Paralytic Ileus (Etiology-Pathology-Clinical picture-Complications-Investigations-Treatment)

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Paralytic Ileus (Etiology-Pathology-Clinical picture-Complications-Investigations-Treatment)

m Etiology:
Unknown but may be due to inhibition of nerve plexuses found in sub mucus and muscular layers of the wall of the intestine by:
1- Reflex sympathetic stimulation due to operative manipulations, fracture spine or grave injuries.
2- Anoxic inhibition: Hypoxia under anesthesia.
3- Toxic inhibition: Peritonitis, uraemia.
4- Biochemical inhibition:Hypokalaemia.
5- Mechanical inhibition: Fibrinous adhesions.

m Clinical Picture:
1- The intestinal motility usually regained within 2 days after operation but in paralytic ileus paralysis persist ® Silent abdomen ® No pain ® No intestinal sound ® No visible peristalsis.
3- Vomiting. 4- Absolute constipation.
5- Dehydration and electrolyte imbalance.
m Investigations:
1- Plain X-ray ® multiple fluid level distended small and large intestinal loops.
2- Serum electrolytes ® hypokalemia
3- Serum urea ® increase urea level.
m Treatment:


1- Prophylactic: Wide N/G tube in all abdominal operations.
2- Curative: 1- N. G suction & I. V. fluids.
2- Morphia ® ­ intestinal motility.
3- Pantothenic acid ® ­ intestinal motility.
@ N.B. Cholinergic drugs(Neostigmin)is contra-indicated as it exhaust the intestine.
SOURCE: DR. AYMAN SALEM'S BOOK
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