Type your tag names separated by a space and hit enter

Gut Motility Disorders: Failure of Transit through Bowel

Gut Motility Disorders: Failure of Transit through Bowel is a topic covered in the Pocket ICU Management.

To view the entire topic, please or purchase a subscription.

Anesthesia Central is an all-in-one web and mobile solution for treating patients before, during, and after surgery. This collection of drug, procedures and test information is derived from Davis’s Drug, MGH Clinical Anesthesia Procedures, Pocket Guide to Diagnostic Tests, and MEDLINE Journals. Explore these free sample topics:

Anesthesia Central

-- The first section of this topic is shown below --

First Things First (assess & treat for the following)

The first step in dealing w/ gut dysmotility is to differentiate ileus from obstruction. Whereas ileus typically resolves w/ supportive care only, & without sequelae, obstruction rarely resolves w/out surgical intervention & can have serious consequences if not aggressively managed.

  • Ileus is functional failure (no demonstrable obstruction) of the gut to propel contents & can be classified as:
    • Adynamic ileus is an inhibition of the neuromuscular complex, also referred to as pseudo-obstruction.
      • Primary adynamic ileus is idiopathic (ie, Ogilvie’s syndrome).
      • Most adynamic ileus is secondary to well-known causes:
        • Postop ileus related to CNS & neural reflexes, hormones, medication & anesthetic agents is normal when it involves the small bowel for up to 24 hrs, the stomach up to 48 hrs & the colon for up to 72 hrs.
        • When postop ileus is prolonged or recurrent, considerations should include:
          • Intra-abdominal inflammation
          • Systemic sepsis
          • Intra-abdominal or retroperitoneal hematoma
          • Occult wound infection
        • Commonly seen after trauma, including:
          • Spinal cord injury
          • Spine fracture
          • Rib fractures
          • Pelvic fracture
        • Common w/ pulmonary atelectasis or pneumonia in the basal segments
        • Drugs that inhibit gut motility include:
          • Narcotics
          • Anticholinergic agents
          • Antihistamines
          • Psychotropic drugs such as haloperidol or tricyclic antidepressants
          • Phenothiazines
          • Ganglionic blocking agents
        • Metabolic causes of ileus are common:
          • Hypokalemia
          • Hyponatremia
          • Hypomagnesemia
        • Other metabolic causes include:
          • Uremia
          • Diabetes
          • Hypoparathyroidism
        • Miscellaneous causes
          • Scleroderma
          • Amyloidosis
    • Spastic ileus is related to hypermotility where uncoordinated peristalsis fails to push contents through.
    • Ischemic ileus is related to vascular occlusion & infarction of the myoelectric components.
  • Obstruction is the physical barrier to movement of bowel contents. In general, the 3 categories include:
    • Extraluminal causes
      • Adhesions
      • Hernias
      • Carcinomas
      • Abscesses
    • Lesions intrinsic to the bowel wall
      • Primary tumors
      • Inflammatory bowel disease (Crohn’s disease)
    • Intraluminal causes
      • Gallstones
      • Enteroliths
      • Foreign bodies
      • Bezoars
    • 80% of bowel obstruction involves the small bowel; the most common etiologies are:
      • Postop adhesions (65-80%); pelvic procedures, specifically gynecologic, appendectomy & colorectal resection, account for 60% of obstructions due to adhesions
      • Hernia (15-25%)
        • Ventral hernia is the most common.
        • Inguinal & internal hernias are common.
        • Less common are femoral, obturator, lumbar & sciatic.
      • Tumors (10-15%)
        • The majority are metastatic lesions that implant through hematogenous spread to the peritoneum.
        • Large intra-abdominal tumors can cause obstruction from extraluminal compression.
        • Obstructing primary small bowel tumors are rare.
      • Crohn’s disease (5%) is the 4th leading cause of small bowel obstruction.
        • Inflammation & edema that resolves w/ nonoperative mgt
        • Stricture that may require resection & reanastomosis or stricturoplasty
      • Abscess can cause obstruction by involving a portion of the intestinal wall, by adhesion or as a result of localized ileus & functional obstruction. Common etiologies include:
        • Ruptured appendix
        • Diverticulitis
        • Dehiscence of abdominal anastomosis
      • Miscellaneous other etiologies include:
        • Intussusception, more common in children; in adults is usually associated w/ a lead point such as a polyp, tumor or Meckel’s diverticulum
        • Enteroliths from jejunal diverticula
        • Foreign bodies
        • Phytobezoars
    • 20% of obstructions involve the colon; the most common etiologies include:
      • Cancer (60%)
      • Diverticulitis (15%)
      • Volvulus (15%)

If obstruction is present, the second step is to determine whether & how urgently surgical intervention is needed.

  • Only about 20% of partial obstructions will require surgical intervention, which can usually be done on a semi-elective (planned) basis.
  • Complete obstruction almost always requires surgical intervention, usually on an emergency basis.
  • The vast majority of obstructions are classified as simple, implying an intact blood supply (ie, gallstone ileus).
  • Strangulated obstruction implies mesenteric vessel occlusion & is associated w/ a higher morbidity & mortality; therefore, early recognition is important.
  • Closed loop obstruction involves occlusion of both afferent & efferent limbs of bowel & is especially dangerous because of rapid progression to strangulation & perforation even before clinical evidence of obstruction. The following closed loop obstructions require emergent surgical intervention if bowel resection is to be avoided:
    • Volvulus
    • Incarcerated ventral hernia
    • Congenital bands
    • Adhesions
    • Malrotation
    • Internal hernia

-- To view the remaining sections of this topic, please or purchase a subscription --

Last updated: May 2, 2010

Citation

"Gut Motility Disorders: Failure of Transit Through Bowel." Pocket ICU Management, PocketMedicine.com, Inc, 2010. Anesthesia Central, anesth.unboundmedicine.com/anesthesia/view/Pocket-ICU-Management/534089/all/Gut_Motility_Disorders:_Failure_of_Transit_through_Bowel.
Gut Motility Disorders: Failure of Transit through Bowel. Pocket ICU Management. PocketMedicine.com, Inc; 2010. https://anesth.unboundmedicine.com/anesthesia/view/Pocket-ICU-Management/534089/all/Gut_Motility_Disorders:_Failure_of_Transit_through_Bowel. Accessed April 25, 2019.
Gut Motility Disorders: Failure of Transit through Bowel. (2010). In Pocket ICU Management. Available from https://anesth.unboundmedicine.com/anesthesia/view/Pocket-ICU-Management/534089/all/Gut_Motility_Disorders:_Failure_of_Transit_through_Bowel
Gut Motility Disorders: Failure of Transit Through Bowel [Internet]. In: Pocket ICU Management. PocketMedicine.com, Inc; 2010. [cited 2019 April 25]. Available from: https://anesth.unboundmedicine.com/anesthesia/view/Pocket-ICU-Management/534089/all/Gut_Motility_Disorders:_Failure_of_Transit_through_Bowel.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Gut Motility Disorders: Failure of Transit through Bowel ID - 534089 Y1 - 2010/05/02/ BT - Pocket ICU Management UR - https://anesth.unboundmedicine.com/anesthesia/view/Pocket-ICU-Management/534089/all/Gut_Motility_Disorders:_Failure_of_Transit_through_Bowel PB - PocketMedicine.com, Inc DB - Anesthesia Central DP - Unbound Medicine ER -