ILEUS

Definition : disturbances of intestinal

passage
Classification :- mecanical obstruction
- neurogenic origin :
- paralytic ileus
- spastic ileus
- vascular origin
Mecanical Intestinal Obstruction
Classification of causes :
- in the lumen of the bowel
- skibala
- parasites
- gallstone
- foreign bodies
- in the wall of the bowel
- inflammation
- tumours : - benign
- malignant
- Out side the bowel wall
- adhesions
- bands
- volvulus
- intussusception
- incarcerated hernia
Level Of Obstruction
- high level : - duodenum
- jejenum
- ileum
- low level : colon & rectum
Pathology
Obstruction

Increase intraluminar tension

Increase pressure on the intestinal wall

Lymph and vein obstruction oedeem

Bacterial translocation

Artery obstruction infarct / gangreen

perforation
Causes of death

- dehydration : - no fluid intake

- vomiting
- septic : - bacterial translocation
- bowel perforation peritonitis
- shock haemorragic : volvulus radix mesenterii
Symptoms
- abdominal pain : - colicky
- continous
- meteoristic
- vomiting
- no defecation and flatus

Systemic Sign : sign of dehydration

- Tachicardia
- Hypotension
- Dry mouth
- Decrease of skin turgor
- Oliguria - anuria
Local sign
Insp. : - scar from previous operation
- distension
- darm contour & darm steifung
- irreducible external hernia
Palp. : - tenderness
- muscular guarding/defans muscular
- abdominal mass
- external hernia
Perc. : - tympatic
Ausc. : - hyperperistaltic
- metallic sound
- gurgling / borborygmy
- absent of bowel sound
Rectal examination : - impact faeces
- rectal tumour
- blood on finger
Laboratory test
- Hb, AL, Diff. Tell., blood grouping
- ureum & creatinin
- electrolyte

X ray examination
plain x ray of the abdomen, supine, semi erect, LLD.
Contrast x ray : - upper GI foto (OMD)
- barium enema (colon in loop)
Treatment
Pre operative : - nasoogastric tube
- indwelling catheter
- replacement therapy of : - fluid
- electrolyte
- acid & basebalance
- antibiotic
Operative : exploratory laparatomy
Post operative : - maintenance of fluid, electrolyte & nutrition
- antibiotic
- realimentation