Ileus

Question 1

Definition of ileus

Answer 1

Is an adynamic bowel due to the absence of normal peristaltic contractions. This can lead to bowel obstruction

Question 2

Aetiology of ileus

Answer 2

• Many causes such as:
‣ ABDOMINAL SURGERY common complication due to extensive handling of the bowel
‣ Pancreatitis
‣ Spinal injury
‣ Electrolyte imbalances (hypokalaemia, hyponatraemia, uraemia)
‣ Drugs (tricyclic antidepressants, analgesics, anaesthetics)
‣ Non-abdominal surgery

Question 3

History and Examination of ileus

Answer 3

• Nausea and vomiting: nausea very common)
• Abdominal distention or tenderness
• No features of mechanical obstruction
• Absolute constipation
• Discomfort with pain: discomfort due to distention, colicky pain uncommon in ileus
• Decreased or hypoactive bowel sounds

Question 4

Investigations for ileus

Answer 4

• FBC: to check for infection
• Serum electrolytes: check for abnormalities (hypokalaemia, hyponatraemia or uraemia)
• ABG: check lactate for ischaemia
• CT scan with contrast: fluid filled intestines

Question 5

Treatment of ileus

Answer 5

1) Nil by mouth and IV fluids: fix any electrolyte abnormalities

+ Reduce opioid analgesia and replace with non-opioid medication: Opioids are known to slow down bowel motility

Manage any underlying conditions

Consider parental nutrition

Question 6

Complications and prognosis of ileus

Answer 6

• Prolonged hospital stay

• Usually resolves with supportive management within 3-4 days of onset. Usually no complications