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| {{Ogilvie syndrome}} | | {{Ogilvie syndrome}} |
| {{CMG}} | | {{CMG}} |
| ==Overview==
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| '''Ogilvie syndrome''' is the acute [[Intestinal pseudoobstruction|pseudoobstruction]] and dilation of the colon in the absence of any mechanical obstruction in severely ill patients.<ref name="NEJM">[http://content.nejm.org/cgi/content/abstract/341/3/137?andorexacttitleabs=and&search_tab=articles&tocsectionid=Original+Articles&tocsectionid=Special+Reports&tocsectionid=Special+Articles&tocsectionid=Clinical+Practice&tocsectionid=Review+ArticlesAORBClinical+PracticeAORBClinical+Implications+of+Basic+ResearchAORBMolecular+Medicine&tocsectionid=EditorialsAORBPerspectiveAORBOutlookAORBBehind+the+Research&tocsectionid=Sounding+BoardAORBClinical+Debate&tocsectionid=Clinical+Implications+of+Basic+Research&tocsectionid=Health+Policy+ReportsAORBHealth+Policy+2001AORBQuality+of+Health+Care&tmonth=Mar&searchtitle=Articles&sortspec=Score+desc+PUBDATE_SORTDATE+desc&excludeflag=TWEEK_element&hits=20&where=fulltext&tyear=2006&andorexactfulltext=and&fyear=1996&fmonth=Mar&sendit=GO&searchterm=ogilvie&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT Neostigmine for the Treatment of Acute Colonic Pseudo-Obstruction], by Ponec R. J., Saunders M. D., Kimmey M. B., [[New England Journal of Medicine]], 1999; 341:137-141, Jul 15, 1999.</ref>
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| | ==[[Ogilvie syndrome overview|Overview]]== |
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| Colonic pseudo-obstruction is characterized by massive dilatation of the [[Cecum#Cecum|cecum]] (diameter > 10 cm) and right colon on abdominal X-ray.<ref name="Sleisenger">{{cite book |last= Feldman |first= Mark |coauthors= Lawrence S. Friedman, Marvin H. Sleisenger |title= [http://intl.elsevierhealth.com/catalogue/title.cfm?ISBN=0721689736 Sleisenger & Fordtran's Gastrointestinal and Liver Disease, 7th edition] |publisher= Elsevier |year= 2002 |month= July |id= ISBN 9780721689739}}</ref><ref name="RCCM">[http://ajrccm.atsjournals.org/cgi/content/full/161/5/1417 Recent Advances in Critical Care Gastroenterology] DANIEL S. PRATT and SCOTT K. EPSTEIN, [http://ajrccm.atsjournals.org/ Am. J. Respir. Crit. Care Med.], Volume 161, Number 5, May 2000, 1417-1420 </ref>
| | ==[[Ogilvie syndrome historical perspective|Historical Perspective]]== |
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| ==Etiology== | | ==[[Ogilvie syndrome pathophysiology|Pathophysiology]]== |
| Recent surgery (most common following [[coronary artery bypass surgery]]),<ref name="AoS">[http://archsurg.ama-assn.org/cgi/content/abstract/135/6/682 Ogilvie Syndrome as a Postoperative Complication] Patty L. Tenofsky, MD; R. Larry Beamer, MD; R. Stephen Smith, MD
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| [http://archsurg.ama-assn.org/ Arch Surg.] 2000;135:682-687. </ref>neurologic disorders, serious infections, cardiorespiratory insufficiency, metabolic disturbances, and drugs that disturb colonic motility (e.g., anticholinergics or narcotics) contribute to the development of this condition.<ref name="Sleisenger"/><ref name="IrwinRippe">{{cite book |last= Irwin |first= Richard S. |coauthors= Rippe, James M. |title= [http://www.lww.com/product/?0-7817-3548-3 Intensive Care Medicine] |publisher= Lippincott Williams & Wilkins, Philadelphia & London |year= 2003 |month= January |id= ISBN 0-7817-3548-3}}</ref>
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| ==Pathophysiology== | | ==[[Ogilvie syndrome causes|Causes]]== |
| The exact mechanism behind the acute colonic pseudo-obstruction is not fully elucidated. The probable explanation is imbalance in the regulation of colonic motor activity by the autonomic nervous system.<ref name="NEJM"/>
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| ==Signs and symptoms== | | ==[[Ogilvie syndrome differential diagnosis|Differentiating Ogilvie syndrome from other Diseases]]== |
| Usually the patient has [[abdominal distention]], pain and altered bowel movements.<ref name="Sleisenger"/><ref name="IrwinRippe"/>
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| ==Diagnosis== | | ==[[Ogilvie syndrome epidemiology and demographics|Epidemiology and Demographics]]== |
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| <gallery>
| | ==[[Ogilvie syndrome risk factors|Risk Factors]]== |
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| Ogilvie's syndrome 001.jpg | | ==[[Ogilvie syndrome screening|Screening]]== |
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| | ==[[Ogilvie syndrome natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
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| Ogilvie's syndrome 002.jpg
| | ==Diagnosis== |
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| Image:
| | [[Ogilvie syndrome history and symptoms|History and Symptoms]] | [[Ogilvie syndrome physical examination|Physical Examination]] | [[Ogilvie syndrome laboratory findings|Laboratory Findings]] | [[Ogilvie syndrome x ray|X Ray]] | [[Ogilvie syndrome CT|CT]] | [[Ogilvie syndrome ultrasound|Ultrasound]] | [[Ogilvie syndrome other imaging findings|Other Imaging Findings]] | [[Ogilvie syndrome other diagnostic studies|Other Diagnostic Studies]] |
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| Ogilvie's syndrome 003.jpg | |
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| </gallery>
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| ==Treatment== | | ==Treatment== |
| It usually resolves with conservative therapy stopping oral ingestions, i.e. [[nil per os]] and a [[Feeding tube|nasogastric tube]],<ref name="Sleisenger"/> but may require [[colonoscopy|colonoscopic]] decompression which is successful in 70% of the cases. A study published in the [[New England Journal of Medicine]] showed that [[neostigmine]] is a potent pharmacological way of decompressing the colon.<ref name="NEJM"/> According to the American Society for Gastrointestinal Endoscopy (ASGE), it should be considered prior to colonoscopic decompression. The use of neostigmine is not without risk since it can induce bradyarrhythmia and bronchospasms.<ref name="IrwinRippe"/> Therefore atropine should be within immediate reach when this therapy is used.<ref name="NEJM"/><ref name="Sleisenger"/><ref name="RCCM"/>
| | [[Ogilvie syndrome medical therapy|Medical Therapy]] | [[Ogilvie syndrome primary prevention|Primary Prevention]] | [[Ogilvie syndrome cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Ogilvie syndrome future or investigational therapies|Future or Investigational Therapies]] |
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| ==Prognosis== | | ==Case Studies== |
| It is a serious medical disorder and the mortality rate can be as high as 30%.<ref name="IrwinRippe"/> The high mortality rate is likely a measure that this syndrome is seen in critically ill patients, rather than this syndrome being in itself lethal.
| | [[Ogilvie syndrome case study one|Case #1]] |
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| ==See also== | | ==Related Chapters== |
| *[[Complication (medicine)|Complication]] | | *[[Complication (medicine)|Complication]] |
| *[[Ileus]] | | *[[Ileus]] |
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| ==Notes==
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| <references/>
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| ==References==
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| * {{cite book | author =Bynum TE | year = 1998 | title = Internal Medicine | chapter = Chapter 342: Intestinal Obstruction and Peritonitis | editor = Stein JH | edition = 5th ed. | publisher = C.V.Mosby | location = New York | id = ISBN 0-8151-8698-3 }}
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| * [http://www.lww.com/product/?0-7817-3548-3 Intensive Care Medicine by Irwin and Rippe]
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| [[Category:Rare diseases]] | | [[Category:Rare diseases]] |