Ileus miasms

Clinic

• Ileus is a disruption of the normal propulsive ability of intestine.
• Causation: Lack of peristalsis or by mechanical obstruction.
• Ileus is an entity

Related disease

• CIPO :Pseudo-obstruction is clearly limited to the colon alone, whereas ileus involves both Intestine 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.
• Ogilvie syndrome: Acute dilatation of the colon due to Imbalance in autonomic nervous supply.
• IBS
• Intussusception: Intestine folds into the section immediately ahead of it. It typically involves small bowel and less commonly Colon.
• Hirschsprung disease: It is a birth defect in which nerves are missing from parts of the intestine. The most prominent symptom is constipation.

Signs and symptoms

• Moderate to severe, diffuse abdominal pain
• Constipation
• Abdominal distension
• Nausea/vomiting, esp after meals
• Vomiting of bilious fluid
• Lack of bowel movement / Flatulence
• Excessive belching

Pathophysiology

• Ileus is an occlusion or paralysis of the bowel preventing the forward passage of the intestinal contents, causing their accumulation proximal to the site of the blockage.
• A key distinction is drawn between mechanical and functional ileus.
• In the pathophysiology of ileus, both types lead to:
  • Accumulation of fluids and gases at elevated intraluminal pressure
  • Microcirculatory dysfunction of the bowel wall
  • Disruption of the mucosal barrier.
• This can, in turn, lead to fluid shifts, transmigration peritonitis, and hypovolemia.

Functional ileus

Paralytic / Functional ileus has multiple causes:

• Reflectory ileus—after abdominal or retroperitoneal surgery
• Drug-induced ileus
• Metabolic ileus
• Vascular ileus due to hypoperfusion of the bowel.

Acute colonic pseudo-obstruction (Ogilvie syndrome) is a kind of functional ileus which is particularly associated with the postoperative state, severe infection, and neurologic disease (such as Parkinson’s disease)

Cause

• Decreased propulsive ability may be broadly classified as caused either by bowel obstruction or intestinal atony or paralysis.
• However, instances with symptoms and signs of a bowel obstruction occur, but with the absence of a mechanical obstruction, mainly in acute colonic pseudo-obstruction, Ogilvie's syndrome.
• Mechanical obstruction of the gastrointestinal tract.
• Causes for an ileus include:
• Abdominal or pelvic surgery.
• Infections such as gastroenteritis or appendicitis
• Some medications including opioids

Intestinal paralysis

• Paralysis of the intestine is often termed paralytic ileus, in which the intestinal paralysis need not be complete, but it must be sufficient to prohibit the passage of food through the intestine and lead to intestinal blockage.
• Paralytic ileus is a common side effect of some types of surgery, commonly called postsurgical ileus.
• It can also result from certain drugs and from various injuries and illnesses, such as acute pancreatitis. Paralytic ileus causes constipation and bloating.

Risk factors

• GI surgery / Procedures
• Electrolyte imbalance (Namely hypokalemia and hypercalcemia)
• Diabetic ketoacidosis (DKA), and other causes of metabolic acidosis
• Hypothyroidism
• Diabetes
• Drugs (e.g. opioids or antimuscarinics)
• Inflammation with peritonitis
• Spinal cord injury above thoracic vertebrae 5 (T5) that causes bowel hypo-motility
• Acute intermittent porphyria

Miasms

CMV intussusception + Colon perforation + Ogilvie's syndrome = Intestinal pseudo- Obstruction

VZV: Ogilvie's syndrome + Intestinal pseudo- Obstruction

PLV

RBS

EBV ,