With obstruction, the bowel sounds are usually high-pitched or musical. In cases of prolonged obstruction and ileus, bowel sounds may disappear as a consequence of decreased motility. Laboratory studies are useful in the diagnosis of ileus or pseudoobstruction which can be caused by an electrolyte imbalance.
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.
Paralytic ileus is marked by abdominal distension, absent bowel sounds and relatively little pain (as compared to mechanical obstruction).
Bowel sounds are absent, flatus is not passed, and there is consequent gastric stasis that could lead to hiccups, discomfort, and effortless vomiting, unless gastric aspiration has been carried out.
The symptoms of ileus are abdominal bloating and pain caused by a buildup of gas and liquids, nausea, vomiting, severe constipation, loss of appetite, and cramps. People may pass watery stool.
Ileus Symptoms
Feel bloated from a buildup of gas and liquid in your belly. Feel sick to your stomach (nausea) Throw up (vomit) Find it hard to poop (constipation)
Ileus, also known as paralytic ileus or functional ileus, occurs when there is a non-mechanical decrease or stoppage of the flow of intestinal contents. [1][2] Bowel obstruction is a mechanical blockage of intestinal contents by a mass, adhesion, hernia, or some other physical blockage.
Some textbooks indicate that bowel sounds are the result of peristalsis in that region, while others state that bowel sounds can be generalized over the entire abdominal wall. With ultrasonography, peristalsis can be visualized in a dynamic and non-invasive manner.
Contemporary textbooks often state that hyperactive, tinkling, metallic or high-pitched bowel sounds are characteristic clinical findings in patients with bowel obstruction[5-8], but the evidence supporting the clinical utility of these findings is sparse.
Absent bowel sounds are a cue that suggest there may be a problem with the movement of contents through the intestines: common causes include peritonitis , a complete bowel obstruction, or perforation of the small or large intestine.
Paralytic ileus, including postoperative ileus, is primarily a clinical diagnosis based on patient history, symptoms, and physical examination. Abdominal imaging is often necessary to rule out differential diagnoses (see “Mechanical bowel obstruction vs. paralytic ileus”).
Pseudo-obstruction is clearly limited to the colon alone, whereas ileus involves both the small bowel and colon. The right colon is involved in classic pseudo-obstruction, which typically occurs in elderly bedridden patients with serious extraintestinal illness or in trauma patients.
Paralytic ileus describes the condition in which the bowel ceases to function and there is no peristalsis. Intestinal pseudo-obstruction is also called Ogilvie's syndrome. It results from massive dilatation of the colon but possibly small intestine too.
(PAYR-uh-LIH-tik IH-lee-us) A condition in which the muscles of the intestines do not allow food to pass through, resulting in a blocked intestine. Paralytic ileus may be caused by surgery, inflammation, and certain drugs.
Borborygmi can occur at any time. The sounds are usually most noticeable when you're hungry. You hear them when you have gas or food moving through your digestive system. An increase in borborygmi is known as hyperactive bowel sounds.
Delayed bowel movement or passage of flatus is the hallmark of postoperative ileus. Common symptoms include abdominal distension, bloating, diffuse, persistent pain, nausea, vomiting, inability to pass flatus, and intolerance to an oral diet.
Reflectory ileus—after abdominal or retroperitoneal surgery (e.g., spinal surgery), or induced by intra-abdominal or retroperitoneal lesions (tumor, hemorrhage, infection) Drug-induced ileus—due to the consumption of opioids, neuroleptic drugs, etc. Metabolic ileus—in patients with hypokalemia or diabetes mellitus.
Mechanical obstruction and adynamic and dynamic ileus are accompanied by severe colicky pain, abdominal distension, vomiting, and constipation. Physiological ileus is a term used to portray the normal absence of motility and propulsion in the small and large intestine.
Physical Examination
The bowel normally makes sounds, such as gurgling and clicking, which can be heard with a stethoscope placed on the abdomen. If you have an obstruction, your healthcare provider may hear high-pitched sounds while listening to your abdomen.
Very high-pitched bowel sounds may be a sign of early bowel obstruction.
Without treatment, it can become life-threatening. If ileus persists, it can cut off blood supply to the intestines and cause tissue death. This can result in an intestinal tear or infection of the abdominal cavity that can be life threatening. Ileus occurs when the intestines do not move food through in the usual way.
Patients with post-operative ileus, opioid-induced constipation, or a soft stool will benefit from a stimulant laxative, such as senna or picosulphate. *In resistant cases, additional therapy can be given via manual evacuation.