PARALYTIC ILEUS

a decrease in or absence of intestinal peristalsis. It may occur after abdominal surgery or

peritoneal injury or be associated with severe pyelonephritis; ureteral stone; fractured ribs;
myocardial infarction; extensive intestinal ulceration; heavy metal poisoning; porphyria;
retroperitoneal hematomas, especially those associated with fractured vertebrae; or any
severe metabolic disease. The most common overall cause of intestinal obstruction,
paralytic ileus is mediated by a hormonal component of the sympathoadrenal system

Paralytic ileus is a common side effect of some types of surgery, in case it is commonly
called postsurgical ileus. It can also result from certain drugs and from various injuries and
illnesses, i.e. acute pancreatitis. Paralytic ileus causes constipation and bloating. On
listening to the abdomen with a stethoscope, no bowel sounds are heard because the bowel
is inactive.

food or drink should be avoided until peristaltic sound is heard from auscultation of the area
where this portion lies.

Paralytic ileus is characterized by abdominal tenderness and distension, absence of bowel

sounds, lack of flatus, and nausea and vomiting. There may be fever, decreased urinary
output, electrolyte imbalance, dehydration, and respiratory distress. Loss of fluids and
electrolytes may be extreme, and, unless they are replaced, the condition may lead to
hemoconcentration, hypovolemia, renal insufficiency, shock, and death.

interventions Typically, computed tomography of the abdomen and pelvis is performed

with PO and IV contrast to rule out anatomic obstruction. The patient is kept in bed in a low
Fowler's position, and nothing is given by mouth. A nasogastric tube may be inserted into
the stomach and connected to intermittent suction and the patient is positioned to facilitate
the advancement of the tube, which is checked at intervals, usually every 30 to 60 minutes.
The character of GI drainage is monitored at intervals, usually every 2 to 4 hours, and any
increase or decrease in the amount or changes in the color or consistency is reported. Bowel
sounds, blood pressure, pulse, and respirations are checked every 2 to 4 hours, or as
indicated in a particular circumstance, and rectal temperature usually every 4 hours.
Abdominal girth is measured at least every 2 hours, and any increase is reported. Parenteral
fluids with electrolytes and medication to promote peristalsis are administered as ordered;
intake and output are measured, and, if less than about 30 mL of urine is excreted per hour,
the physician is informed. The patient is helped to turn and deep breathe every 2 to 4 hours
and is given oral hygiene every 1 to 2 hours. Active or passive range-of-motion exercises are
performed every 4 hours. Walking is helpful as gravity is a useful force. When intestinal
output increases and bowel sounds return, the intestinal tube may be clamped and small
amounts of warm tea may be given. If pain, distension, or cramps do not recur, the intestinal
tube may be removed, but a rectal tube or an enema may be ordered to relieve distension.
nursing considerations The concerns of the health care providers include monitoring and
reporting the signs of paralytic ileus and its potential complications, ensuring that the
patient is as comfortable as possible, explaining the purpose of the intestinal tube, and
walking with the patient, encouraging ambulation. The patient is instructed to try to avoid
mouth breathing because swallowed air can increase distension. Before surgery, patients
need reassurance that the sutures are strong and the distended abdomen will not burst.

CAUSES

• Chemical, electrolyte, or mineral disturbances (such as decreased potassium levels)

• Complications of intra-abdominal surgery
• Decreased blood supply to the abdominal area (mesenteric artery ischemia--
Mesenteric artery ischemia occurs when there is a narrowing or blockage of one or
more of the three mesenteric arteries, the major arteries that supply the small and
large intestines.)
• Injury to the abdominal blood supply
• Intra-abdominal infection
• Kidney or lung disease
• Use of certain medications, especially narcotics(narcotics can slow the bowel, and
lead to symptoms of constipation, bloating, or nausea. This relates to the well known
effects of narcotics on the bowel, opiate bowel dysfunction. In addition in about
5−10% of individuals, narcotics may actually sensitize the nerves and make pain
worse. This is narcotic bowel syndrome (NBS).)

Tests that show obstruction include:

• Abdominal CT scan
• Abdominal x-ray
• Barium enema
• Colonoscopy, small bowel investigation with ingested camera or push endoscopy,
and laparoscopy are other diagnostic options.

Treatment involves placing a tube through the nose into the stomach or intestine to
help relieve abdominal distention and vomiting.

Surgery may be needed to relieve the obstruction if the tube does not relieve the
symptoms, or if there are signs of tissue death.

Overview
Patients may be treated with supervised bed rest in a hospital and bowel rest, where
nothing is taken by mouth, and patients are fed intravenously or through the use of a
nasogastric tube, a tube inserted through the nose, down the throat, and into the stomach.
A similar tube ca...[read article]
 Tests for Paralytic Ileus
1.
Abdominal X-Ray
Abdominal films are x-ray images of the abdomen. More
Costs

2.
Abdominal Ultrasound
Abdominal ultrasound is an imaging procedure used to examine the internal organs of the
abdomen, including the liver, gallbladder, spleen, pancreas, and kidneys. Th... More
Costs

3.
History and Physical Exam
During a physical examination, a health care provider studies a patient's body to determine
the presence or absence of physical problems. A typical physical ex... More
Costs

4.
Abdomen Examination

5.
Ultrasound Scan
Ultrasound involves the use of high-frequency sound waves to create images of organs and
systems within the body. More

6.
X-Ray
X-rays are a form of electromagnetic radiation, just like visible light. In a health care setting,
a machines sends are individual x-ray particles, called photons. ... More

Top

Medical Procedures for Paralytic Ileus

1.
Insertion of Nasogastric Tube
Nasogastric intubation refers to the process of placing a soft plastic nasogastric (NG) tube
through a patient's nostril, past the pharynx and down the esophag... More

2.
Intravenous Rehydration
Sterile water solutions containing small amounts of salt or sugar, are injected into the body
through a tube attached to a needle that is inserted into a vein. More

Surgical Procedures for Paralytic Ileus

Ileectomy and Ileostomy
Colostomy Procedure
Ileostomy Procedure
Definition

Ileus is a partial or complete non-mechanical blockage of the small and/or large intestine.

Description
There are two types of intestinal obstructions, mechanical and non-mechanical.
Mechanical obstructions occur because the bowel is physically blocked and its contents
can not pass the point of the obstruction. This happens when the bowel twists on itself
(volvulus) or as the result of hernias, impacted feces, abnormal tissue growth, or the
presence of foreign bodies in the intestines.
Unlike mechanical obstruction, non-mechanical obstruction, called ileus or paralytic
ileus, occurs because peristalsis stops. Peristalsis is the rhythmic contraction that moves
material through the bowel. Ileus is most often associated with an infection of the
peritoneum (the membrane lining the abdomen). It is one of the major causes of bowel
obstruction in infants and children.
Another common cause of ileus is a disruption or reduction of the blood supply to the
abdomen. Handling the bowel during abdominal surgery can also cause peristalsis to
stop, so people who have had abdominal surgery are more likely to experience ileus.
When ileus results from abdominal surgery the condition is often temporary and usually
lasts only 48–72 hours.
Ileus can also be caused by kidney diseases, especially when potassium levels are
decreased. Heart disease and certainche motherapy drugs, such as vinblastine (Velban,
Velsar) and vincristine (Oncovin, Vincasar PES, Vincrex), also can cause ileus. Infants
with cystic fibrosis are more likely to experience meconium ileus (a dark green material
in the intestine). Over all, the total rate of bowel obstruction due both to mechanical and
non-mechanical causes is one in one thousand people (1/1,000).
SIGNS AND SYMPTOMS
When the bowel stops functioning, the following symptoms occur:
•abdominal cramping
•abdominal distention
•nausea and vomiting
•failure to pass gas or stool

DIAGNOSIS
When a doctor listens with a stethoscope to the abdomen there will be few or no bowel
sounds, indicating that the intestine has stopped functioning. Ileus can be confirmed by x
rays of the abdomen, computed tomography scans (CT scans), or ultrasound. It may be
necessary to do more invasive tests, such as a barium enema or upper GI series, if the
obstruction is mechanical. Blood tests also are useful in diagnosing paralytic ileus. Barium
studies are used in cases of mechanical obstruction, but may cause problems by increasing
pressure or intestinal contents if used in ileus. Also, in cases of suspected
mechanical obstruction involving the gastrointestinal tract (from the small intestine
downward) use of barium x rays are contraindicated, since they may contribute to the
obstruction. In such cases a barium enema should always be done first.

TREATMENT
Patients may be treated with supervised bed rest in a hospital, and bowel rest—where
nothing is taken by mouth and patients are fed intravenously or through the use of a
nasogastric tube. A nasogastric tube is a tube inserted through the nose, down the throat,
and into the stomach. A similar tube can be inserted in the intestine. The contents are then
suctioned out. In some cases, especially where there is a mechanical obstruction, surgery
may be necessary.
Drug therapies that promote intestinal motility (ability of the intestine to move
spontaneously), such as cisapride and vasopressin (Pitressin), are sometimes prescribed.

ALTERNATIVE TREATMENT
Alternative practitioners offer few treatment suggestions, but focus on prevention by
keeping the bowels healthy through eating a good diet, high in fiber and low in fat. If the
case is not a medical emergency, homeopathic treatment and traditional Chinese medicine
can recommend therapies that may help to reinstate peristalsis.

PROGNOSIS
The outcome varies depending on the cause of ileus.

PREVENTION
Most cases of ileus are not preventable. Surgery to remove a tumor or other mechanical
obstruction will help prevent a recurrence