Ileus Chalk Talk

 First thing: Rule out SBO

get a KUB

dilation of more than 10cm

Fix correctables: avoid CCBs, opioids, anticholinergics

electrolytes: hypokalemia, hypomagnesemia, hypophosphatemia

NGT, rectal decompression

Basics - 

ileus - functional hypomotility of the small intestine ("paralytic ileus")  

adynamic ileus, not due to anatomic obstruction

Presentation - 

n/v, obstupation, no gas high gastric residual volumes

ddx - pseudoobstruction (ogilvie) marked dilation of colon, bowel perforation

work up

abdominal xray - distended gas filled loops of bowel, CT scan - definitive

causes / correctables - opioids - loperamides, ccbs, clonidine, alpha adrenergic medications, anticholinergics - antipsychotics, tricyclics, anithistamines, muscle relaxants (baxlofen, cyclobenzaprine, tizanidine), parkinson's disease medications

electrolyte abnormalities - hypokalemia, hyponatremia, hypomagnesemia, hypothyroidism, hyperglycemia, uremia

abdominal pathology - surgery, appendicitis, cholecystitis, pancreatitis

treatment

- ileus temporarily stop feeding

Decompression

- Nasogastric tube drainage - not usually needed, 

Pro motility agents

erythromycin may slow transit - even though promotility

Opioid antagonists - reduce dose, enteral naloxne via feeding tube acts on gut affects gut more 4-8mg of enteral naloxone per feeding tube q6hrs if needed

prevention - early feeding

- 

three six nine damn she's fine

duodenum 

https://radiopaedia.org/articles/3-6-9-rule-bowel?lang=us