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.

CCC 700 6

Critical Care

Compendium

Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health and Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

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

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

Leave a Reply

This site uses Akismet to reduce spam. Learn how your comment data is processed.