Paralytic Ileus
Questions Received:
Provide journal references on paralytic ileus post operative.
Do you have any information regarding treatment of a non-mechanical paralytic ileus?
Responses:
5th July 1998
Paralytic ileus (also called adynamic ileus) is one type of intestinal obstruction.
Recall that the movement of food through the intestines can be impeded in two rather different ways:
Either by a physical obstruction of the lumen such as a growing tumour, a mass of parasitic worms, hernia, intussusception, or a foreign object - anything that impedes the progress of food along the digestive tract
...or by a loss of normal peristaltic function in a part or all of the intestine, as for example when the smooth muscle in the intestinal wall fails to work because of a severe electrolyte imbalance, a loss of nerve or blood supply, or the presence of a toxin or an anticholinergic drug.
The incidence of paralytic ileus is high in comparison to physical obstruction but generally the prognosis is better. Paralytic ileus is frequently encountered when nursing patients on surgical wards following an operation. It is also a major cause of obstruction in infants and children, where it is sometimes referred to as pseudo-obstruction (Barr, 1998). Peristalsis ceases and stagnation occurs in both the small and large bowel producing severe nausea and vomiting. There is abdominal distention and a reduction or absence of bowel sounds.
The many situations which can provoke paralytic ileus include:
Peritonitis
Trauma to the nerves supplying the gut wall during intra-abdominal surgery
Decreased blood supply to the intestinal wall
Prolonged use of opiates either during an operation or in the post operative phase
Metabolic disturbances, particularly those which result in decreased potassium levels
Spinal injury
Pneumonia
Pancreatitis
The condition is managed by inserting a naso-gastric tube and aspirating the stomach contents. The objective is to decompress and rest the intestine as this will relieve abdominal distention and vomiting. Thereafter aspiration takes place at regular intervals (hourly) or the naso-gastric tube is placed on siphon drainage until the condition resolves. Electrolyte and fluid balance are restored and maintained by giving crystalloid solutions intravenously with potassium being added as required. If the patient does not improve rapidly with these conservative measures, an operation will be required to locate the obstruction and restore normal bowel continuity and function.
Click here for clinical notes about acute intestinal obstruction
Reference
Barr, J.M. (1998) Understanding pediatric intestinal pseudo-obstruction: implications for nurses. Gastroenterol Nursing, 21, 1, 11-13 (Jan).
Provide journal references on paralytic ileus post operative.
24th October 1999
We have listed several relevant publications below. If you need further information try visiting the PubMed online resource at http://www.ncbi.nlm.nih.gov/PubMed/ and putting in your search words.
Sample References
Anderson, I.D., and Fearon, K.C.H. (1995) Paralytic ileus and enteral feeding. British Journal of Intensive Care, 5(4), 117-121 (Apr). (This article describes the common causes and effects of paralytic ileus, together with approaches to management.)
Cargile, N.D. (1985) Buying time when you face a bowel obstruction. RN, 48(8), 40-44 (Aug).
LaRosa, J.A., Saywell, R.M. Jr., Zollinger, T.W., Oser, T.L., Erner, B.K., and McClain, E. (1993) The incidence of adynamic ileus in postcesarean patients. Patient-controlled analgesia versus intramuscular analgesia. Journal of Reproductive Medicine, 38(4), 293-300 (Apr). (Patient-controlled analgesia pumps increase the risk of adynamic ileus postoperatively. Usage should be accompanied with close monitoring of bowel motility.)
McConnell, E.A. (1987) Meeting the challenge of intestinal obstruction. Nursing, 17(7), 34-41 (Jul).
McConnell, E.A. (1994) Loosening the grip of intestinal obstructions. Nursing, 24(3), 34-41 (Mar). (Nursing care and assessment for different kinds of obstruction.)
Ogilvy, A.J., and Smith, G. (1995) The gastrointestinal tract after anaesthesia. European Journal of Anaesthesiology, 10(Suppl), 35-42 (May). (Gastrointestinal tract motility may be reduced markedly after surgery, partly by the surgery itself, partly by the residual effects of anaesthetic agents, and partly by opioids administered for post-operative pain relief. These changes may be antagonized to a certain extent by administration of prokinetic agents such as cisapride.)
Taylor, P.R.; and Rowe, P.H. (1989) Bowel obstruction: spotting it early averts crises. Geriatric Medicine, 19(8), 41-44, 47 (Aug).
Do you have any information regarding treatment of a non-mechanical paralytic ileus?
20th December 1999
Non-mechanical paralytic ileus is characterized by a failure of the intestine to propel its contents along, even though the lumen is unobstructed. An alternative name in common usage in the medical literature is chronic intestinal pseudo-obstruction - CIP. It is quite a rare condition (for an overview see Coulie and Camilleri, 1999, and for the nursing aspects see Barr, 1998). The symptoms and signs can be very similar to those of mechanical bowel obstruction, and include pain, vomiting, constipation, and diarrhoea (Mann et al, 1997). Weight loss and severe malnutrition can occur in advanced stages of the disorder. Two main types of CIP are recognized: myogenic, in which the smooth muscle of the gut wall is affected, and neurogenic, caused by abnormalities of the nerve supply to the intestines (Stanghellini, Corinaldesi, and Barbara, 1988).
Management depends on the cause of the disorder, the extent and location of intestine involved, and the severity of symptoms. The goals of treatment are the restoration of normal gut peristalsis and the correction of nutritional deficiencies (Colemont and Camilleri, 1989). General measures include dietary changes (Scolapio et al, 1999), prokinetic agents, and sometimes surgical intervention (Patel and Christensen, 1995; Mann, Debinski, and Kamm, 1997). Some cases are reversible if the causative factor is known (for example: drugs, metabolic abnormalities, or infection). Small bowel transplantation may be a treatment option in certain patients with intestinal failure (Scolapio et al, 1999).
References
Barr, J.M. (1998) Understanding pediatric intestinal pseudo-obstruction: implications for nurses. Gastroenterol Nurs, 21(1), 11-13 (Jan-Feb).
Colemont, L.J., and Camilleri, M. (1989) Chronic intestinal pseudo-obstruction: diagnosis and treatment. Mayo Clinical Proceedings, 64(1), 60-70 (Jan).
Coulie, B., and Camilleri, M. (1999) Intestinal pseudo-obstruction. Annual Review of Medicine, 50, 37-55.
Mann, S.D., Debinski, H.S., and Kamm, M.A. (1997) Clinical characteristics of chronic idiopathic intestinal pseudo-obstruction in adults. Gut, 41(5), 675-681 (Nov).
Patel, R., and Christensen, J. (1995) Chronic intestinal pseudo-obstruction: diagnosis and treatment. Gastroenterologist, 3(4), 345-356 (Dec)
Scolapio, J.S., Nguyen, J.H., Steers, J., and Ukleja, A. (1999) Success with intestinal failure: from adaptation to transplantation. Digestive Dis, 17(2), 107-112.
Scolapio, J.S., Ukleja, A., Bouras, E.P., and Romano, M. (1999) Nutritional management of chronic intestinal pseudo-obstruction. Journal of Clinical Gastroenterology, 28(4), 306-312 (Jun).
Stanghellini, V., Corinaldesi, R., and Barbara, L. (1988) Pseudo-obstruction syndromes. Baillières Clinical Gastroenterology, 2(1):225-254 (Jan)