Intestinal Obstruction

and Ileus
definition
Caused by any condition that prevents the normal flow of chyme
through the intestinal lumen or failure of normal intestinal motility in
the absence of an obstructing lesion (ileus).
ileus
Postoperative paralytic ileus results from inhibitory neural
reflexes associated with inflammatory mediators, and the
influence of exogenous (meperidine) and endogenous opioids
(endorphins) that affect the entire GI tract, including the
stomach
CLINICAL MANIFESTATIONS
• Colicky pains (intermittent)
• Distention
• Nausea
• Vomit
• Obstruction at Pylorus > clear gastric fluid
• Obstruction at proximal small intestine > bile-stained fluid
• Obstruction at distal small intestine > may not occur/fecal material
• Hypotension > SNS response > tachycardia + sweating
• If ischemia occurs > more constant and severe pain
• If ischemia progresses to necrosis, perforation, and peritonitis occurs > fever, leukocytosis, rebound
tenderness
• Partial Obstruction > constipation/diarrhea
• Complete Obstruction > constipation + increased bowel sound, metabolic acidosis signs
EVALUATION AND TREATMENT
• Ultrasound and radiography
• Replacement of fluid and electrolytes and decompression of the
lumen with gastric or intestinal suction are essential forms of therapy.
• Laparoscopic procedures can release adhesions.
• Immediate surgical intervention is required for strangulation and
complete obstruction.
• Neostigmine, a parasympathomimetic, is used for colonic pseudo-
obstruction and colonoscopic decompression may be required