What is the difference between ileus and bowel obstruction

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Gastric decompression with gastric tube. Resuscitation with isotonic fluid. No need for antibiotics for ileus or obstruction unless associated infectious cause or perforation suspected. Assess for intra-abdominal hypertension with bladder pressure.

Correct electrolyte abnormalities, specifically potassium. Rule out life threatening cause of ileus intra-abdominal sepsis or small bowel obstruction with CT scan. Assess abdominal exam for peritoneal signs, present or absence of bowel sounds, presence of hernias.

CT scan consistent with obstruction: assess; if partial: NGT decompression, bowel rest; if complete: NGT decompression, surgical consult. Signs of paralytic ileus are very similar to bowel obstruction. Nausea, abdominal pain, bloating with vomiting, abdominal distention and obstipation being accompanying symptoms. Classically paralytic ileus is suggested by hypoactive bowel sounds whereas small bowel obstruction is described with rushes and bowel sounds consistent with peristalsis against the obstruction.

However, if obstruction has led to ischemia and intra-abdominal sepsis, the patient may have hypoactive bowel sounds. In a critically ill patient who is sedated and has impaired mental status, it may be difficult to elicit complaints of nausea or pain.

Anasarca can mask abdominal distention. Obstipation and constipation may be overlooked as secondary to medications. A high index of suspicion should be maintained in patients who develop high gastric tube residuals or become intolerant of tube feeding.

Patients with electrolyte abnormalities are at a higher risk for paralytic ileus, as are multiple trauma, burn, and post operative patients, as well as patients with any inflammatory response.

Patients who are status post abdominal surgical procedure can develop post operative bowel obstruction from adhesions. The key is to distinguish ileus from obstruction as early as possible since small bowel obstruction can lead to ischemia and perforation. Although plain abdominal films — flat, upright and decubitus films — are often initial tests ordered outside the ICU, inside the ICU these films are often of poor quality for discerning ileus from small bowel obstruction.

Ileus usually has air throughout colon into rectum compared to small bowel obstruction, which when complete does not show colonic air. However these findings are not consistant when dealing with partial or early small bowel obstruction. Air fluid levels are difficult to ascertain in the critically ill, as upright and decubitus films are usually inadequate. Figure 1 and Figure 2. KUB showing dilated small bowel loops with minimum air in colon suggesting small bowel obstruction.

CT scan with oral water soluble contrast can help distinguish ileus from obstruction and also determine partial vs. CT scan can also reveal causes for ileus or obstruction such as pancreatitis, retroperitoneal bleed, mass or hernia.

CT scan is also sensitive in assessing for ischemic bowel in cases of obstruction. Figure 3. CT scan showing dilated proximal small bowel with collapsed distal small bowel consistent with complete bowel obstruction.

Findings such as mesenteric edema, asymmetrical bowel wall enhancement, pneumotosis intenstinalisis and portal vein air are all signs of possible bowel ischemia. The whirl sign, when the mesentery of small bowel is wrapped around its vessel, is in some reports predictive of small bowel obstruction that will require surgery. Most ileus care is supportive, treating the underlying correctable cause, if any. Since ileus can be caused by innumerable things, treating life threatening conditions such as infection and bleeding are first priority.

Keeping electrolytes, especially potassium, normal is essential in these patients. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. Updated by: Bradley J. Editorial team. Intestinal obstruction and Ileus. Obstruction of the bowel may be due to: A mechanical cause, which means something is in the way Ileus, a condition in which the bowel does not work correctly, but there is no structural problem causing it Paralytic ileus, also called pseudo-obstruction, is one of the major causes of intestinal obstruction in infants and children.

Causes of paralytic ileus may include: Bacteria or viruses that cause intestinal infections gastroenteritis Chemical, electrolyte, or mineral imbalances such as decreased potassium level Abdominal surgery Decreased blood supply to the intestines Infections inside the abdomen, such as appendicitis Kidney or lung disease Use of certain medicines, especially narcotics Mechanical causes of intestinal obstruction may include: Adhesions or scar tissue that forms after surgery Foreign bodies objects that are swallowed and block the intestines Gallstones rare Hernias Impacted stool Intussusception telescoping of one segment of bowel into another Tumors blocking the intestines Volvulus twisted intestine.

Symptoms may include: Abdominal swelling distention Abdominal fullness, gas Abdominal pain and cramping Breath odor Constipation Diarrhea Inability to pass gas Vomiting. Exams and Tests. Outlook Prognosis. Possible Complications. Complications may include or may lead to: Electrolyte blood chemical and mineral imbalances Dehydration Hole perforation in the intestine Infection Jaundice yellowing of the skin and eyes If the obstruction blocks the blood supply to the intestine, it may cause infection and tissue death gangrene.

When to Contact a Medical Professional. Call your provider if you: Cannot pass stool or gas Have a swollen abdomen distention that does not go away Keep vomiting Have unexplained abdominal pain that does not go away. Some causes of obstruction cannot be prevented. Alternative Names.