Documente Academic
Documente Profesional
Documente Cultură
OTJE HUDAJA
FK UKM
2007
TYPES OF ILEUS
TYPES OF ILEUS
FUNCTIONAL ILEUS
- PARALYTIC ILEUS, THE CESSATION OF
GI MOTILITY (PARALYSSIS)
- SPASTIC ILEUS, SPASM OF THE BOWEL
DUE TO INTOXICATION, PORPHYRIA
ASCARIS
PATHOLOGY
OBSTRUCTION CAUSES DISTENSION OF THE
BOWEL WALL DECREASE OF THE
VASCULARISATION LOCAL HYPOXIA LOCAL
DECREASE OF THE FUNCTION
OBSTRUCTION PENETRATION OF THE
BACTERIA INTO THE DARM WALL
TOXICAEMIA
OEDEMA OF THE WALL HYPOVOLAEMIA
FLUID IN THE LUMEN HYPOVOLAEMIA,
SHOCK
PATHOLOGY
IN 20% OF THE PATIENTS THE
ILEOCAECAL VALVE IS COMPETENT AND
DECOMPRESSION INTO THE SMALL
BOWEL DOES NOT OCCUR.
CLOSED-LOOP OBSTRUCTION
THEREFORE OCCURS, THE CAECUM
PROGRESSIVELY DISTENDING (LAPLACE)
ISCHAEMIA AND PERFORATION OF THE
CAECUM MAY OCCUR
INVESTIGATIONS
Hb, FULL BLOOD COUNT
WHITE CELL COUNT, NEUTROPHILIA MAY
INDICATE STRANGULATION
UREUM, ELECTROLYTS, AMILASE
ENDOSCOPY
SIGMOIDOSCOPY
COLONOSCOPY
TO EXCLUDE PSEUDO-OBSTRUCTION
STENTING
TREATMENT
INTRAVENOUS FLUIDS
CORRECT ELECTROLYTE IMBALANCE
NIL ORALLY
NASOGASTRIC ASPIRATION
CATHETERIZIED
SURGERY
STRANGULATING OBSTRUCTION. E.g. A
TENDER IRREDUCIBLE HERNIA REQUIRE
URGENT SURGERY
IF A CONSERVATIVE DRIP AND SUCK
REGIMEN HAS BEEN UNDERTAKEN FOR
OBSTRUCTION, SURGERY IS INDICATED
FOR SIGN OF INCIPIENT
STRANGULATION (PYREXIA,
TACHYCARDIA, LOCALIZED TENDERNESS)
SURGERY
SURGERY IS ALSO REQUIRED FOR
SIMPLE OBSTRUCTION WHICH FAILS TO
SETTLE, e.g. GALLSTONES ILEUS,
ADHESIONS
AT SURGERY THE AFFECTED BOWEL IS
INSPECTED FOR VIABILITY
SURGERY
INDICATIONS OF NON-VIABILITY
INCLUDE :
- ABSENCE OF PERISTALSIS
- LOSS OF NORMAL SHEEN
- LOSS OF PULSATION IN BOWEL
MESENTERY
SURGERY
COLOUR :
- GREEN OR BLACK BOWEL IS NON
VIABLE AND RESECTION IS REQUIRED
- PLUM-COLOURED BOWEL MAY
RESPOND TO WRAPPING FOR A FEW
MINUTES IN WARM SALINE-SOAKED PACKS.
IF COLOUR RETURNS AND IT WILL TRANSMIT
A PERISTALTIC WAVE, IT IS VIABLE
SURGERY
GALLSTONE, REMOVAL OF STONE BY
MILKING THROUGH ILEOCAECAL VALVE
OR REMOVAL BY ENTEROTOMY
ADHESIOLYSIS
RESECTION (TUMOURS, GANGRENE)
RETROGRAD REDUCTION OF
INTUSSUCEPTION
DECOMPRESSION (OPEN, CLOSE)
IN A POORLY PATIENT
DEFUNCTIONING COLOSTOMY OR
CAECOSTOMY MAY BE CARRIED OUT AND
ELECTIVE RESECTION DELAYED UNTIL THE
LATER DATE WHEN THE PATIENT IS FITTER
SIGMOID VOLVULUS MAY BE TREATED BY
RESECTION AND A PAUL-MICKULICZ
PROCEDURE
COLONIC STENTING MAY BE CARRIED OUT IN
THOSE UNFIT FOR SURGERY
PARALYTIC ILEUS
THIS IS THE CESSATION OF GI MOTILITY
AETIOLOGICAL FACTORS :
- FRACTURES OF THE SPINE AND PELVIS
- RETROPERITONEAL HAEMORRHAGE
- VASCULAR : EMBOLUS, THROMBOSIS
- INFLAMMATION, TOXIC (PERITONITIS)
- HYPOKALIAEMIA (METABOLIC)
- DRUGS : GANGLION BLOCKERS, ANTICHOLINERGIC
AGENTS
- ABDOMINAL SURGERY, IMMOBILIZATION
PARALYTIC ILEUS
ATONY OF THE BOWEL MAY BE EXPECTED FOR
24 - 48 HOURS POSTOPERATIVELY
PARALYTIC ILEUS CONTINUING AFTER 48
HOURS MAY HAVE AN UNDERLYING CAUSE
SYMPTOMS AND SIGNS :
- ABDOMINAL DISTENSION
- VOMITING, CONSTIPATION
- TENSE TYMPANITIC ABDOMEN
- ABSENT OF BOWEL SOUNDS
PARALYTIC ILEUS
INVESTIGATIONS
AXR : GASEOUS DISTENSION WITH FLUID
LEVELS THROUGHOUT THE LARGE AND SMALL
BOWEL
TREATMENT
- PASS NG TUBE AND ASPIRATE HOURLY
- ENSURE ADEQUATE HYDRATION
- CORRECT ANY POTASIUM IMBALANCE
- MEDICATIONS : FURSULTHIAMINE
SURGERY
PERITONITIS
MESENTERIC ARTERY ISCHAEMIA/
OCCLUSION
PARALYTIC ILEUS
: USUALLY SETTLES IN 4
DAYS
BOWEL SOUNDS : ABSENT
PAIN
: PAINLESS
AXR
:
GENERAL GASEOUS DILATATION OF
SMALL AND LARGE BOWEL
TIME
OBSTRUCTION
TIME : MAY PERSIST LONGER THAN 3 - 4
DAYS
BOWEL SOUNDS : HIGH-PICTHED AND
TINKLING
PAIN : COLICKY ABDOMINAL PAIN
AXR :
LOCALIZED SMALL BOWEL DISTENSION
WITH ABSENT GAS IN COLON AND
RECTUM