Constipation Adynamic Ileus

Nature's Quick Constipation Cure

Constipation Help Relief In Minutes

Get Instant Access

Constipation (nejm 2003:349 1360)

• Definition (Rome III criteria): must include 2 of the following (in at least ' 4 of BMs):

straining during defecation, lumpy hard stools, incomplete evacuation, sensation of anorectal obstruction blockage; stool frequency <3 per wk

• Etiology: fxnal (nl transit, slow transit, pelvic floor disorders. IBS); obstruction

(cancer, stricture); metabolic (DM. hypothyroid. hypoK. preg.. panhypopiL. hyperCa); meds (opioids, anticholinergics ind.TCAs & antipsychotics, iron. CCB); neurogenic (Parkinson's. Hirschsprung's, amyloid. MS. Chagas. autonomic neuropathy)

• Treatment (fiber supplementation — osmotic laxative -♦ stimulant laxative)

bulk laxatives (psyllium, methylcellulose. polycarbophil): t colonic residue, t peristalsis osmotic laxatives (Mg, sodium phosphate, lactulose, etc.): draw water into intestines stimulant laxatives (senna, castor oil. bisacodyl. docusate sodium): Î motility & secretion rectal enema suppository (phosphate, mineral oil, tap-water, soapsuds, bisacodyl) tegaserod: Î motility, but recently withdrawn from market b c ? CV toxicity lubiprostone: î secretion (useful for severe constipation)

Adynamic ileus

• Definition: loss of intestinal peristalsis in absence of mechanical obstruction

Ogilvie's = acute colonic adynamic ileus in presence of competent ileocecal valve

• Précipitants: intra-abd. process (surgery, pancreatitis, peritonitis); severe medical illness

(eg. PNA. sepsis); intestinal ischemia; meds (opiates, anticholinergics); electrolyte abnl

• Clinical manifestations: abd. discomfort, N V. hiccups, abd. distention. 1 or absent bowel sounds, no peritoneal signs (unless perforation); cecum ^10-12 cm * rupture

• Dx: supine & upright abdominal films gas-filled loops of small & large intestine; must exclude mechanical obstruction (absence of gas in rectum); consider abd. CT

• Treatment: NPO. mobilize (walk. roll), d c drugs that i intestinal motility, enemas;

decompression (NGT. rectal tubes, colonoscope); erythromycin, neostigmine

Was this article helpful?

0 0
Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

Get My Free Ebook

Post a comment