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| {{CMG}} | | {{CMG}} |
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| ==Overview== | | ==[[Ileus overview|Overview]]== |
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| '''Ileus''' is a disruption of the normal propulsive [[gastrointestinal tract|gastrointestinal]] motor activity from non-mechanical mechanisms<ref>Townsend CM, Beauchamp RD, Evers BM, Mattox KL. Sabiston Textbook of Surgery. The biological basis of modern surgical practice. 17/e. Elsevier Saunders, 2004.</ref><ref>Livingston EH, Passaro EP. Postoperative ileus. Dig Dis Sci 1990;35:121.</ref>. Motility disorders that result from structural abnormalities are termed mechanical [[bowel obstruction]]. Some mechanical obstructions are misnomers, such as gallstone ileus and [[Meconium|meconium ileus]], and are not true examples of ileus by the classic definition <ref>Feldman M, Friedman LS, Brandt LJ, Sleisenger MH. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. Intestinal Obstruction and Ileus. 8/e. Elsevier Saunders, 2006.</ref>.
| | ==[[Ileus historical perspective|Historical Perspective]]== |
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| ==Diagnosis== | | ==[[Ileus classification|Classification]]== |
| === Mechanical Obstruction ===
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| * Adenomatous polyps
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| * Adhesions
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| * Adhesive bands
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| * Annular [[pancreas]]
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| * Ascariades
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| * [[Atresia]]
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| * Biliary calculus
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| * Bowel duplication
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| * [[Carcinomatosis]]
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| * [[Colon Cancer]]
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| * Congenital [[megacolon]]
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| * [[Crohn's Disease]]
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| * Cysts
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| * Diverticular stricture
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| * [[Diverticulitis]]
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| * [[Endometriosis]]
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| * Foreign body
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| * [[Gallstone]] ileus
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| * Hematoma of the bowel wall
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| * [[Hernia]]
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| * Hirschprung's disease
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| * Iatrogenic
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| * Imperforate anus
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| * Incarcerated hernia
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| * Inflammatory
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| * Intrabdominal abscess
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| * Intrabdominal hematoma
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| * Invagination, intussisception
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| * [[Ischemia]]
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| * Malrotation
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| * [[Meckel's Diverticulum]]
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| * Megacolon
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| * Multiple polyposis syndromes
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| * Neoplasm
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| * [[Ovarian Cancer]]
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| * Pneumatosis intestinalis
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| * Postoperative
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| * [[Pregnancy]]
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| * [[Radiation]] induced stenosis
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| * [[Sarcoma]]
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| * [[Scleroderma]]
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| * Surgical anastomosis
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| * Therapy with dietary fiber
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| * [[Trauma]]
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| * [[Tuberculosis]]
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| * [[Ulcerative colitis]]
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| * [[Volvulus]]
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| === Non-Mechanical Obstruction === | | ==[[Ileus pathophysiology|Pathophysiology]]== |
| * Acid-base imbalance
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| * Acute [[pancreatitis]]
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| * Anticholinergics
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| * Antihistamines
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| * Apoplexy
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| * [[Brain tumor]]
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| * [[Cancer]]
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| * [[Catecholamines]]
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| * [[Cholecystolithiasis]]
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| * Connective tissue disease
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| * Diabetic [[coma]]
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| * [[Empyema]]
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| * [[Hyperparathyroidism]]
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| * [[Hypokalemia]]
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| * [[Lead poisoning]]
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| * [[Lymphoma]]
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| * [[Mechanical ventilation]]
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| * [[Mesenteric infarction]]
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| * [[Morphine]]
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| * Narcotics
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| * [[Osteomyelitis]] of the spine
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| * [[Ovarian torsion]]
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| * [[Pancreatitis]]
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| * Penetrating wounds
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| * Perinephric [[abscess]]
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| * Peritoneal [[carcinomatosis]]
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| * [[Peritonitis]]
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| * [[Pneumonia]]
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| * [[Porphyria]]
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| * Postoperative
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| * Psoas [[abscess]]
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| * [[Pyelonephritis]]
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| * [[Renal colic]]
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| * [[Retroperitoneal hematoma]]
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| * Spinal cord inflammation
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| * Spinal cord injury
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| * Spinal cord trauma
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| * Systemic [[infection]]
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| * [[Testicular torsion]]
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| * Ulcer perforation
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| * [[Uremia]]
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| * Uro[[sepsis]]
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| * Vitamin deficiency
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| === Pseudo-Obstruction === | | ==[[Ileus causes|Causes]]== |
| * Aerophagia
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| * Functional bowel disease
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| ==Types== | | ==[[Ileus differential diagnosis|Differentiating Ileus from other Diseases]]== |
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| ===Postoperative Ileus=== | | ==[[Ileus epidemiology and demographics|Epidemiology and Demographics]]== |
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| It is a temporary paralysis of a portion of the intestines typically after an abdominal surgery. Since the intestinal content of this portion is unable to move forward, food or drink should be avoided until peristaltic sound is heard from auscultation of the area where this portion lies.
| | ==[[Ileus risk factors|Risk Factors]]== |
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| ===Acute colonic pseudoobstruction=== | | ==[[Ileus screening|Screening]]== |
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| Also known as [[Ogilvie's syndrome]]
| | ==[[Ileus natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
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| ==Pathogenesis== | | ==Diagnosis== |
| ===Inhibitory neural reflexes===
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| ===Inflammation===
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| Ileus may increase adhesion formation, because intestinal segments have more prolonged contact, allowing fibrous adhesions to form, and intestinal distention causes serosal injury and ischemia. Intestinal distention has been shown to cause adhesions in foals <ref>Lundin C, Sullins KE, White NA and al. Induction of peritoneal adhesions with small intestinal ischaemia and distention in the foal. ''Equine Vet J'' 21: 451, 1989</ref>. In a recent survey of ACVS diplomates on drugs to prevent ileus and therefore prevent adhesions (unpublished data). The drug used in this survey was lidocaine, erythromycin, and cisapride <ref>Van Hoogmoed and Snyder</ref>. Some respondents also mentioned the importance of walking horses postoperatively to stimulate motility. Repeat celiotomy to decompress chronically distended small intestine and remove fibrinous adhesions is also a useful method of treating ileus and reducting adhesions, and it has been associated with a good outcome <ref>Vachon AM, Fisher AT. Small intestinal herniation through the epiploic foramen: 53 cases (1987-1993). ''Equine Vet J'' 27: 373, 1995</ref><ref>Southwood LL, Baxter GM. Current concepts in management of abdominal adhesions. ''Vet Clin North Am Eq Prac'' 13:2 415 1997</ref>
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| ===Neurohumoral peptides===
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| ==Symptoms==
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| Symptoms of ileus include, but are not limited to:
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| * moderate, diffuse [[Abdominal pain|abdominal discomfort]]
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| * [[constipation]]
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| * [[abdominal distension]]
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| * [[nausea]]/[[vomiting]], especially after meals
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| * lack of [[Defecation|bowel movement]] and/or [[flatulence]]
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| ==Risk Factors==
| | [[Ileus diagnostic criteria|Diagnostic Criteria]] | [[Ileus history and symptoms|History and Symptoms]] | [[Ileus physical examination|Physical Examination]] | [[Ileus laboratory findings|Laboratory Findings]] | [[Ileus electrocardiogram|EKG]] | [[Ileus CT|CT]] | [[Ileus MRI|MRI]] | [[Ileus echocardiography or ultrasound|Echocardiography or Ultrasound]] | [[Ileus other imaging findings|Other Imaging Findings]] | [[Ileus other diagnostic studies|Other Diagnostic Studies]] |
| * [[Lower_gastrointestinal_surgery|gastrointestinal surgery]] or other GI procedures
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| * [[electrolyte imbalance]]
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| * [[hypothyroidism]]
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| * [[medications]] (e.g. [[opiates]])
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| * severe [[illness]]
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| ==Treatment== | | ==Treatment== |
| [[Nil per os]] (NPO or "Nothing by Mouth") is mandatory in all cases. [[Nasogastric intubation|Nasogastric suction]] and [[parenteral]] feeds may be required until passage is restored.
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| There are several options in the case of paralytic ileus. Most treatment is supportive. If caused by medication, the offending agent is discontinued or reduced. Bowel movements may be stimulated by prescribing [[lactulose]], [[erythromycin]] or in severe cases, ([[Ogilvie's syndrome]]) [[neostigmine]].
| | [[Ileus medical therapy|Medical Therapy]] | [[Ileus surgery|Surgery]] | [[Ileus primary prevention|Primary Prevention]] | [[Ileus secondary prevention|Secondary Prevention]] | [[Ileus cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Ileus future or investigational therapies|Future or Investigational Therapies]] |
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| If possible the underlying cause is corrected (e.g. replace electrolytes).
| | ==Case Studies== |
| | [[Ileus case study one|Case #1]] |
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| ==External links== | | ==External links== |
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| ==Related Chapters== | | ==Related Chapters== |
| * [[Bowel obstruction]] | | * [[Bowel obstruction]] |
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| ==References==
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| {{reflist|2}}
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| {{Gastroenterology}} | | {{Gastroenterology}} |