis.
• Consider obtaining [blood cultures][12] if sepsis is suspected.
• If chronic intestinal pseudo-obstruction suspected, perform PubMed29570554Journal of pediatric gastroenterology and nutritionJ Pediatr Gastroenterol Nutr20180601666991-1019991abdominal x-ray in all patients, and consider contrast imaging to rule out organic cause of obstruction or malrotation.
• Other diagnostic tests include gastric emptying test (gastroparesis), small-bowel follow-through testing, antroduodenal manometry (to differentiate myopathy or neuropathy), investigation for small intestinal bacterial overgrowth (SIBO), small intestinal biopsies, high-resolution esophageal manometry (associated esophageal dysmotility), and high-resolution anorectal manometry (associated defecatory disorder).