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Essentials of Diagnosis
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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
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General Considerations
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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
Pneumonia
Respiratory failure requiring intubation
Sepsis or severe infections
Uremia
Diabetic ketoacidosis
Electrolyte abnormalities (hypokalemia, hypercalcemia, hypomagnesemia, hypophosphatemia)
Medications, such as
Opioids
Anticholinergics
Phenothiazines
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
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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
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Differential Diagnosis
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Mechanical obstruction of small intestine or proximal colon, eg, adhesions, volvulus, Crohn disease
Chronic intestinal pseudo-obstruction
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Obtain serum electrolytes, potassium, magnesium, phosphorus, and calcium
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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
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Alvimopan
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
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Therapeutic Procedures
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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
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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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Ileus usually resolves within 48–72 h
Following surgery, small intestinal motility normalizes first (within hours), followed by stomach (24–48 h) and colon ...