Adynamic ileus

Ileus refers a disruption of the normal propulsive function of the gastrointestinal tract.

Following trauma to the intestine, a direct inhibition of smooth muscle occurs and causes a decrease in intestinal motility.

Due in part to activation of opioid receptors and is relieved by opioid blocking agents.

Originally ref2242ed to any lack of digestive propulsion, including any bowel obstruction,

Adynamic ileus restricts its meaning to failure of peristalsis, rather than by mechanical obstruction.

Decreased propulsive function classified as caused either by bowel obstruction or intestinal atony or paralysis.

With symptoms and signs of a bowel obstruction, but with the absence of a mechanical obstruction, refers to an acute colonic pseudo-obstruction, the Ogilvie’s syndrome.

Paralysis of the intestine is often termed paralytic ileus.

Paralytic ileus is a common result of some types of surgery, commonly called post surgical ileus.

Paralytic ileus can also result from some drugs, injuries and illnesses, such as acute pancreatitis.

Paralytic ileus causes constipation, bloating and absence of bowel sounds.

Post surgical ileus is a temporary paralysis of a portion of the intestines.

Intestinal atony or paralysis may be caused by inhibitory neural reflexes, inflammation and neurohumoral peptides.

Ileus symptoms include: diffuse abdominal discomfort, constipation, abdominal distension, nausea/vomiting, vomiting of bile, lack of bowel movement and/or flatulence and excessive belching.

Associated with gastrointestinal surgery, GI procedures, electrolyte abnormalities, diabetic ketoacidosis, hypothyroidism, opiate medications, peritonitis, and spinal cord injury.

Management is nothing by mouth historically, but mild feedings by enteral feeding tube may help to restore motility by triggering the gut’s normal feedback signals, so this is the recommended management initially.

With persistence of impaired motility nasogastric suction and parenteral nutrition may be required until passage is restored.

For paralytic ileus treatment is mostly supportive.

Bowel movements may be stimulated by lactulose, erythromycin or, in cases with a neurological component, neostigmine.

Chewing gum may stimulate gastrointestinal motility in the post-operative period and reduce the duration of postoperative ileus.

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