• Precipitating factors
• Nausea, vomiting, obstipation, distention
• Minimal abdominal tenderness; decreased bowel sounds
• Plain abdominal radiography with gas and fluid distention in small and large bowel
• Neurogenic failure or loss of peristalsis in the intestine in the absence of any mechanical obstruction
• Common in hospitalized patients as a result of the following
– Intra-abdominal processes, such as
▪ Recent gastrointestinal or abdominal surgery
▪ Peritoneal irritation (peritonitis, pancreatitis, ruptured viscus, hemorrhage)
– Severe medical illness, such as
▪ Respiratory failure requiring intubation
▪ Sepsis or severe infections
▪ Diabetic ketoacidosis
▪ Electrolyte abnormalities (hypokalemia, hypercalcemia, hypomagnesemia, hypophosphatemia)
– Medications, such as
• Postoperative ileus is reduced by
– Use of patient-controlled or epidural analgesia
– Avoidance of intravenous opioids
– Early ambulation
– Gum chewing
– Initiation of a clear liquid diet
• Mild diffuse, continuous abdominal discomfort
• Nausea and vomiting
• Generalized abdominal distention
• Minimal abdominal tenderness
• No signs of peritoneal irritation
• Bowel sounds are diminished to absent
• Mechanical obstruction of small intestine or proximal colon, eg, adhesions, volvulus, Crohn disease
• Chronic intestinal pseudo-obstruction
• Obtain serum electrolytes, potassium, magnesium, phosphorus, and calcium
• Plain abdominal radiography: air-fluid levels, distended gas-filled loops of small and large intestine
• Limited barium small bowel series or a CT scan can help exclude mechanical obstruction
– A peripherally acting mu-opioid receptor antagonist with limited absorption or systemic activity that reverses opioid-induced inhibition of intestinal motility
– Reduces time to first flatus, bowel movement, solid meal, and hospital discharge in postoperative patients
– May be considered in patients undergoing partial large or small bowel resection when postoperative opioid therapy is anticipated
• Treat underlying primary medical or surgical illness
• Nasogastric suction for discomfort or vomiting
• Restrict oral intake, administer intravenous fluids
• Liberalize diet gradually as bowel function returns
• Minimize anticholinergic and opioid medications
• Severe or prolonged ileus requires nasogastric suction and infusion of parenteral fluids and electrolytes
• Return of bowel function usually heralded by return of appetite and passage of flatus
• Serial plain film radiography and/or abdominal CT warranted for persistent or worsening symptoms to distinguish from mechanical obstruction
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