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| Paralytic ileus |
Clinical features,
- Abdominal distension without any pain
- Vomiting (Effortless)
- Absolute constipation
- No platus
Aetiology
- Sepsis of Peritonitis
- Hypokalaemia (reduced K ion)
- Uremia
- Diabetic coma
- Excessive bowel handling
- Abdominal trouma
- Prolong hypotension
- Prolong pypoxia
- Immoilization
- Opioid drugs
History and investigations for managements
- Duration
if more than 3 to 5 day, mechanical cause
- Bowel sounds
if silent, diagnostic for paralytic ileus
if noicy, mechanical obstruction
- Pain
if positive (+), mechanical obstruction
if negative (-) paralytic ileus
- Timing
- X- Ray
if localized loop of distention without gas Shadow, mechanical obstruction
if diffuse distension with sags shadows, paralytic ileus
Management
Prophylactic before surgery
- Correct biochemical imbalance
- Gently bowel handling during surgery
In established case
- NG tube to prevent gaseous distension
- Nill by mouth
- Correct electrolyte imbalance
- Drugs, morality stimulant such as metoclopramide together with erythromycine
