Paralytic ileus vs intestinal obstruction

Professional Reference articles are designed for health professionals to use. You may find one of our health articles more useful. NICE has issued rapid update guidelines in relation to many of these.

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This guidance is changing frequently. The term ileus is now most often used to imply non-mechanical intestinal obstruction. The term paralytic ileus is sometimes used when the problem is inactivity of the bowel. NB : obstruction to free passage of contents can occur at any level of the gut but only obstruction beyond the duodenum will be considered here. Of all patients admitted to hospital with intestinal obstruction, most have small intestinal obstruction.

paralytic ileus vs intestinal obstruction

Significant numbers of colorectal malignancies present with obstruction. Volvulus, impaction of the intestine, constipation and megacolon are all more common in patients with presenile dementia and Alzheimer's disease, Parkinson's disease, multiple sclerosis and quadriplegia. Schizophrenia has an increased risk for megacolon and constipation whilst major depression is associated only with constipation but with none of the other colonic diseases. The typical clinical symptoms associated with obstruction include nausea, vomiting, dysphagia, abdominal pain and failure to pass bowel movements.

Clinical signs include abdominal distention, tympany due to an air-filled stomach and high-pitched bowel sounds [ 9 ]. There is considerable overlap with the presentation of the various conditions although some features may be more prominent or occur earlier in one cause than another. Differentiation on clinical grounds alone is often not possible. In patients with uncomplicated obstruction, management is conservative, including fluid resuscitation, electrolyte replacement, intestinal decompression and bowel rest.

Endoscopy can be used for bowel decompression, dilation of strictures or placement of self-expandable metal stents to restore the luminal flow either as a final treatment or to allow for a delay until elective surgical therapy. When gastrointestinal obstruction results in ischaemia, perforation or peritonitis, then emergency surgery is required [ 9 ].

Resuscitation is very important.

Bowel obstruction

Correction of fluid and electrolytes considerably reduces the operative risk before surgery for obstruction. In pseudo-obstruction, correction of such abnormalities will facilitate the return of normal bowel function. Note urine output as a sign of adequate replacement. In paralytic ileus a nasogastric tube will reduce vomiting. In intestinal pseudo-obstruction the cautious use of neostigmine may aid recovery but most important is the correction of fluid and electrolyte imbalance [ 20 ].

Colonoscopy may need to be used for decompression. Early recognition and management are vital if perforation is to be avoided [ 21 ].Ileus defined as nonmechanical obstruction of bowel usually secondary to inhibition of peristalsis. Small bowel obstruction defined as mechanical obstruction of small bowel due to adhesions, mass, volvulus or other internal or external compression. Ileus: paralytic ileus, adynamic ileus, non mechanical obstruction, intestinal pseudo obstruction.

Post operative ileus, internal hernia, midgut volvulus, gall stone ileus, incomplete and complete small bowel obstruction, colonic obstruction.

Ileus can be caused by indolent factors such drugs or electrolyte abnormalities as well as abdominal catastrophes. In the ICU patient who may not be able to communicate change in toleration of enteral feeds, increased gastric output, distended abdomen, or decreased stool output should prompt investigation for cause. Signs of Ileus in the ICU patient can include abdominal distention, intolerance to enteral feeds, increased gastric output, increase in abdominal pressure, decreased flatus, decreased bowel sounds and decreased stool output.

Sypmptoms of ileus can include abdominal pain, nausea,vomiting. Bowel obstruction in the ICU patient can have very similiar signs, such as abdominal distention, intolerance to feeds, increased gastric output and decreased flatus and stool. But often the distinguishing feature can be cramping abdominal pain and hyperactive or high pitched bowel sounds.

As ileus is caused by other factors including life threatening intra-abdominal processes such as peritonitis, it is necessary to quickly determine first this is an ileus vs. If ileus, is there a life threatening procress associated with it? If bowel obstruction, is it partial, complete or closed loop? Bowel decompression, fluid resuscitation and diagnosis are mainstays of initial treatment for both ileus and bowel obstruction.

Gastric decompression with gastric tube. Resuscitation with isotonic fluid. No need for antibiotics for ileus or obstruction unless associated infectious cause or perforation suspected. Assess for intra-abdominal hypertension with bladder pressure. Correct electrolyte abnormalities, specifically potassium.

Rule out life threatening cause of ileus intra-abdominal sepsis or small bowel obstruction with CT scan. Assess abdominal exam for peritoneal signs, present or absence of bowel sounds, presence of hernias. CT scan consistent with obstruction: assess; if partial: NGT decompression, bowel rest; if complete: NGT decompression, surgical consult. Signs of paralytic ileus are very similar to bowel obstruction. Nausea, abdominal pain, bloating with vomiting, abdominal distention and obstipation being accompanying symptoms.

Classically paralytic ileus is suggested by hypoactive bowel sounds whereas small bowel obstruction is described with rushes and bowel sounds consistent with peristalsis against the obstruction. However, if obstruction has led to ischemia and intra-abdominal sepsis, the patient may have hypoactive bowel sounds.

In a critically ill patient who is sedated and has impaired mental status, it may be difficult to elicit complaints of nausea or pain. Anasarca can mask abdominal distention. Obstipation and constipation may be overlooked as secondary to medications. A high index of suspicion should be maintained in patients who develop high gastric tube residuals or become intolerant of tube feeding.

Patients with electrolyte abnormalities are at a higher risk for paralytic ileus, as are multiple trauma, burn, and post operative patients, as well as patients with any inflammatory response. Patients who are status post abdominal surgical procedure can develop post operative bowel obstruction from adhesions. The key is to distinguish ileus from obstruction as early as possible since small bowel obstruction can lead to ischemia and perforation.

Although plain abdominal films — flat, upright and decubitus films — are often initial tests ordered outside the ICU, inside the ICU these films are often of poor quality for discerning ileus from small bowel obstruction. Ileus usually has air throughout colon into rectum compared to small bowel obstruction, which when complete does not show colonic air. However these findings are not consistant when dealing with partial or early small bowel obstruction.

Air fluid levels are difficult to ascertain in the critically ill, as upright and decubitus films are usually inadequate. Figure 1 and Figure 2.Written and peer-reviewed by physicians—but use at your own risk. Read our disclaimer. Bowel obstruction is the interruption of the normal passage of bowel contents either due to a functional decrease in peristalsis or mechanical obstruction.

Functional bowel obstructionor paralytic ileusis a temporary disturbance of peristalsis in the absence of mechanical obstruction. Postoperative ileus is the most common cause of paralytic ileuswhich can also be caused by metabolic disturbances e.

Mechanical bowel obstruction is classified according to the location as either small bowel obstruction SBO or large bowel obstruction LBO and, depending on the severity of obstruction, as either partial or complete. The most common cause of SBO is postoperative bowel adhesionswhile the most common cause of LBO is malignant tumors.

Regardless of the cause, bowel obstruction typically manifests with nausea, vomiting, abdominal painabdominal distention, and constipation or obstipation. In paralytic ileusbowel sounds are usually absent on auscultationwhereas a high-pitched tinkling sound would be heard in the early phase of a mechanical bowel obstruction. Bowel distention leads to third-space volume loss, resulting in dehydration and electrolyte abnormalities.

Symptoms are less severe in partial bowel obstruction. Diagnosis is confirmed on imaging with contrast-enhanced CT scan and abdominal x-rays.

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Typical findings in mechanical bowel obstruction include dilated bowel loops proximal to the obstruction, collapse of bowel loops distal to the obstruction, and, on contrast-enhanced imaging, a cut-off or transition point at the site of obstruction.

In paralytic ileusfindings include generalized dilatation of bowel loops with no transition point and air that is visible in the rectum. Surgical intervention i. In all other cases, conservative treatment is usually successful and involves bowel rest, gastric decompression nasogastric suctionfluid resuscitationand correction of electrolyte abnormalities.

References: [1] [2] [3] [4]. Reference: [5]. Partial bowel obstruction causes gradually progressive symptoms that are milder than those of complete obstruction. Obstipation is absent in partial bowel obstruction. In the workup of suspected mechanical bowel obstructionimaging allows for quick confirmation of the diagnosis as well as detection of conditions requiring immediate surgery e. Laboratory tests may further help to assess the severity of the condition e.

Consists of erect and supine abdominal x-rays and an erect chest x-ray. More sensitive than x-ray. When imaging with contrast CT, enema and perforation is expected, use water-soluble oral contrast. Peristalsis -inducing medication e.

Intestinal Obstruction \u0026 Paralytic Ileus - Surgery

Bowel obstruction requires a swift workup to establish whether emergent surgery is necessary!The small intestine and colon are components of your digestive tract, which processes the foods you eat. The intestines extract nutrients from the foods. What isn't absorbed by the intestines continues along the digestive tract and is expelled as stool during a bowel movement. Intestinal obstruction is a blockage that keeps food or liquid from passing through your small intestine or large intestine colon.

Causes of intestinal obstruction may include fibrous bands of tissue adhesions in the abdomen that form after surgery; hernias; colon cancer; certain medications; or strictures from an inflamed intestine caused by certain conditions, such as Crohn's disease or diverticulitis.

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Without treatment, the blocked parts of the intestine can die, leading to serious problems. However, with prompt medical care, intestinal obstruction often can be successfully treated.

Because of the serious complications that can develop from intestinal obstruction, seek immediate medical care if you have severe abdominal pain or other symptoms of intestinal obstruction. Intussusception is a rare, serious disorder in which one part of the intestine slides inside an adjacent part. In children, the most common cause of intestinal obstruction is telescoping of the intestine intussusception.

Intestinal pseudo-obstruction paralytic ileus can cause signs and symptoms of intestinal obstruction, but it doesn't involve a physical blockage. In paralytic ileus, muscle or nerve problems disrupt the normal coordinated muscle contractions of the intestines, slowing or stopping the movement of food and fluid through the digestive system. Mayo Clinic does not endorse companies or products. Advertising revenue supports our not-for-profit mission.

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This content does not have an English version. This content does not have an Arabic version. Overview Colon and small intestine Open pop-up dialog box Close. Colon and small intestine The small intestine and colon are components of your digestive tract, which processes the foods you eat. Request an Appointment at Mayo Clinic. Intussusception Open pop-up dialog box Close. Intussusception Intussusception is a rare, serious disorder in which one part of the intestine slides inside an adjacent part.Intestinal obstruction is a partial or complete blockage of the bowel.

paralytic ileus vs intestinal obstruction

The contents of the intestine cannot pass through it. Paralytic ileus, also called pseudo-obstruction, is one of the major causes of intestinal obstruction in infants and children. Causes of paralytic ileus may include:. During a physical exam, the health care provider may find bloating, tenderness, or hernias in the abdomen. Treatment involves placing a tube through the nose into the stomach or intestine.

This is to help relieve abdominal swelling distention and vomiting. Volvulus of the large bowel may be treated by passing a tube into the rectum. Surgery may be needed to relieve the obstruction if the tube does not relieve the symptoms. It may also be needed if there are signs of tissue death. The outcome depends on the cause of the blockage.

Most of the time, the cause is successfully treated. If the obstruction blocks the blood supply to the intestine, it may cause infection and tissue death gangrene. Risks for tissue death are related to the cause of the blockage and how long it has been present.

Hernias, volvulus, and intussusception carry a higher gangrene risk. In a newborn, paralytic ileus that destroys the bowel wall necrotizing enterocolitis is a life-threatening condition. It may lead to blood and lung infections.

paralytic ileus vs intestinal obstruction

Prevention depends on the cause. Treating conditions, such as tumors and hernias that can lead to a blockage, may reduce your risk. Paralytic ileus; Intestinal volvulus; Bowel obstruction; Ileus; Pseudo-obstruction - intestinal; Colonic ileus; Small bowel obstruction. Small intestine.This method really does speed up the time it takes for gluten-free bread to rise. Just be sure to carefully watch the process so that your bread does rise over the top of the pan before baking.

Work With Room Temperature IngredientsYeast loves a warm environment and bread will rise more quickly and completely when ingredients are at room temperature rather than cold. The Waste-free LunchboxIt has been estimated that on average a school-age child using a disposable lunch generates 67 pounds of waste per school year.

That equates to 18,760 pounds of lunch waste for just one average-size elementary school. If you're like us, you're always on the lookout for small changes that make a real difference in the world, and packing a waste-free lunch is once such change that's easy to make.

If you walk around at lunchtime and take a good look at the lunches our children bring to school, here's what the typical lunch will look like: In this scenario very little trash is generated because foods are bought in bulk or in larger packages. The packaging is left at home for reuse or recycling.

Food waste also decreases because with a reusable lunch container, children can re-pack uneaten food instead of dumping it, packaging and all, into the school trash can. Education is the first step in the transition to a waste-free lunch.

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Talk to your children about why the school has decided to institute a waste-free lunch program. Provide them with age-appropriate information about the negative impact of a disposable lunch. Below is a list of suggestions that will help build communication and foster understanding. Read this list with your children. Ask them to circle the foods they'd like to see in their lunchboxes.

The above information was excerpted from The Laptop Lunch User's Guide: Fresh Ideas for Making Wholesome, Earth-friendly Lunches Your Children Will Love. Copyright 2002, Morning Run Press. Sign up for our free monthly e-newsletter.

Email: Tips for Parents It has been estimated that on average a school-age child using a disposable lunch generates 67 pounds of waste per school year. Understanding the Problem The Typical Lunch: If you walk around at lunchtime and take a good look at the lunches our children bring to school, here's what the typical lunch will look like: sandwiches in disposable plastic bags fruits and vegetables in plastic bags prepackaged chips, cookies, fruit bars, granola bars, cheeses, and fruit leathers single-use yogurts, applesauces, and puddings crackers, pretzels, chips, and other snack foods sealed in plastic bags disposable juice boxes, juice pouches, juice cans, water bottles, and milk cartons plastic forks and spoons paper napkins reusable lunchboxes and disposable paper and plastic bags A Waste-free Lunch: sandwiches and other main dishes, fresh fruits and, fresh vegetables, and treats in a reusable lunch container or containers cloth napkins stainless-steel forks and spoons reusable drink containers reusable lunchboxes In this scenario very little trash is generated because foods are bought in bulk or in larger packages.

Educating Your Family Education is the first step in the transition to a waste-free lunch. Teach children about recycling at home. Encourage them to help separate the recyclables from the non-recyclables.

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Intestinal Obstruction and Ileus

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