Ileus

Question 1

When can Ileus occur

Answer 1

Up to 72hrs s/p surgery

Question 2

Ddx for Ileus symptoms: n/v, bloating, minimal/absent flat us/distention

Answer 2

small bowel obstruction

bowel injury

intra-abdominal or retroperitoneal bleeding

intra-abdominal abscess

Question 3

Imaging studies if suspect Ileus

Answer 3

KUB

Question 4

SBO vs Ileus on imaging

Answer 4

SBO: transition point (dilated bowl then point after where bowel is decompressed), air fluid levels

Ileus: dilated loops

Question 5

Electrolytes to watch in Ileus

Answer 5

K–hypokalemia can exacerbate Ileus

Mg–watch and replace

Question 6

Pain mess to use/avoid in Ileus

Answer 6

NSAIDs

Avoid narcotics

Question 7

How long to wait for signs of improvement with supportive therapy?

Next steps if decompensate or no improvement in this time?

Answer 7

24-48hrs

CT scan abd/pelvis

Question 8

Risk factors for Ileus

Answer 8

1. prolonged abdominal or pelvic surgery
2. laparotomy (which necessitates more bowel manipulation)
3. lower gastrointestinal surgery
4. intra-abdominal infection
5. intraoperative bleeding
6. narcotic use.

Question 9

Persistent vomiting/significant distention: next step?

Answer 9

NGT–decompress bowel