The following are the signs and symptoms of paralytic ileus:

• Abdominal distention due to accumulation of fluid and gas
• Constipation
• Diarrhea
• Abdominal bloating
• Vomiting
• Inability to pass gas
• Abdominal pain
• Abdominal cramps
• Breath odor

• Fever

  He didn’t feel any fever, and he didn’t experienced pain nor bloody in his urine. 3 days before commotion, his stomach getting bigger and getting more filled up. He still experience the abdominal discomfort. [authorstream.com]

  It is characterized by obstipation, severe abdominal pain, vomiting and fever. General status of the patient is very severe, dehydration often occurs, and abdomen is sensitive even to gentle palpation. [oxy.hr]

  However, two days later, her general condition worsened with aplasia (PMN 130/mmc), severe abdominal pain, distension, hyponatremia and fever. Therapy with G-CSF was started. [ncbi.nlm.nih.gov]

  […] is the cause): Abdominal guarding (increased abdominal muscular tone, which intensifies on slight pressure), pain when attempting to cough, rebound tenderness (pain upon removal of pressure greater than upon application of pressure), and frequently fever [empendium.com]

  Haug Browse recently published Learning/CME Learning/CME View all learning/CME CME Case 3-2019: A 70-Year-Old Woman with Fever, Headache, and Progressive Encephalopathy Caplacizumab Treatment for Acquired Thrombotic Thrombocytopenic Purpura Randomized [nejm.org]

• Weight Loss

  He reported a 28-pound unintentional weight loss. Computed tomography scan on admission showed diffuse small-bowel dilation and wall thickening suggestive of small-bowel obstruction (Figure A). [cghjournal.org]

  Proper nutrition is important to prevent malnutrition and weight loss, as well as supply necessary nutrients for healing. This is accomplished by tube feeding. [livestrong.com]

  loss Diagnosis A physician may use a physical exam and one or more different imaging tests to diagnose an ileus. [verywellhealth.com]

  After 3 doses of VCR (vincristine), he developed severe abdominal pain with marked constipation associated with weight loss. X-ray of the abdomen showed gas/fluid-levels scattered throughout the abdomen. Blood count showed pancytopenia (PMN 90/mmc). [ncbi.nlm.nih.gov]

• Pathologist

  Furthermore, another underreporting may have occurred; the fatal cases was derived from death certificates and not all physicians/pathologists might not be aware of clozapine effects on the GI systems. 59 Number of fatal cases was low, illustrated by [academic.oup.com]

• Acutely Ill Patient

  Films taken in the upright position (standing or sitting in acutely ill patients) or when lying on the side (the most sensitive view) may demonstrate free intraperitoneal air, which is evidence of GI perforation (Figure 6.1-16). [empendium.com]

• Pallor

  Physical examination revealed he was mildly dehydrated, with no pallor or icterus. His abdomen was distended and tympanic with absent bowel sounds. There were no signs of peritonism or herniae. [hindawi.com]

• Pneumonia

  Pneumonia and cardiac arrhythmias represent the most common life-threatening complications during delirium tremens. [ncbi.nlm.nih.gov]

  True enough, among the precipitating factors that could cause acute paralytic ileus are electrolyte abnormalities (which could interfere in neurotransmission), peritonitis (or inflammation of the peritoneum), surgery, severe medical illness such as pneumonia [constipation-remedies.co.uk]

  An unending ode to pneumonia Brian F. [ccjm.org]

  Ileus sometimes occurs in association with renal or thoracic disease (eg, lower rib fractures, lower lobe pneumonias, MI). Gastric and colonic motility disturbances after abdominal surgery are common. [youtube.com]

  Chronic ischemia refers to progression of atherosclerosis of the abdominal arteries. 7) Drugs (opioids, anticholinergics). 8) Diseases of organs located in the chest: Myocardial infarction, lower lobar pneumonia. Clinical FeaturesTop 1. [empendium.com]

• Abdominal Pain

  He experienced the abdominal pain and intermittent. Patient experienced the abdominal discomfort in every regio in his stomach. [authorstream.com]

  Interventions • Interventions Notify surgeon of changes in: o VS o Bowel sounds o Decreased urine output o Increased abdominal distention o Pain Maintain strict I&O record Monitor for signs of dehydration and electrolyte imbalance Assess pain and provide [slideshare.net]

  Described is a case in which a patient presented with chest and abdominal pain after methamphetamine use. The patient was ultimately diagnosed with a methamphetamine-induced paralytic ileus. [ncbi.nlm.nih.gov]

• Abdominal Distension

  She presented with remarkable abdominal distension and respiratory difficulty but was effectively treated by surgical removal of the tumor with preoperative and operative management using alpha and beta adrenergic blocking agents. [ncbi.nlm.nih.gov]

  Initally, abdominal distension without pain, but later symptoms may mimic those of true obstruction. History relevant to cause, e.g. recent surgery. E: Abdominal distension. Bowel sounds may be reduced or absent. [europeanmedical.info]

  Presentation Prolonged hospitalization, electrolyte imbalance, painful abdominal distension Patient Data Age: 70 years Gender: Male Loading images... Marked distension of bowel loops with air-fluid levels. No evidence of mechanical obstruction. [radiopaedia.org]

• Acute Abdomen

  abdomen and the diagnostic possibilities of magnetic resonance have decreased the role of conventional radiology techniques, especially of plain abdominal film in the diagnosis of acute abdomen. [ncbi.nlm.nih.gov]

  Therefore, paralytic ileus accompanies practically all cases of acute abdomen – perforated peptic ulcer, acute pancreatitis, intestinal perforation, etc. [health-tutor.com]

  Merck Manual Professional Version. http://www.merckmanuals.com/professional/gastrointestinal-disorders/acute-abdomen-and-surgical-gastroenterology/ileus. Accessed Sept. 18, 2015. [mayoclinic.org]

  Introduction The abdominal plain film is often the first port of call in imaging of the acute abdomen. It can be somewhat of a gatekeeper in deciding who proceeds to CT or Ultrasound or for other procedures. [wikiradiography.com]

• Absent Bowel Sounds

  […] occur) Absent bowel sounds or high pitched bowel sounds above obstruction (upon auscultation) Temperature > 100° (rare occurrence, secondary to strangulation or peritonitis occurring) 6. [slideshare.net]

  Obstipation or constipation Abdominal distention High-pitched, tinkling bowel sounds (early) Absent bowel sounds (late) Diffuse, continuous abdominal pain Vomiting Obstipation or constipation Marked abdominal distention Tympany on percussion Absent bowel [amboss.com]

  Common presenting features therefore are: Failure to pass flatus or faeces Sensation of bloating and distention Nausea and vomiting/ high NG output On examination, there will be abdominal distention and absent bowel sounds (whereas in mechanical obstruction [teachmesurgery.com]

  His abdomen was distended and tympanic with absent bowel sounds. There were no signs of peritonism or herniae. Rectal examination revealed a collapsed rectum with no masses. [hindawi.com]

  While in the surgical unit, he developed progressive abdominal distension and absent bowel sounds. His urine output progressively declined and the serum creatinine was rising. [thyroidresearchjournal.biomedcentral.com]

• Abdominal Bloating

  […] is carried out to analyze the abdominal tenderness and bloating. [symptoma.com]

  Some of the common symptoms can include: Abdominal bloating, swelling, or distension. Constipation Diarrhea Foul smelling breath Gs Having no bowel sounds Nausea that may or may not include vomiting. [hellomrdoctor.com]

  The symptoms of ileus are abdominal bloating caused by a buildup of gas and liquids, nausea, vomiting, severe constipation, loss of appetite, and cramps. People may pass watery stool. [msdmanuals.com]

  Abdominal Bloating The failure to defecate and pass gas leads to bloating of the abdomen. Vomiting Intestinal obstruction commonly leads to vomiting. Excessive Belching The inability to pass gas forces the sufferer to belch every now and then. [primehealthchannel.com]

• Hypotension

  Hypermagnesemia is a well-known cause of hypotension and cardiac dysfunction but not well recognized is the induction of paralytic ileus. This report details the second and third adult patients reported with hypermagnesemia-induced paralytic ileus. [ncbi.nlm.nih.gov]

  Summary Hypermagnesemia is a well-known cause of hypotension and cardiac dysfunction but not well recognized is the induction of paralytic ileus. [link.springer.com]

  gas, and intestinal contents can build up pressure and cause the bowel to collapse, collapsed bowel can build up pressure and lead to leakage of F&E into peritoneal cavity and ultimately lead to severe reduction in blood volume which can result in hypotension [slideshare.net]

  English Do not use in dogs with cardiac failure, hypotension, hypovolaemia, respiratory depression, hypertension, a history of epilepsy, non age related corneal pathology or those who have or are suspected of having a paralytic ileus. [mymemory.translated.net]

• Seizure

  Other features may include decreased muscle tone (hypotonia) or stiffness (spasticity) of the torso and limbs, weakness in the muscles that control eye movement (ophthalmoplegia), intellectual disability, seizures, unusual facial features, or recurrent [icdlist.com]

  […] ħafna*: enċefalopatija akuta; newropatija awtonomika (li tirriżulta f’ilju paralitiku u ipotensjoni ortostatika), aċċessjonijiet English Very rare*: acute encephalopathy, autonomic neuropathy (resulting in paralytic ileus and orthostatic hypotension), seizures [mymemory.translated.net]

A physical examination is carried out to analyze the abdominal tenderness and bloating. Blood work would show dehydration, electrolyte imbalance and infection.

An abdominal x-ray would also be required to analyze the nature of the obstruction. A serial abdominal x-ray with dyes may demonstrate the progression of ileus recovery in post-operative patients [5]. In addition, CT scan of the abdomen would also be done. A diagnostic procedure known as upper GI and small bowel series is a type of x-ray that is done to study the internal features of the abdomen. In this test, the patient is given barium milkshake to drink prior to the procedure. When the contrast media stays more than 4 hours in a bowel region, this is already suggestive of an obstructive process [6]. Going forward an x-ray of the abdomen will be done.

• Bowel Distention

  Paralytic ileus typically presents with abdominal distention and minimal pain, which intensifies with increasing distention. Bowel sounds are generally minimal or absent. [patientcareonline.com]

  Obstipation or constipation Abdominal distention High-pitched, tinkling bowel sounds (early) Absent bowel sounds (late) Diffuse, continuous abdominal pain Vomiting Obstipation or constipation Marked abdominal distention Tympany on percussion Absent bowel [amboss.com]

  Clinically, the abdomen may be distended and tympanic, depending on the degree of abdominal and bowel distention, and may be tender. [gmjournal.co.uk]

  It is characterized by bowel distention, lack of bowel sounds, accumulation of GI gas and fluid, and delayed passage of flatus and stool (TABLE 1).1 The reported incidence of POI ranges from 4% to 32%.2,3 A higher incidence is associated with abdominal [uspharmacist.com]

• Hyponatremia

  Etiology Adynamic ileus can be caused by a number of conditions: drugs: e.g. opioids metabolic: e.g. hyponatremia sepsis: especially gram-negative bacteria abdominal trauma or surgery (see below) myocardial infarction / congestive heart failure head injury [radiopaedia.org]

  Hyponatremia 3. Hypomagnesemia 4. Hypermagensemia • Reflex ileus. This may occur following fractures of the spine or ribs, retroperitoneal haemorrhage or even the application of a plaster jacket. 9. [slideshare.net]

  Among them, hyponatremia could be a significant correlate for prolonged ileus. A distinction between postoperative ileus and mechanical small-bowel obstruction is sometimes difficult and confusing. [news-medical.net]

  However, two days later, her general condition worsened with aplasia (PMN 130/mmc), severe abdominal pain, distension, hyponatremia and fever. Therapy with G-CSF was started. [ncbi.nlm.nih.gov]

Treatment of paralytic ileus is largely dependent on relieving the underlying causative factors. This would help resolve the condition in some days. Primary management care is focused on correcting electrolyte imbalances and dehydration. Intravenous hydration is administered to replenish for the lost fluids. In addition, a tube may be required to be inserted through the nasal route to relieve the symptoms of distention and vomiting.

If the above supportive treatment regime fails to show any effect then medications are prescribed to facilitate peristalsis. Current studies have identified the drug alvimopan to hasten bowel peristalsis in postoperative patients [7]. If there are signs of tissue death then surgery may be required.

Prognosis of the condition depends on the severity of the disease. Usually with prompt diagnosis and treatment, the prognosis is expected to be good. Paralytic ileus is a temporary phenomenon and gets resolved with proper treatment. Other abdominal surgery like laparoscopic resection of the colon may have a short lived ileus compared to the rectal surgery which may have an extended ileus consequently affects morbidity rate and duration of hospital sate [4].

Complications

Paralytic ileus inhibits the ability of the intestines to absorb nutrients from the food and also does not allow the passage of digested food through the digestive system. Thus, electrolyte imbalance and dehydration are some of the notable complications of paralytic ileus. In addition, this condition can also bring along the following complications if treatment is not initiated on time.

• Infection
• Jaundice
• Perforation in the intestine
• Necrotizing enterocolitis
• Tissue death
• Gangrene 

Paralytic ileus is not caused due to any kind of physical obstruction. It is purely the result of malfunctioning of the intestinal muscles and nerves. As a result of the malfunctioning, the normal process of digestion, absorption and elimination does not take place calling for an emergency situation. The causes of paralytic ileus are described as below:

• Gastroenteritis 
• Pancreatitis 
• Complications as a result of surgical procedures [2].
• Obstruction of the mesenteric nerve which is responsible for supplying blood to the abdomen (mesenteric ischemia). 
• Appendicitis
• Electrolyte imbalances
• Drugs containing opioids and narcotics often slow down the peristalsis movement of the intestine.
• Disorders of the lung or kidney

Statistics reveal that about 50% of patients undergoing abdominal surgery suffer from paralytic ileus as a secondary complication to the surgical procedure [3]. It is a common condition for patients undergoing any kind of abdominal surgical procedure. It has also been estimated that, paralytic ileus is the main cause of intestinal obstruction in children and infants.

Under normal circumstances, the food that is digested in the stomach passes through the intestine where the nutrients are absorbed. In condition of paralytic ileus, the muscles and nerves of the intestine get paralyzed. When such a condition takes place, the nutrients from the food are not absorbed and the passage of fluid and food through the digestive tract is disrupted. This causes an accumulation of fluid and gas.

In many cases, development of paralytic ileus cannot be prevented. Conditions such as hernias and tumors should be promptly treated. It is also necessary to avoid medications such as opiates like morphine which are known to promote development of ileus [8]. The thoracic epidural administration option with combined local anesthetics during abdominal surgery may shorten the course of the ileus postoperatively [9]. The administration of preoperative celcoxib in patients have significantly prevented post-operative ileus compared to other non-steroidal anti-inflammatory drugs (NSAIDs) [10].

Paralytic ileus is a condition characterized by hypomotility of the intestine. Such a condition does not result from any kind of physical obstruction; but occurs due to malfunctioning of the nerves and muscles of the intestine. This condition is also known as pseudoobstruction and is a common compliant amongst children and infants.

Physiologic ileus resolves within 2 to 3 days; thus, ileus persisting beyond 3 days are already considered adynamic or paralytic etiologically [1]. Paralytic ileus is an emergency and should receive prompt treatment to avoid serious complications going forward. This condition hinders with the absorption of the nutrients from the food that is digested. Due to malfunctioning of the intestine, the nutrients are not absorbed and the residue does not pass through the system causing buildup of fluid and gas in the stomach.

Definition 

Paralytic ileus also known as pseudoobstruction is a disorder characterized by malfunctioning of the muscles and nerves of the intestine. In this condition, there is no mechanical obstruction. Paralytic ileus is most common cause of intestinal obstruction in children and infants. Such a condition hinders the passage of food through the intestine.

Cause

Causes of paralytic ileus include intestinal infections due to bacteria or fungi, mineral imbalances, postoperative complications, lung disease, kidney disorders, mesenteric ischemia, certain medications and appendicitis.

Symptoms

Symptoms of paralytic ileus begin with vomiting and dehydration. The patient may also experience abdominal bloating and distention followed by severe pain. Other symptoms include dehydration, diarrhea, constipation, electrolyte imbalance, inability to pass gas and breathe odor.

Diagnosis

A physical examination of the abdomen would reveal distention and fullness. In addition, imaging studies such as CT scan would be done to reveal the nature of the obstruction. X-ray of the abdomen using barium milkshake would help in examination of the internal structures. Blood tests are required to determine electrolyte imbalance and dehydration.

Treatment

The primary goal of treating paralytic ileus is to correct the underlying cause of the condition. Once this is achieved then the ileus resolves by itself. In addition to this, several methods to relieve symptoms are employed. Administration of intravenous fluids is done to replenish the lost fluids through vomiting and diarrhea. A tube is also inserted through the nasal route to relieve the distention. Medications may also be required to ensure the muscles of the intestine work.

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