Paralytic ileus of the colon & small bowel
The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines
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Definition: loss of intestinal peristalsis in absence of mechanical obstruction
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Abd discomfort & distention, ↓ or absent bowel sounds, ± N/V, hiccups
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Typically in elderly, hospitalized, ill Pts; precipitated by: intra-abd process (surgery, pancreatitis, peritonitis, intestinal ischemia), severe illness (eg, sepsis), meds (opiates, CCB, anticholin.), metab/endo abnl (thyroid, DM, kidney failure, liver failure, hypoK), spinal cord compression/trauma, neurologic d/o (Parkinson’s, Alzheimer’s, MS)
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KUB/CT w/ colonic dilatation (in ileus, dilated loops of SB) w/o mech obstruction; cecal diam >12 cm a/w high-risk perf in Ogilvie’s syndrome (colonic pseudo-obstruction)
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CT scan with oral water soluble contrast can help distinguish ileus from obstruction and also determine partial vs. complete obstruction. CT scan can also reveal causes for ileus or obstruction such as pancreatitis, retroperitoneal bleed, mass or hernia. CT scan is also sensitive in assessing for ischemic bowel in cases of obstruction. (Figure 3)
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Treatment: NPO, avoid offending meds, IV neostigmine (monitor for bradycardia), methylnaltrexone; bowel decompression w/ NGT, rectal tube, nutrition support. Ogilvie’s only: colonoscopic decompression; if refractory, colostomy or colectomy.
Intestinal Pseudo-obstruction
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Definition:
Paralytic ileus of the colon & small bowel, also known as intestinal pseudo-obstruction, is a condition characterized by loss of intestinal peristalsis in the absence of mechanical obstruction.
Symptoms:
Symptoms of paralytic ileus of the colon & small bowel include abdominal discomfort and distention, decreased or absent bowel sounds, nausea and vomiting, and hiccups.
Causes:
Paralytic ileus of the colon & small bowel typically occurs in elderly, hospitalized, ill patients; precipitating factors include intra-abdominal process (surgery, pancreatitis, peritonitis, intestinal ischemia), severe illness (eg, sepsis), medications (opiates, CCB, anticholinergics), metabolic/endocrine abnormalities (thyroid, DM, kidney failure, liver failure, hypokalemia), spinal cord compression/trauma, and neurologic disorders (Parkinson’s, Alzheimer’s, MS).
Diagnosis:
KUB/CT with colonic dilatation (in ileus, dilated loops of small bowel) in the absence of mechanical obstruction; cecal diameters >6 cm in adults and >4 cm in children.
Treatment:
Treatment of paralytic ileus of the colon & small bowel includes NPO, avoidance of offending medications, IV neostigmine (monitor for bradycardia), methylnaltrexone; bowel decompression with NGT, rectal tube, nutrition support. Ogilvie’s only: colonoscopic decompression; if refractory, colostomy or colectomy.
窩的英文不太好
定義：
結腸和小腸的麻痺性腸梗阻，也稱為假性腸梗阻，是一種在沒有機械性梗阻的情況下以腸道蠕動喪失為特徵的病症。
症狀：
結腸和小腸麻痺性腸梗阻的症狀包括腹部不適和腹脹、腸鳴音減弱或消失、噁心和嘔吐以及打嗝。
原因：
結腸和小腸麻痺性腸梗阻通常發生在老年、住院、患病的患者身上；促發因素包括腹內過程（手術、胰腺炎、腹膜炎、腸缺血）、嚴重疾病（如敗血症）、藥物（阿片類藥物、CCB、抗膽鹼能藥）、代謝/內分泌異常（甲狀腺、糖尿病、腎衰竭、肝衰竭、低鉀血症）、脊髓壓迫/創傷和神經系統疾病（帕金森氏症、阿爾茨海默氏症、多發性硬化症）。
診斷：
在沒有機械性梗阻的情況下，KUB/CT 伴有結腸擴張（腸梗阻、小腸袢擴張）；成人盲腸直徑>6 cm，兒童>4 cm。
治療：
結腸和小腸麻痺性腸梗阻的治療包括 NPO、避免違規藥物、靜脈注射新斯的明（監測心動過緩）、甲基納曲酮；使用 NGT、直腸管、營養支持進行腸減壓。 Ogilvie’s only：腸鏡減壓；如果難治，結腸造口術或結腸切除術。