Ileus
OVERVIEW
- Ileus = absence of bowel motility
TYPES
(1) dynamic ileus
(2) spastic ileus (rare: porphyria or lead poisoning)
(3) ischaemic ileus
CLINICAL FEATURES
- abdominal pain
- N+V
- constipation
- abdominal distension
- intolerant of enteral feeding
- absent bowel sounds
- can produce: intestinal ischaemia, perforation and abdominal compartment syndrome
INVESTIGATIONS
- AXR: air fluid levels, air in bowel, distension
MANAGEMENT
Resuscitation
- A, B and C
- optimise oxygenation and perfusion to promote organ function, minimise catecholamines
- avoid excessive IV hydration as bowel oedema worsens ileus
- avoid narcotics
Acid-base and Electrolytes
- correct: K+, Mg2+
Specific Therapy
- metoclopramide: widely used, does seem to increase motility
- erythromycin: similar molecular structure to motilin
- NSAIDs: ketorolac increases tolerance but also causes GIH and renal impairment
- neostigmine: dramatic effect on colonic pseudo-obstruction (2mg IV)
- narcotic antagonists: methylnaltrexone
- experimental: NO synthase inhibitors, protein tyrosine kinase inhibitors
Underlying Cause
- need to rule out mechanical obstruction
- feeding: avoid prolonged starvation, feeding @ 10-20mL/hr better than nothing, even those with an ileus should be fed enterally, TPN is not a substitute.
References and Links
Introduction to ICU Series
Introduction to ICU Series Landing Page
DAY TO DAY ICU: FASTHUG, ICU Ward Round, Clinical Examination, Communication in a Crisis, Documenting the ward round in ICU, Human Factors
AIRWAY: Bag Valve Mask Ventilation, Oropharyngeal Airway, Nasopharyngeal Airway, Endotracheal Tube (ETT), Tracheostomy Tubes
BREATHING: Positive End Expiratory Pressure (PEEP), High Flow Nasal Prongs (HFNP), Intubation and Mechanical Ventilation, Mechanical Ventilation Overview, Non-invasive Ventilation (NIV)
CIRCULATION: Arrhythmias, Atrial Fibrillation, ICU after Cardiac Surgery, Pacing Modes, ECMO, Shock
CNS: Brain Death, Delirium in the ICU, Examination of the Unconscious Patient, External-ventricular Drain (EVD), Sedation in the ICU
GASTROINTESTINAL: Enteral Nutrition vs Parenteral Nutrition, Intolerance to EN, Prokinetics, Stress Ulcer Prophylaxis (SUP), Ileus
GENITOURINARY: Acute Kidney Injury (AKI), CRRT Indications
HAEMATOLOGICAL: Anaemia, Blood Products, Massive Transfusion Protocol (MTP)
INFECTIOUS DISEASE: Antimicrobial Stewardship, Antimicrobial Quick Reference, Central Line Associated Bacterial Infection (CLABSI), Handwashing in ICU, Neutropenic Sepsis, Nosocomial Infections, Sepsis Overview
SPECIAL GROUPS IN ICU: Early Management of the Critically Ill Child, Paediatric Formulas, Paediatric Vital Signs, Pregnancy and ICU, Obesity, Elderly
FLUIDS AND ELECTROLYTES: Albumin vs 0.9% Saline, Assessing Fluid Status, Electrolyte Abnormalities, Hypertonic Saline
PHARMACOLOGY: Drug Infusion Doses, Summary of Vasopressors, Prokinetics, Steroid Conversion, GI Drug Absorption in Critical Illness
PROCEDURES: Arterial line, CVC, Intercostal Catheter (ICC), Intraosseous Needle, Underwater seal drain, Naso- and Orogastric Tubes (NGT/OGT), Rapid Infusion Catheter (RIC)
INVESTIGATIONS: ABG Interpretation, Echo in ICU, CXR in ICU, Routine daily CXR, FBC, TEG/ROTEM, US in Critical Care
ICU MONITORING: NIBP vs Arterial line, Arterial Line Pressure Transduction, Cardiac Output, Central Venous Pressure (CVP), CO2 / Capnography, Pulmonary Artery Catheter (PAC / Swan-Ganz), Pulse Oximeter
Critical Care
Compendium
