Ileum is the last part of small intestine. Ileus is a term used when there is temporary absence of peristalsis in the small intestine. Peristalsis is contraction and relaxation of intestine which causes the digested food and content of intestine to move forward. Paralytic ileus is a serious gastrointestinal tract condition that needs immediate medical attention. Paralytic ileus does not cause actual physical obstruction in the intestine. But there is failure of the nerves and muscles that initiate peristaltic movement.
Several causes such as electrolyte balance, severe diarrhea, pancreatitis, appendicitis, abdominal surgery, opiates, medications etc can produce paralytic ileus. Symptoms of paralytic ileus are sudden or gradual such as cramps in abdomen, gaseous distension of abdomen, cramps in abdomen, vomiting, constipation.
In paralytic ileus patient is kept nil by mouth until the bowel starts working again. A nasogastric tube is administered through the nose into the stomach to remove the stomach juices so that the stomach remains empty.
What Are The Common Causes Of Paralytic Ileus?
Paralytic ileus occurs when the nerves and muscles of intestine do not function properly and they impair peristaltic movement of intestine. There is no physical obstruction involved. Several causes can disrupt intestinal contraction and most of them are those related to disorders pertaining to gastrointestinal system. Conditions that can cause paralytic ileus are:
- Severe gastroenteritis that leads to diarrhea, vomiting and dehydration. In majority of cases it is caused due to bacterial or viral infection.
- Electrolyte imbalance
- Botulism a type of food poisoning.
- Diabetic ketoacidosis a complication of diabetes.
- Ischemia of mesenteric vessels.
- As a complication of intestinal surgery.
- Sedative and opiate medications.
- Antispasmodic medicines, anti motility medicines.
- People suffering from Parkinson’s disease are at greater risk of this condition.
- Spinal fractures
- Diabetic ketoacidosis
Signs And Symptoms Of Paralytic Ileus
In paralytic ileus the main symptoms involve those of gastrointestinal tract. They are as follows:
- Abdominal distension
- Cramps in abdomen
- Bowel sound are absent on examination with a stethoscope.
- Nausea and vomiting
- Foul breath from mouth
- Accumulation of gas in stomach and intestine that will lead to abnormal swelling of abdomen. Patient is unable to pass gasses through rectum.
If the condition is severe patient complains of severe pain in abdomen that sometimes makes him bend and walk.
Diagnosis And Treatment Of Paralytic Ileus
Medical history is important for determining if there is paralytic ileus. The physician will first take the history of patient. He will try to find the underlying etiology, for this he may ask the patient what medicines he had taken before this incidence, whether he was suffering from diarrhea prior to possible paralytic ileus. He may also ask for any history of traumatic injury to abdomen etc. During examination he will put his stethoscope over abdomen to hear abdominal sounds. In case of paralytic ileus, there will be very feeble persistaltic sound.
Besides clinical examination and medical history, he will also recommend certain tests. Plain X-ray will show trapped gas in the intestine. Ultrasound and CT scan of abdomen confirms paralytic ileus. Blood tests are also done to find the electrolyte level and white cell count.
Once ileus is diagnosed most patients are treated conservatively. However, often the patient needs to be hospitalized. The first line of treatment consists of nothing by mouth. Patient is advised to avoid taking anything by mouth. The intention is to give rest to intestine. A nasogastric tube is placed through nose inside the stomach. From time to time gastric fluid is aspirated out with the help of large syringe. It also helps to release of gas.
At the same time intravenous fluids is started to prevent electrolyte imbalance. Intravenous fluids also help to provide nutrients. Antibiotics are also administered through intravenous route. During the stay the patient is constantly monitored. As the doctor is able to listen to peristaltic sound in the abdomen, he will first recommend the patient to start with oral liquids and gradually semisolid food over few days. Paralytic ileus is a serious condition which can become life threatening is patient does not take treatment.