Acute Paralytic Ileus

-Ileus is a condition in which there is neurogenic failure or loss of peristalsis in the intestine in the absence of any mechanical obstruction.

-It is commonly seen in hospitalized patients as a result of abdominal surgery, peritonitis, pancreatitis, hemorrhage, pneumonia, sepsis, diabetic ketoacidosis, electrolyte abnormalities, and medications which affect intestinal motility such as opioids, phenothiazines, anticholinergics).

Symptoms and Signs: nausea, vomiting, abdominal pain, abdominal distention, diminished to absent bowel sounds.

Diagnosis: Serum electrolytes, abdominal x ray shows distended gas-filled loops of the small and large intestine.

Treatment:

-Treat the primary surgical or medical illness which precipitated the ileus;

-Restriction of oral intake with gradual liberalization of diet; nasogastric suction, parenteral administration of fluids and electrolytes.

-Opioids exacerbate postoperative ileus through activation of mu-opioid receptors. -Peripherally acting mu-opioid receptor antagonists do not cross the blood-brain barrier, so they can reduce postoperative ileus without diminishing the analgesic effect of opioids.

-Alvimopan: a peripherally acting mu-opioid receptor antagonist that reverses opioid-induced inhibition of intestinal motility.

-Methylnaltrexone: useful to treat opioid-induced constipation.