Please confirm topic selection

Are you sure you want to trigger topic in your Anconeus AI algorithm?

Please confirm action

You are done for today with this topic.

Would you like to start learning session with this topic items scheduled for future?

Updated: Dec 15 2021

Paralytic / Adynamic Ileus

  • Snapshot
    • A 47-year-old woman on the surgery floor complains of abdominal pain and bloating. She was admitted for appendicitis and underwent a laparoscopic appendectomy 2 days ago. She reports feeling fine since the surgery and denies any fever, swelling, hematuria, hematochezia, or nausea. Her last bowel movement was 3 days ago and she denies any flatulence. A physical examination is unremarkable except for a lack of bowel sounds.
  • Introduction
    • Clinical definition
      • medical condition characterized by the disruption of the normal coordinated propulsive motor activity (peristalsis) of the gastrointestinal tract without any structural/mechanical obstruction
  • Epidemiology
    • Demographics
      • gastrointestinal/abdominal surgery is the most common cause
    • Risk factors
      • gastrointestinal surgery
      • electrolyte imbalance (e.g., hypokalemia or hypercalcemia)
      • diabetes
      • medications (e.g., opioids or antimuscarinics)
      • spinal cord injury
      • severe illness
      • hypothyroidism
      • acute intermittent porphyria
    • Pathogenesis
      • the degree of intestinal paralysis does not need to be complete but enough to functionally prohibit the passage of food leading to intestinal blockage
      • normal gastrointestinal motility is controlled and facilitated by a complex network of various neural networks and neurohumoral peptides
        • enteric nervous system, which is the intrinsic neural network of the gastrointestinal system
        • extrinsic network consists of the visceral sensory afferents of the vagus, splanchnic, and pelvic nerves as well as the visceral motor efferent of the autonomic nervous system
      • gastrointestinal dysmotility can result from various mechanisms
        • inflammation (e.g., surgery or severe illness)
        • neural reflexes
        • neurohumoral peptides (e.g., certain medications)
  • Presentation
    • Symptoms
      • abdominal pain
        • rarely presents as the colicky pain present in mechanical bowel obstruction
      • nausea
      • vomiting
      • vague discomfort
    • Physical exam
      • abdominal distension
      • lack of bowel sounds on auscultation
        • in contrast to the high-pitched tinkling sounds in mechanical bowel obstruction
      • no abdominal tenderness
  • imaging
    • Abdominal radiograph
      • best initial test
      • supine and upright views
      • positive findings may show dilated loops of bowel without a transition zone, air-fluid levels, and air in the colon and rectum
      • allows for rule out of other causes of abdominal pain (e.g., perforated viscus)
  • Studies
    • Diagnostic testing
      • diagnostic approach
        • diagnosis is often based on clinical presentation followed by rule out of other causes of bowel obstruction
      • studies
        • laboratory studies are to be ordered given the clinical presentation to determine etiology/cause
        • electrolyte panel
          • hypokalemia and hypercalcemia may worsen ileus; hypomagnesemia can lead to hypokalemia
        • creatinine and blood urea nitrogen
          • uremia can lead to ileus
        • liver function tests, amylase, and lipase
          • pancreatitis may lead to ileus
        • thyroid panel
          • hypothyroidism may lead to ileus
  • Differential
    • Mechanical bowel obstruction
      • differentiating factors
        • physical examination will demonstrate high-pitched tinkling and history will often include colicky abdominal pain
    • Pancreatitis
      • differentiating factors
        • although can lead to paralytic ileus, patients with pure pancreatitis will not have dilated bowels on imaging
  • Treatment
    • First-line
      • supportive management
        • NPO or dietary restriction
        • if severe, nasogastric suction with parenteral nutrition
        • IV fluids
      • address underlying etiology
        • remove offending medication if applicable
        • replace electrolytes
      • facilitate bowel movements
        • lactulose
        • erythromycin
        • neostigmine
          • for severe cases thought to have a neurological component (e.g., Oglivie syndrome)
  • Complications
    • Perforation
    • Bowel necrosis/ischemia
    • Peritonitis
    • Hemodynamic instability
    • Death
1 of 0
1 of 2
Private Note

Attach Treatment Poll
Treatment poll is required to gain more useful feedback from members.
Please enter Question Text
Please enter at least 2 unique options
Please enter at least 2 unique options
Please enter at least 2 unique options