paralytic ileus


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ileus

 [il´e-us]
failure of appropriate forward movement of bowel contents. It may be secondary to either mechanical obstruction of the bowel (mechanical ileus) or a disturbance in neural stimulation (adynamic ileus). Ileus is a surgical emergency that may or may not require surgical intervention; the cause needs to be established promptly.

Adynamic (or paralytic) ileus often accompanies peritonitis and is also found accompanying the colicky pains of gallstones or kidney stones; following spinal cord injury, pneumonia, or other generalized conditions; or being caused by peritoneal contamination by pus (from a perforated appendix) or acid (from a perforated ulcer). Mechanical ileus is that due to adhesions, ischemia, tumor, or stone and requires prompt decompression of the bowel to prevent perforation.
Symptoms. The principal symptoms of ileus are abdominal pain and distention, constipation, and vomiting in which the vomitus may contain fecal material. If the intestinal obstruction is not relieved, the circulation in the wall of the intestine is impaired and the patient appears extremely ill with symptoms of shock and dehydration.
Treatment. Distention of the abdomen is relieved by decompression, which involves intubation with a long, balloon-tipped tube (e.g., miller-abbott tube) that extends to the site of the obstruction, and use of constant suction. Because of the disruption in absorption of fluids and nutrients from the intestinal tract, fluids, electrolytes, and glucose are given intravenously. Surgical intervention to remove the cause of ileus is usually necessary when the obstruction is complete or the bowel is likely to become gangrenous. The type of surgical procedure will depend on the condition of the bowel and the cause of the obstruction. In some cases ileostomy or colostomy, either temporary or permanent, may be necessary. In cases of paralytic ileus due to causes other than contamination by pus or acid, tube decompression may be sufficient, but even in these patients, surgery may be needed to protect the bowel from overdistention and perforation. See also intestinal obstruction for patient care.
adynamic ileus that caused by inhibition of bowel motility; see ileus.
dynamic ileus (hyperdynamic ileus) spastic ileus.
mechanical ileus that caused by a mechanical cause, such as hernia, adhesions, or volvulus; see ileus.
meconium ileus ileus in the newborn due to intestinal obstruction by thick meconium.
paralytic ileus adynamic ileus.
spastic ileus that due to persistent contracture of a bowel segment.
ileus subpar´ta ileus due to pressure of the gravid uterus on the pelvic colon.

a·dy·nam·ic il·e·us

obstruction of the bowel due to paralysis of the bowel wall, usually as a result of localized or generalized peritonitis or shock.
Synonym(s): paralytic ileus

paralytic ileus

Etymology: Gk, paralyein, to be paralyzed, eilein, to twist
a decrease in or absence of intestinal peristalsis. It may occur after abdominal surgery or peritoneal injury or be associated with severe pyelonephritis; ureteral stone; fractured ribs; myocardial infarction; extensive intestinal ulceration; heavy metal poisoning; porphyria; retroperitoneal hematomas, especially those associated with fractured vertebrae; or any severe metabolic disease. The most common overall cause of intestinal obstruction, paralytic ileus is mediated by a hormonal component of the sympathoadrenal system. Also called adynamic ileus.
observations Paralytic ileus is characterized by abdominal tenderness and distension, absence of bowel sounds, lack of flatus, and nausea and vomiting. There may be fever, decreased urinary output, electrolyte imbalance, dehydration, and respiratory distress. Loss of fluids and electrolytes may be extreme, and, unless they are replaced, the condition may lead to hemoconcentration, hypovolemia, renal insufficiency, shock, and death.
interventions Typically, computed tomography of the abdomen and pelvis is performed with PO and IV contrast to rule out anatomical obstruction. The patient is kept in bed in a low Fowler's position, and nothing is given by mouth. A nasogastric tube may be inserted into the stomach and connected to intermittent suction and the patient is positioned to facilitate the advancement of the tube, which is checked at intervals, usually every 30 to 60 minutes. The character of GI drainage is monitored at intervals, usually every 2 to 4 hours, and any increase or decrease in the amount or changes in the color or consistency is reported. Bowel sounds, blood pressure, pulse, and respirations are checked every 2 to 4 hours, or as indicated in a particular circumstance, and rectal temperature usually every 4 hours. Abdominal girth is measured at least every 2 hours, and any increase is reported. Parenteral fluids with electrolytes and medication to promote peristalsis are administered as ordered; intake and output are measured, and, if less than about 30 mL of urine is excreted per hour, the physician is informed. The patient is helped to turn and deep breathe every 2 to 4 hours and is given oral hygiene every 1 to 2 hours. Active or passive range-of-motion exercises are performed every 4 hours. Walking is helpful as gravity is a useful force. When intestinal output increases and bowel sounds return, the intestinal tube may be clamped and small amounts of warm tea may be given. If pain, distension, or cramps do not recur, the intestinal tube may be removed, but a rectal tube or an enema may be ordered to relieve distension.
nursing considerations The concerns of the health care providers include monitoring and reporting the signs of paralytic ileus and its potential complications, ensuring that the patient is as comfortable as possible, explaining the purpose of the intestinal tube, and walking with the patient, encouraging ambulation. The patient is instructed to try to avoid mouth breathing because swallowed air can increase distension. Before surgery, patients need reassurance that the sutures are strong and the distended abdomen will not burst.

paralytic ileus

GI disease Functional 'obstruction' of intestinal flow, often following abdominal surgery, as well as electrolyte defects–eg, hypokalemia, drugs–eg, phenothiazine, narcotics, gram-negative sepsis, catecholamines, diabetic ketoacidosis, mesenteric vascular disease, porphyria, retroperitoneal hemorrhage, spinal and pelvic fractures. See Gastroparesis, Intestinal obstruction, Volvulus.

a·dy·nam·ic il·e·us

(ā'dī-nam'ik il'ē-ŭs)
Obstruction of the bowel due to paralysis of the bowel wall, usually as a result of localized or generalized peritonitis or shock.
Synonym(s): paralytic ileus.

paralytic

1. pertaining to paralysis.
2. an animal affected with paralysis.

paralytic bladder
see atonic neurogenic urinary bladder.
paralytic ileus
loss of all intestinal tone and motility as a result of reflex inhibition in acute peritonitis, from excessive handling during bowel surgery, prolonged and severe distention due to intestinal obstruction and in grass sickness of horses. The effect is the same as that of an acute intestinal obstruction. Called also ileus, adynamic ileus.
paralytic myoglobinuria
a disease of horses characterized by red-brown urine due to myoglobinuria, and acute myopathy with muscle weakness, often to the point of being unable to get up. It occurs after exercise after several days of inaction while still being fed a high-energy ration. Called also azoturia and Monday morning disease.
paralytic rabies
see rabies.
paralytic shellfish poisoning
syndrome of flaccid paralysis after ingestion of bivalve molluscs whose tissues have accumulated tetrahydroxypurine toxins from some marine dinoflagellates; syndrome identical with tetrodotoxin poisoning. See also saxitoxin. Called also PSP.
References in periodicals archive ?
The patient developed an acute intestinal obstruction after the appendectomy, which was mistaken for paralytic ileus due to the findings on the abdominal radiograph and a history of abdominal surgical procedure.
The patient's recurrent nausea and vomiting led to a diagnosis of pancreatitis and recurrent paralytic ileus.
Paralytic ileus due to strongyloidiasis: case report and review of the literature.
A total of 120 patients with various patterns of presentation who were admitted to surgical unit or referred to surgical department with acute mechanical intestinal obstruction and underwent laparotomy were included in our study while those with non- mechanical intestinal obstruction like history of trauma and paralytic ileus were excluded from the study.
Five patients developed fever, three de-veloped paralytic ileus and three developed postop-erative wound infections and one maternal death occurred due to irreversible damage as she was re-ferred late in a state of shock and despite BIAL and hysterectomy she succumbed to dissemination intra-vascular coagulation and massive transfusion and its complications.
Paralytic ileus was noted in 12 patients--three patients with Grade III and nine patients with Grade IV severity--and all received magnesium infusion.
Neostigmine is known to reduce gastric acid output and oesophageal and gastric tone whilst increasing salivation and lower gastrointestinal tract motility, indeed, it is increasingly used to treat paralytic ileus (Ponec et al 1999).
Question: A patient developed postoperative paralytic ileus with intractable vomiting.
Paralytic ileus and an accumulation of intra-abdominal fluid push the diaphragm upward, lowering the capacity for lung expansion within the thorax and contributing to partial lung collapse
On day 12, he had sudden deterioration, with recurrence of fever, chills, and rigors, severe paralytic ileus, and systemic hypotension requiring mechanical ventilation and inotropic support.
The early signs and symptoms-including abdominal distention, nausea, pain, and constipation-can be difficult to differentiate from paralytic ileus, according to Dr.