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.

Introduction to ICU Series

CCC 700 6

Critical Care

Compendium

Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the  Clinician Educator Incubator programme, and a CICM First Part Examiner.

He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.

His one great achievement is being the father of three amazing children.

On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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