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[L. ileus, colic fr Gr. eileos, a twisting]
Loss of bowel motility, occasionally resulting in intestinal obstruction. It is characterized by loss of the forward flow of intestinal contents, often accompanied by cramps in the abdomen, increasing abdominal distention, obstipation or constipation, vomiting, electrolyte disturbances, and dehydration.
SYN: SEE: adynamic ileus; SEE: paralytic ileus
Ileus usually occurs after abdominal surgery but may also occur in response to trauma, toxemia, or peritonitis or because of electrolyte deficiencies (esp. hypokalemia) or from use of drugs, e.g., anticholinergics and ganglionic blocking agents.
Prevention of ileus in postoperative patients can sometimes be achieved by encouraging early ambulation and gradually increasing activity. The patient should receive analgesics so that pain does not interfere with mobilization; opioids, however, slow gastrointestinal (GI) motility.
The patient is assessed for abdominal distention (abdominal girth is measured and the site marked to ensure the accuracy of future assessments). In the absence of evidence of mechanical obstruction, oral intake may begin even before bowel sounds return. (Bowel sounds are an indication of bowel motility, not absorption; even when bowel sounds are absent, the small bowel is capable of absorbing nutrients.) Ambulation is encouraged, and when nausea, vomiting and obstipation are present, a nasogastric (NG) or weighted nasointestinal (Miller-Abbott) tube is inserted as prescribed. Characteristics and quantity of drainage from the NG tube are documented. The tube is attached to continuous low suction for decompression, and the pH of drainage from an intestinal tube is measured to help determine its placement level. Oral hygiene and misting are provided to manage dryness and prevent cracking of the lips, sordes, and obstruction of the salivary glands. Lemon and glycerin preparations may etch tooth enamel and add to drying, and are not used. Intravenous fluids are given, renal function is assessed, and fluid and electrolyte balance is monitored to maintain normal hydration. Vital signs also are monitored: a drop in blood pressure may indicate dehydration or shock. If colonoscopy or a rectal tube is used to aid decompression, the treatment is explained. Cholinergic agents may sometimes be prescribed. When ileus develops secondary to another illness, e.g., severe infection or electrolyte imbalance, the primary problem is treated.