PARALYTIC ILEUS
PREPARED BY: LAURENCE A. ADENA, MAN
The bowel, or intestine, is the part of the digestive tract that
absorbs nutrients from foods we eat. The residue of digested
food passes through the bowel and is excreted during
elimination, the final stage of digestion. This process can be
interrupted or halted by the presence of a bowel obstruction,
a blockage that prevents the passage of intestinal contents.
Paralytic Ileus ( Pseudo Obstruction)
It is the occurrence of intestinal blockage in the absence of an actual physical
obstruction. This type of blockage is caused by a malfunction in the nerves and
muscles in the intestine that impairs digestive movement.
Bacteria/ viruses
Electrolyte imbalances such as those involving
potassium and calcium
Appendicitis
CAUSES: Pancreatitis
Surgical complications
Obstruction of mesenteric artery w/c supplies blood
to the abdomen
Opiods and sedatives
Neonatal necrotizing enterocolitis ( dse. that causes
death of intestinal tissue in newborns)
CLINICAL MANIFESTATIONS: Characteristics are dependent on the location
of obstructions
1. colicky abdominal pain
2. nausea- rapid develop onset of N/V, proximal to obstruction
N/V – distal to obstruction, gradual onset
3. vomiting- often relieves abdominal pain in the higher intestines.
distal to obstruction- foul smell that looks like stool, indicates long standing
obstruction, requiring immediate surgery
proximal to obstruction- vomiting maybe projectile and contain bile.
4. abdominal distention- usually absent or minimally noticeable in proximal obstructions
and lower intestinal obstructions. Constipation and lack of flatus occurs later.
5. Abdominal tenderness- rigidity ( usually absent unless strangulation or peritonitis
occur).
6. Absent bowel sound, but there is a high pitched bowel sound above obstruction upon
auscultation.
Abdominal cancers
RISKS FACTORS
OF PARALYTIC Conditions that affect muscle and nerve
ILEUS function such as parkinson’s disease.
Infections/ sepsis
Use of medications, such as opiods,
sedatives or narcotics.
COMPLICATION
S:
Kidney failure
Necrosis
Shock
Spread of infection
Peritonitis
Treatments of Paralytic Ileus depends on its severity:
Partial obstruction
A condition like Crohn’s disease or diverticulitis will mean that part of the
intestine isn’t moving, but some bowel material can get through. The doctor may
recommend a low fiber diet, to reduce the bulky stool. However if it doesn’t work,
surgery may be needed.
Complete obstruction = abdominal surgery to remove the blockage or the
damaged intestine.
INTESTINAL OBSTRUCTION
Intestinal obstruction is defined as any hindrance to
the passage of intestinal contents through the small
and/or large bowel.
Obstruction may be partial or complete.
Severity depends upon the area of bowel affected, the
degree of blockage, and the degree of vascular
impairment.
Mechanical Obstruction results from obstruction within the
lumen of the intestine or mural obstruction from pressure on
the walls of the intestines
Causes include:
Foreign bodies such as fruit pits, parasitic worms, or gallstones.
Volvulus
Intussusception
Hernia
Tumor Adhesions Swallowed
object
Although less common, mechanical obstructions can also block your colon, or large
intestine. This can be due to:
impacted stool
adhesions from pelvic infections or surgeries
ovarian cancer
colon cancer
meconium plug in newborns
volvulus and intussusceptions
Diverticulitis
stricture
Non-mechanical obstruction is the result of physiological disturbances.
Small and large intestines normally work in a coordinated system of
movement. If something interrupts these coordinated contractions,
it can cause a functional intestinal obstruction. If it’s a temporary
condition, it’s referred to as an ileus. It’s called a pseudo-
obstruction if it becomes chronic, or long term.
Causes for ileus include:
abdominal or pelvic surgery
infections, such as gastroenteritis or
appendicitis
some medications, including
opioid pain medications
electrolyte imbalances
Intestinal pseudo-obstruction can be caused by:
Parkinson’s disease, multiple sclerosis, and other nerve and muscle
disorders
Hirschsprung’s disease, a disorder in which there is a lack of nerves in
sections of the large intestine
disorders that cause nerve injury
hypothyroidism, or an underactive thyroid gland
Signs and symptoms of small bowel
obstruction
colicky pain, In later stages,
If the small bowel obstruction is
constipation, complete, the peristaltic waves dehydration and plasma
become quite vigorous, assuming
loss result in
nausea, and reverse direction and propelling
intestinal contents toward the hypovolemic shock.
vomiting.
mouth rather than the rectum.
Signs and symptoms of large bowel obstruction
Constipation may be the only symptom for several days.
Eventually, the distended colon loops will be visible on the abdomen.
Nausea and cramps, abdominal pain will occur.
Vomiting is absent at first, but when obstruction becomes complete, fecal
vomiting will occur.
If the obstruction is only a partial one, any of the above symptoms may
occur in a less severe form. Additionally, liquid stool may leak around the
obstruction.
Diagnosis/Findings
1. Physical Assessment
2. Laboratory Studies
3. Abdominal x-ray and CT scan
4. Colonoscopy
Potential Complications
o dehydration
o electrolyte imbalances
o perforation
o kidney failure
If the obstruction is preventing blood from getting to a segment of intestine, this can lead to:
o Infection
o tissue death
o intestinal perforation
o sepsis
o multiple organ failure
o death
TREATING INTESTINAL OBSTRUCTION
For partial obstructions or an ileus, it may be possible to treat by
simply resting the bowels and giving intravenous (IV) fluids. Bowel
rest means you’ll be given nothing to eat, or clear liquids only, during
that time.
If the cause of the obstruction is known, the doctor treats that
as well.
A tube may need to be passed through your nose and down into your throat, stomach, and
intestines to relieve:
pressure swelling vomiting
While prescription medications can’t treat the obstruction itself,
they can help reduce your nausea until further interventions are
performed.
Examples:
antibiotics
antinausea
pain relievers
Surgical Management
For the most common causes of obstruction, such as hernia and adhesions, the
surgical procedure involves repairing the hernia or dividing the adhesion to which
the intestine is attached.
In some instances, the portion of affected bowel may be removed and an
anastomosis performed. The complexity of the surgical procedure depends on the
duration of the intestinal obstruction and the condition of the intestine.
Laparoscopy has become increasingly common because it can facilitate diagnosis
and is easily converted to open laparotomy if warranted.
Nursing Management
Nursing management of patient with a small bowel obstruction who does not require surgery
includes:
o maintaining the function of the NG tube
o assessing and measuring the NG output
o assessing for fluid and electrolyte imbalance
o monitoring nutritional status, and
o assessing for manifestations consistent with resolution (e.g., return of normal bowel sounds,
decreased abdominal distention, subjective improvement in abdominal pain and
tenderness, passage of flatus or stool).
The nurse’s role is to monitor the patient for symptoms indicating that the intestinal
obstruction is worsening and to provide emotional support and comfort.
o The nurse administers IV fluids and electrolytes as prescribed.
o If the patient’s condition does not respond to nonsurgical treatment, the nurse prepares
the patient for surgery.
o This preparation includes preoperative education as the patient’s condition indicates.
o After surgery, routine postoperative nursing care is provided, including abdominal wound
care.
Nursing Implication for Intestinal
Obstruction.
1. Abdominal girths should be measured daily.
For accuracy of comparison, follow these
suggested guidelines:
(a) Use the same measuring tape each time.
(b) Place the patient in the same position each
time.
(c) Ensure that the tape measure is placed in the
same position each time. This can be done by
drawing small tic marks on the patient’s
abdomen to indicate position for the tape
(d) Measure the patient at the same time each
day.
2. Note the color and character of all vomitus. Test for the
presence of occult blood.
3. Any stool passed should be tested for the presence of
occult blood.
4. Monitor vital signs closely. Elevations of temperature
and pulse may indicate infection or necrosis.
5. Monitor I&O closely. Fluid and electrolyte losses must
be replaced.
Outlook for intestinal obstruction
When left untreated, intestinal obstruction can cause the tissue in
the affected part of your intestine to die. It can also lead to a hole, or
perforation in the wall of your intestine, severe infection, and shock.
Overall, the outlook of your condition depends on its cause. Most
cases of intestinal obstruction are treatable. However, other causes,
such as cancer, require long-term treatment and monitoring.
CELIAC SPRUE DISEASE
THE SMALL INTESTINE
The small intestine or small bowel is an organ in the gastrointestinal tract.
It is divided into three divisions: duodenum, jejunum and ileum.
It lies between the stomach and large intestine. The small intestine carries
out most of the digestive process, absorbing almost all of the nutrients you
get from foods into your bloodstream. The walls of the small intestine make
digestive juices, or enzymes, that work together with enzymes from the
liver and pancreas to do this.
Iron is absorbed in the duodenum; Folate (Vitamin B9) in the duodenum
and jejunum; Vitamin B12 and bile salts are absorbed in the terminal
ileum. Water is absorbed by osmosis and lipids by passive diffusion
throughout the small intestine.
CELIAC SPRUE DISEASE
Celiac disease, also known as nontropical sprue, is a disorder that causes
severe malabsorption. It is characterized by marked atrophy of the villi in the
proximal intestine induced by the ingestion of gluten-containing foods.
Clinical Manifestations
1. Diarrhea
2. Steatorrhea
3. Weakness that is relieved when the client begins to have a gluten-free diet.
4. Weight loss
5. Bloating and gas
6. Abdominal pain
7. Nausea and vomiting
8. Constipation
Risk factors
Celiac disease tends to be more common in people who have:
•A family member with celiac disease or dermatitis herpetiformis
•Type 1 diabetes
•Down syndrome or Turner syndrome
•Autoimmune thyroid disease
•Microscopic colitis (lymphocytic or collagenous colitis)
•Addison's disease
Celiac Sprue Serologic Tests
1. Gliadin antibody tests for Immunoglobulin G (IgG ) and IgA
- Done for complaints of diarrhea
- Used for screening purposes
- Used to follow response to a gluten-free diet
2. Endomysial antibody test
Endomysium is a connective tissue protein in human tissue.
Clients with celiac sprue disease have IgA antibodies against endomysium.
3. Tissue transglutaminase is an enzyme released by
fibroblasts when the small intestine is inflamed. Positive
results with endomysial antibody or tissue
transglutaminase should be followed by biopsy
4. Biopsy
5. Human leukocyte antigen (HLA) typing to confirm a
diagnosis of celiac sprue
Complications
•Malnutrition.
•Bone weakening.
•Infertility and miscarriage. Malabsorption of calcium and vitamin D can contribute to reproductive
issues.
•Lactose intolerance.
•Cancer.
•Nervous system problems. Some people with celiac disease can develop problems such as
seizures or a disease of the nerves to the hands and feet (peripheral neuropathy).
