Medical history (history of illness) represents an important component in the diagnosis of ileus (bowel obstruction). Family history Social history Current anamnesis/systemic anamnesis (somatic and psychological complaints). Do you suffer from abdominal pain and nausea/vomiting?* Have you noticed a very distended abdomen? How long have these symptoms been present? When did you last have a … Intestinal Obstruction (Ileus): Medical History
Respiratory System (J00-J99) Pneumonia (pneumonia) Blood, blood-forming organs – immune system (D50-D90). Hemolytic crisis – acute hemoptysis in the context of anemia (anemia). Hemophilia (hemophilia). Endocrine, nutritional and metabolic diseases (E00-E90). Addisonian crisis – decompensation of insidious adrenocortical insufficiency. Acute adrenal insufficiency C1 esterase inhibitor deficiency (angioneurotic edema) – disease caused by the lack of … Intestinal Obstruction (Ileus): Or something else? Differential Diagnosis
The following are the most important diseases or complications that may be contributed to by ileus (intestinal obstruction): Infectious and parasitic diseases (A00-B99). Sepsis (blood poisoning) with symptoms of shock. Mouth, esophagus (food pipe), stomach, and intestines (K00-K67; K90-K93). Transmigratory peritonitis – peritonitis due to the escape of germs (intestinal bacteria) from the thin, mechanically … Intestinal Obstruction (Ileus): Complications
Therapeutic target Restoration of intestinal peristalsis and pain relief. Therapy recommendations If the patient’s symptoms are indicative of an incomplete ileus (= restricted food passage), conservative therapy can be used initially. This approach necessitates close reevaluation (reassessment of findings or a situation in the course of disease). In case of doubt, surgery must always be … Intestinal Obstruction (Ileus): Drug Therapy
Obligatory medical device diagnostics. Abdominal ultrasonography (ultrasonography of abdominal organs) – as a standard diagnostic tool for abdominal pain (abdominal pain); because of distended abdomen, abdominal ultrasonography is usually of secondary importance [free fluid?, incarcerated hernia?] Small bowel ileus [fluid-filled luminal dilation (> 25 mm); “ladder sign” on lateral/lateral sonication] X-ray of the abdomen (X-ray … Intestinal Obstruction (Ileus): Diagnostic Tests
According to studies, surgical intervention can be delayed for a period of five days and replaced by conservative measures. However, this is also associated with an increased risk of morbidity and mortality (risk of illness and death): Surgery within 24 hours of hospital admission: mortality, 1.8%; major complications, 4%. Intervention after five days or even … Intestinal Obstruction (Ileus): Surgical Therapy
To prevent ileus (intestinal obstruction), attention must be paid to reducing individual risk factors. Environmental exposures – Intoxications (poisonings). Alcohol intoxication Prevention factors (protective factors) Coffee drinking: one study examined the effect of coffee compared with herbal or fruit tea on postoperative bowel function and concluded that patients who drank coffee daily had a bowel … Intestinal Obstruction (Ileus): Prevention
The following symptoms and complaints may indicate ileus (intestinal obstruction): Abdominal discomfort (abdominal pain; abdominal pain). Meteorism (bloated abdomen) Abnormal bowel sounds (“dead silence “* versus metallic bowel sounds* * ). Nausea (nausea)/vomiting, possibly vomiting (miserere, copremesis). Absence of defecation Symptoms of shock * VD on paralytic ileus (intestinal paralysis) * * VD on mechanical … Intestinal Obstruction (Ileus): Symptoms, Complaints, Signs
Pathogenesis (development of disease) In mechanical ileus, there are several causes of obstruction (closure): Extraluminal: lumen obstruction/compression from the outside (postoperative adhesions (adhesions), bride/scar strand in the abdominal cavity; hernia/intestinal hernia). Intraluminal: lumen obstruction (foreign bodies (bezoars), gallstones, coprostasis/fecal impaction, meconium (infantile saliva), intussusception/invagination of a segment of the intestine, tumors) Intramural: change in the … Intestinal Obstruction (Ileus): Causes
To treat intestinal obstruction, the underlying disease must be treated. General measures If intestinal obstruction is suspected, it is necessary that you do not eat or drink anything from now on! Review of permanent medication due topossible effect on the existing disease. Conventional non-surgical therapy methods Placement of a gastric tube for decompression (abstinence from … Intestinal Obstruction (Ileus): Therapy
A comprehensive clinical examination is the basis for selecting further diagnostic steps: General physical examination – including blood pressure, pulse, body weight, height; further: Inspection (viewing). Skin and mucous membranes Abdomen (abdomen) Shape of the abdomen? Skin color? Skin texture? Efflorescences (skin changes)? Pulsations? Bowel movements? Visible vessels? Scars? Hernias (fractures)? Auscultation (listening) of the … Intestinal Obstruction (Ileus): Examination
Laboratory parameters of the 1st order – obligatory laboratory tests. Small blood count Differential blood count Inflammatory parameter – CRP (C-reactive protein) Urine status (rapid test for: pH, leukocytes, nitrite, protein, glucose, ketone, urobilinogen, bilirubin, blood), sediment, if necessary urine culture (pathogen detection and resistogram, that is, testing suitable antibiotics for sensitivity / resistance). Electrolytes … Intestinal Obstruction (Ileus): Test and Diagnosis
