Paralytic ileus

Introduction to paralytic ileus The intestinal tube is inhibited by peristalsis after excessive stimulation of the sympathetic nerve, and the obstruction phenomenon caused by the inability of the intestinal contents to operate effectively is called paralytic intestinal obstruction. basic knowledge The proportion of illness: 0.05-0.08% Susceptible people: no special people Mode of infection: non-infectious Complications: constipation Ascites Nausea and vomiting Abdominal pain Diarrhea Hematuria

Cause of paralytic ileus

(1) Causes of the disease

The occurrence of paralytic ileus is often associated with the following conditions.

1. Mechanical stimulation in abdominal surgery During surgery, the peristaltic function is temporarily lost due to the stimulation of the intestine and its mesentery, or there is an uncoordinated peristalsis in the intestinal wall, but no intestinal contents are pushed. At the time of rhythm, the patient often has abdominal flatulence after surgery, and sometimes abdominal pain. Generally, the rhythm of intestinal peristalsis returns to normal after 2 to 3 days after surgery. The intestinal gas and fluid can be discharged from the body smoothly, and the abdominal distension and abdominal pain disappear.

2. Inflammation in the abdominal cavity stimulates peritonitis caused by various causes, especially diffuse peritonitis, which often causes intestinal paralysis and even abdominal distension.

3. Neuroreflexive stimulation of various types of strangling pain, such as renal colic, biliary colic, colic retorting, cochlear pedicle torsion and spermatic cord strangulation, recurrent intestinal paralysis can occur.

4. Chest and abdomen or spine, damage to the central nervous system can cause gas accumulation in the intestine, effusion and abdominal distension.

5. Retroperitoneal lesions such as infection, bleeding, tumors, etc. can also cause varying degrees of intestinal paralysis.

6. Mesenteric lesions such as mesenteric vascular occlusion, tumor, torsion, etc., can be caused by intestinal impulses due to nerve impulse conduction to the intestinal wall.

7. Others such as long-term ether anesthesia, over-extended plaster vests, and infections in other parts of the abdomen such as pneumonia, meningitis or various sepsis, occasionally can cause reflex intestinal paralysis.

(two) pathogenesis

Pathogenesis

The mechanism leading to intestinal paralysis is still not fully understood. In the past, it was thought that the intestinal smooth muscle completely lost its peristaltic function and was paralyzed after intestinal paralysis, but in fact it was not the case. As early as 1909, Hotz used peritonitis. When the animal intestinal fistula was used as an experimental model, it was found that the muscles of the intestinal wall still had the ability to contract, and the stimulation of the drug also showed a normal reaction. When Frey used iodine as a chemical peritonitis test in 1926, the skin was observed through the small window of the cellulite on the abdominal wall. The contraction of intestinal fistula after injection of choline still exists. In 1971, Petri found that the levels of adrenaline and norepinephrine in the blood of intestinal paralysis were 7-8 times higher than those of normal people, and chlorpromazine could be used after major abdominal surgery. Abdominal distension was relieved, and bowel movements were earlier than usual. In 1992, Zhang Xuequan and other patients who underwent abdominal infusion of procaine intravenously, the average recovery time of bowel sounds was 9.4 h earlier than the control group. The above facts fully explain the peritonitis. Intestinal paralysis is not caused by the muscles of the intestinal wall itself, but by the external motor nerves, and most of the motor nerves of the intestines come from fans. Nerve, while the sympathetic nerves inhibit the smooth muscle of the intestinal wall and contract the sphincter. It can be speculated that this intestinal paralysis is caused by the excessive stimulation of the sympathetic nerves that innervate the intestinal wall, and the movement of the intestinal wall is temporarily Sexual inhibition state.

When Hotz was doing animal experiments, he used air to inject into the intestine to dilate it. After the intestinal wall was dilated, the rhythmic peristalsis of the intestinal fistula stopped, and after the gas was expelled, the peristalsis of the intestinal fistula was restored, so Hotz thought The intestinal paralysis of peritonitis is not the effect of toxins, but the result of flatulence of the intestines. Once the intestines are dilated, the absorption of the intestinal wall can be weakened, and the secretion is enhanced. The accumulation of gas and liquid will further expand the intestines and the intestines. The peristalsis disappears, and the formation of a vicious circle is the real cause of intestinal obstruction.

2. Pathology

Intestinal dilatation due to intestinal fistula often affects the entire intestine, but sometimes the lesion may only involve a small intestine or large intestine, the degree of expansion is different, and the intestinal tract accumulates a large amount of gas and liquid. The intestinal lumen is enlarged and the intestinal wall is thinned. The intestinal wall is often dark red due to congestion. The surface of the intestine is dilated and veined, but necrosis and perforation rarely occur. In peritonitis, the visceral peritoneum on the intestinal wall may be congested by inflammation. Swelling, the surface may have cellulose deposition, the intestinal wall of the lesion may ooze out, and the turbid liquid may accumulate in the abdominal cavity. In other reflex intestinal paralysis, the intestinal wall itself and the visceral peritoneum may be normal, intraperitoneal. There is no free effusion, when the paralytic ileus is obstructed, the result of intestinal swell is almost the same as that caused by mechanical factors. Because there is a large amount of gas accumulation in the intestinal lumen, the effusion and intestinal pressure can be continuously increased. Ischemia, hypoxia, and even necrosis can also occur in the late intestinal wall. After the intestinal wall is paralyzed, the capillary wall of the intestinal wall can exude a large amount of plasma protein, and its resorption is reduced by the damage of the intestinal wall. Induced plasma protein loss, abdominal distension after addition due to blocked blood return leg, can reduce the effective circulating blood volume, bloating so that high compression diaphragm bead heart, lung, can lead to respiratory and circulatory dysfunction.

Paralytic ileus prevention

There is no effective preventive measure for this disease. Early detection and early diagnosis are the key to the prevention and treatment of this disease.

Paralytic ileus complications Complications constipation ascites nausea and vomiting abdominal pain diarrhea hematuria

Complications of paralytic intestinal obstruction, abnormal abdominal digestive tract, causing constipation, nausea, fatigue, abdominal mass, inguinal lymphadenopathy, ascites, black stool. Blood in the stool and blood mixed with feces, frequent urination, poor defecation, abnormal frequency of bowel movements, heavy and heavy, abdominal pain with nausea, vomiting, abdominal pain with diarrhea, nausea, nausea and vomiting. Have liver and kidney function, abnormal hematuria, fever and abnormal body temperature.

Paralytic ileus symptoms Common symptoms Intestinal palsy soft sputum pain, abdominal distension, intestinal paralysis, dyspnea, abdominal tenderness, bowel, sputum, intestinal tract, diarrhea, drug constipation, liver dullness, shrinking or disappearing

The prominent manifestation of paralytic ileus is obvious abdominal distension. The range of bloating is often full abdomen, and often accompanied by vomiting of stomach contents. There is no fecal smell in vomit. Patients may have abdominal pain and discomfort without mechanical intestinal obstruction. Paroxysmal abdominal cramps, due to severe abdominal distension, patients with difficulty breathing, due to large loss of body fluids, patients are extremely thirsty, decreased urine output, physical examination: abdominal distension, abdominal breathing disappeared, no intestinal type and intestinal peristaltic waves; Abdominal tenderness is not significant; percussion is uniform drum sound, liver dullness is reduced or disappeared, bowel sounds are obviously weakened or completely disappeared during auscultation, patients are often more serious, but no special pain.

Examination of paralytic ileus

X-ray inspection

(1) Abdominal plain film: Abdominal plain film shows:

1 stomach, small intestine and colon have inflated mild to severe expansion, small intestine inflation can be light and heavy, colon inflation is more significant, often manifested as peritoneal colonic balloon inflated, standing in the liver, the most obvious in the colon of the spleen; The gas is more common in the transverse colon and the sigmoid colon. The small intestine is distributed in the middle abdomen within the colon. When the identification is difficult, the lateral fluoroscopy is seen in the anterior abdomen. When the expansion is heavy, the intestinal fistula is continuous in tubular shape. Inflated intestinal tube.

2 Abdominal standing flat film, the dilated stomach and small intestine, the liquid surface of the wide and narrow in the colon, the liquid level can be different, the liquid level is still, the general liquid level is less than the mechanical intestinal obstruction.

3 Colonic feces, whether it is a granular paste or a fecal mass of feces, is a reliable sign to confirm the colon.

4 acute peritonitis often appear in the abdominal plain film of abdominal effusion sign, severe cases can also appear abdominal fat line blurred.

5 intestinal wall due to edema, congestion and thickening, and even the movement of the diaphragm is limited, pleural effusion signs.

(2) Gastrointestinal angiography: 60% of metoclopramide 60ml is administered orally or via a gastric tube. Due to the stimulation of the intestinal tract by this hypertonic iodine solution, the amount of intestinal fluid can be increased and gastrointestinal motility can be promoted. When the paralytic ileus is lighter, after 3 to 6 hours of medication, the iodine can enter the colon, and the mechanical intestinal obstruction of the small intestine is excluded. When the paralytic ileus is severe, the contrast agent can also go very slowly. After taking the drug for 3-6 hours, he still stayed in the stomach and duodenum, and in the upper jejunum.

2. CT scan

The image shows that the stomach, small intestine, and colon have aerated dilation, and the colon changes are more obvious. The liquid level is visible. Compared with mechanical intestinal obstruction, the dynamic intestinal obstruction has a wide range of intestinal dilatation, but the degree is mild, and the cause of dynamic intestinal obstruction is complicated. In addition to intra-abdominal lesions, abdominal wall lesions can also cause reflex intestinal swelling. After treatment, the inflated expansion of the intestines is gradually reduced. For example, combined with intestinal wall edema, ascites, pneumoperitoneum and other manifestations in peritonitis, continue to observe. The primary cause of the disease is to provide a basis for clinical treatment.

3.MRI

There are few reports on MRI applications, including the general expansion of the stomach, duodenum, small intestine and colon, gas accumulation, effusion and gas-liquid plane.

Diagnosis and diagnosis of paralytic ileus

According to the medical history, clinical manifestations, combined with X-ray, CT and other examinations, the diagnosis can be made clear. When the standing X-ray film is examined, often all the intestinal fistulas have inflation and expansion, and there are multiple liquid levels in the intestinal lumen, but there are also In a few cases, only local intestinal fistula with local intestinal fistula occurred. This image should be differentiated from mechanical intestinal obstruction and strangulated intestinal obstruction.

The disease should be differentiated from mechanical intestinal obstruction. The latter is often associated with intestinal blockage, congenital malformation of the small intestine and extraintestinal compression. The clinical manifestations are paroxysmal abdominal cramps, and the auscultation of bowel sounds is hyperactive. Most of the paralytic ileus is persistent pain, no colic attacks, weakened or disappeared bowel sounds, X-ray examination, inflated and inflated intestines in mechanical intestinal obstruction are limited to the intestine above the obstruction, inflatable intestine lining The size is different; paralyzed intestinal obstruction can be seen in the gastrointestinal tract inflation, the small intestine inflatable intestinal fistula size is more consistent.

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