Topic
Review Topic
0
0
https://upload.medbullets.com/topic/120186/images/ogilvie.jpg
https://upload.medbullets.com/topic/120186/images/ogilvie_ct_coronal.jpg
Snapshot
  • A 71-year-old man with coronary artery disease, diabetes, chronic obstructive lung disease, lung cancer, and arthritis is admitted for septic arthritis of his right knee after a recent steroid injection. He undergoes treatment with antibiotics and incision and drainage of the right knee. He reports feeling better with good pain control with hydrocodone; however, on postoperative day 3, he develops acute abdominal distention that is slightly tender to palpation. Abdominal radiography demonstrates cecal dilation to 11 cm.
Introduction
  • Clinical definition
    • acute dilation of the large intestine in the absence of mechanical obstruction, also known as acute colonic pseudo-obstruction (ACPO)
    • most often involves right colon and cecum
  • Epidemiology
    • often in the elderly
    • risk factors
      • narcotics
      • anticholinergics
      • recent surgery
      • sepsis
      • malignancy
  • Pathogenesis
    • mechanism unknown
    • possibly due to autonomic nervous system dysfunction
  • Associated conditions
    • hypothyroidism
    • spinal cord injury
Presentation
  • Symptoms
    • bloating
    • abdominal pain
    • nausea and vomiting
  • Physical exam
    • abdominal distention
    • abdomen tender to palpation
    • fever
Studies
  • Diagnostic testing
    • imaging
      • abdominal radiography
        • screening test and for serial monitoring
        • massively dilated cecum and right colon with decompression near splenic flexure
      • abdominal computed tomography scan
        • diagnostic test
        • rule out mechanical obstruction
Differential
  • Toxic megacolon
    • distinguishing factors
      • associated severe colitis
      • systemic toxicity such as tachycardia, fever, and altered mental status
  • Large bowel obstruction
    • distinguishing factor
      • mechanical obstruction present
Treatment
  • First line
    • discontinue offending medications
    • conservative care
      • intravenous fluids and electrolyte repletion
      • nasogastric tube decompression
  • Second line
    • neostigmine
      • if no resolution with 24-48 hours of conservative care
      • atropine for possible bradyarrhythmia
  • Third line
    • colonoscopic decompression
      • if no resolution after neostigmine
  • Fourth line
    • cecostomy
      • if no resolution after colonoscopic decompression
Complications
  • Ischemic colitis
  • Intestinal perforation
  • Volvulus
 

Please rate topic.

Average 3.6 of 7 Ratings

Thank you for rating! Please vote below and help us build the most advanced adaptive learning platform in medicine

The complexity of this topic is appropriate for?
How important is this topic for board examinations?
How important is this topic for clinical practice?
Topic COMMENTS (4)
Private Note