Ileus medical therapy: Difference between revisions
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==Overview== | ==Overview== | ||
The majority of cases of ileus are resolved with correction of underlying electrolyte disorder and only require supportive care. Intravenous hydration is advised with appropriate rapid supplementation for electrolyte abnormalities. NSAID are used as baseline analgesic medications and opiates are used in case of severe intractable pain. Patients are put on NPO and nasogastric tube to relieve recurrent vomiting or abdominal distention associated with pain. Prokinetic agents such as erythromycin are not routinely recommended. | The majority of cases of ileus are resolved with correction of underlying [[Electrolyte abnormalities|electrolyte disorder]] and only require supportive care. [[Intravenous]] [[hydration]] is advised with appropriate rapid supplementation for [[Electrolyte abnormalities|electrolyte abnormalities.]] [[NSAID]] are used as baseline [[analgesic]] medications and [[opiates]] are used in case of severe intractable pain. Patients are put on [[NPO]] and [[nasogastric tube]] to relieve recurrent vomiting or [[Abdominal distension|abdominal distention]] associated with pain. [[Prokinetic|Prokinetic agents]] such as [[erythromycin]] are not routinely recommended. | ||
==Medical Therapy== | ==Medical Therapy== | ||
Medical therapy for ileus includes correcting the underlying condition and supportive therapy.<ref name="pmid26703957">{{cite journal |vauthors=Bruns BR, Kozar RA |title=Feeding the Postoperative Patient on Vasopressor Support: Feeding and Pressor Support |journal=Nutr Clin Pract |volume=31 |issue=1 |pages=14–7 |year=2016 |pmid=26703957 |doi=10.1177/0884533615619932 |url=}}</ref><ref name="pmid10696888">{{cite journal |vauthors=Cali RL, Meade PG, Swanson MS, Freeman C |title=Effect of Morphine and incision length on bowel function after colectomy |journal=Dis. Colon Rectum |volume=43 |issue=2 |pages=163–8 |year=2000 |pmid=10696888 |doi= |url=}}</ref><ref name="pmid25503902">{{cite journal |vauthors=Wu Z, Boersema GS, Dereci A, Menon AG, Jeekel J, Lange JF |title=Clinical endpoint, early detection, and differential diagnosis of postoperative ileus: a systematic review of the literature |journal=Eur Surg Res |volume=54 |issue=3-4 |pages=127–38 |year=2015 |pmid=25503902 |doi=10.1159/000369529 |url=}}</ref><ref name="pmid19209273">{{cite journal |vauthors=Lubawski J, Saclarides T |title=Postoperative ileus: strategies for reduction |journal=Ther Clin Risk Manag |volume=4 |issue=5 |pages=913–7 |year=2008 |pmid=19209273 |pmc=2621410 |doi= |url=}}</ref> | Medical therapy for ileus includes correcting the underlying condition and supportive therapy.<ref name="pmid26703957">{{cite journal |vauthors=Bruns BR, Kozar RA |title=Feeding the Postoperative Patient on Vasopressor Support: Feeding and Pressor Support |journal=Nutr Clin Pract |volume=31 |issue=1 |pages=14–7 |year=2016 |pmid=26703957 |doi=10.1177/0884533615619932 |url=}}</ref><ref name="pmid10696888">{{cite journal |vauthors=Cali RL, Meade PG, Swanson MS, Freeman C |title=Effect of Morphine and incision length on bowel function after colectomy |journal=Dis. Colon Rectum |volume=43 |issue=2 |pages=163–8 |year=2000 |pmid=10696888 |doi= |url=}}</ref><ref name="pmid25503902">{{cite journal |vauthors=Wu Z, Boersema GS, Dereci A, Menon AG, Jeekel J, Lange JF |title=Clinical endpoint, early detection, and differential diagnosis of postoperative ileus: a systematic review of the literature |journal=Eur Surg Res |volume=54 |issue=3-4 |pages=127–38 |year=2015 |pmid=25503902 |doi=10.1159/000369529 |url=}}</ref><ref name="pmid19209273">{{cite journal |vauthors=Lubawski J, Saclarides T |title=Postoperative ileus: strategies for reduction |journal=Ther Clin Risk Manag |volume=4 |issue=5 |pages=913–7 |year=2008 |pmid=19209273 |pmc=2621410 |doi= |url=}}</ref> | ||
*Patients should receive intravenous hydration. | *Patients should receive [[intravenous]] [[hydration]]. | ||
*Patients of ileus from electrolyte abnormalities should be treated with appropriate supplementation. | *Patients of ileus from [[electrolyte abnormalities]] should be treated with appropriate supplementation. | ||
*Bowel rest and nasogastric decompression can relieve recurrent vomiting or abdominal distention associated with pain.<ref name="pmid15859962">{{cite journal |vauthors=Kehlet H, Williamson R, Büchler MW, Beart RW |title=A survey of perceptions and attitudes among European surgeons towards the clinical impact and management of postoperative ileus |journal=Colorectal Dis |volume=7 |issue=3 |pages=245–50 |year=2005 |pmid=15859962 |doi=10.1111/j.1463-1318.2005.00763.x |url=}}</ref><ref name="pmid16377496">{{cite journal |vauthors=Kehlet H, Büchler MW, Beart RW, Billingham RP, Williamson R |title=Care after colonic operation--is it evidence-based? Results from a multinational survey in Europe and the United States |journal=J. Am. Coll. Surg. |volume=202 |issue=1 |pages=45–54 |year=2006 |pmid=16377496 |doi=10.1016/j.jamcollsurg.2005.08.006 |url=}}</ref> | *[[Bowel]] rest and nasogastric decompression can relieve recurrent [[vomiting]] or [[Abdominal distension|abdominal distention]] associated with [[pain]].<ref name="pmid15859962">{{cite journal |vauthors=Kehlet H, Williamson R, Büchler MW, Beart RW |title=A survey of perceptions and attitudes among European surgeons towards the clinical impact and management of postoperative ileus |journal=Colorectal Dis |volume=7 |issue=3 |pages=245–50 |year=2005 |pmid=15859962 |doi=10.1111/j.1463-1318.2005.00763.x |url=}}</ref><ref name="pmid16377496">{{cite journal |vauthors=Kehlet H, Büchler MW, Beart RW, Billingham RP, Williamson R |title=Care after colonic operation--is it evidence-based? Results from a multinational survey in Europe and the United States |journal=J. Am. Coll. Surg. |volume=202 |issue=1 |pages=45–54 |year=2006 |pmid=16377496 |doi=10.1016/j.jamcollsurg.2005.08.006 |url=}}</ref> | ||
*Antimotility drugs and other medications (narcotics) which may alter intestinal motility should be stopped. | *Antimotility drugs and other medications ([[narcotics]]) which may alter [[intestinal]] [[motility]] should be stopped. | ||
*Prokinetic agents such as erythromycin are not routinely recommended. | *[[Prokinetic]] agents such as [[erythromycin]] are not routinely recommended. | ||
**'''1.1 - Post-operative pain''' | **'''1.1 - Post-operative pain''' | ||
*** Preferred regimen (1): [[Acetaminophen]] 1000 mg [[Orally ingested|orally]] every six hours (or [[IV]] incase patient is [[NPO]]). | *** Preferred regimen (1): [[Acetaminophen]] 1000 mg [[Orally ingested|orally]] every six hours (or [[IV]] incase patient is [[NPO]]). | ||
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***: '''Note (1):''' Rapid infusion of [[isotonic]] [[fluid]] is advised until symptoms resolve. | ***: '''Note (1):''' Rapid infusion of [[isotonic]] [[fluid]] is advised until symptoms resolve. | ||
**'''1.3 Recurrent vomiting or Abdominal distension''' | **'''1.3 Recurrent vomiting or Abdominal distension''' | ||
*** Preferred regimen (1): Nasogastric (NG) tube placement until symptoms resolve | *** Preferred regimen (1): [[Nasogastric tube|Nasogastric]] (NG) tube placement until symptoms resolve. | ||
***: '''Note (1):''' The tip of NG tube should be placed in the stomach. | ***: '''Note (1):''' The tip of [[Nasogastric tube|NG tube]] should be placed in the [[stomach]]. | ||
***: '''Note (2):''' To prevent fluid loss, volume of fluid removed should be replaced with isotonic saline. | ***: '''Note (2):''' To prevent fluid loss, volume of fluid removed should be replaced with [[isotonic]] saline. | ||
===Contraindicated medications=== | ===Contraindicated medications=== | ||
Revision as of 16:45, 5 February 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Akshun Kalia M.B.B.S.[2]
Overview
The majority of cases of ileus are resolved with correction of underlying electrolyte disorder and only require supportive care. Intravenous hydration is advised with appropriate rapid supplementation for electrolyte abnormalities. NSAID are used as baseline analgesic medications and opiates are used in case of severe intractable pain. Patients are put on NPO and nasogastric tube to relieve recurrent vomiting or abdominal distention associated with pain. Prokinetic agents such as erythromycin are not routinely recommended.
Medical Therapy
Medical therapy for ileus includes correcting the underlying condition and supportive therapy.[1][2][3][4]
- Patients should receive intravenous hydration.
- Patients of ileus from electrolyte abnormalities should be treated with appropriate supplementation.
- Bowel rest and nasogastric decompression can relieve recurrent vomiting or abdominal distention associated with pain.[5][6]
- Antimotility drugs and other medications (narcotics) which may alter intestinal motility should be stopped.
- Prokinetic agents such as erythromycin are not routinely recommended.
- 1.1 - Post-operative pain
- Preferred regimen (1): Acetaminophen 1000 mg orally every six hours (or IV incase patient is NPO).
- Preferred regimen (2): Add diclofenac 50 mg orally twice a day with meals for two days and adjust as-needed.
- Preferred regimen (3): Add oxycodone 5 to 10 mg orally every three hours as needed for breakthrough pain.
- Alternate regimen (1): Hydromorphone 0.2 to 0.5 mg IV every four hours as needed for severe breakthrough pain not responsive to oral medications.
- 1.2 Fluid replacement
- 1.3 Recurrent vomiting or Abdominal distension
- Preferred regimen (1): Nasogastric (NG) tube placement until symptoms resolve.
- 1.1 - Post-operative pain
Contraindicated medications
Paralytic ileus is considered an absolute contraindication to the use of the following medications:
References
- ↑ Bruns BR, Kozar RA (2016). "Feeding the Postoperative Patient on Vasopressor Support: Feeding and Pressor Support". Nutr Clin Pract. 31 (1): 14–7. doi:10.1177/0884533615619932. PMID 26703957.
- ↑ Cali RL, Meade PG, Swanson MS, Freeman C (2000). "Effect of Morphine and incision length on bowel function after colectomy". Dis. Colon Rectum. 43 (2): 163–8. PMID 10696888.
- ↑ Wu Z, Boersema GS, Dereci A, Menon AG, Jeekel J, Lange JF (2015). "Clinical endpoint, early detection, and differential diagnosis of postoperative ileus: a systematic review of the literature". Eur Surg Res. 54 (3–4): 127–38. doi:10.1159/000369529. PMID 25503902.
- ↑ Lubawski J, Saclarides T (2008). "Postoperative ileus: strategies for reduction". Ther Clin Risk Manag. 4 (5): 913–7. PMC 2621410. PMID 19209273.
- ↑ Kehlet H, Williamson R, Büchler MW, Beart RW (2005). "A survey of perceptions and attitudes among European surgeons towards the clinical impact and management of postoperative ileus". Colorectal Dis. 7 (3): 245–50. doi:10.1111/j.1463-1318.2005.00763.x. PMID 15859962.
- ↑ Kehlet H, Büchler MW, Beart RW, Billingham RP, Williamson R (2006). "Care after colonic operation--is it evidence-based? Results from a multinational survey in Europe and the United States". J. Am. Coll. Surg. 202 (1): 45–54. doi:10.1016/j.jamcollsurg.2005.08.006. PMID 16377496.