Compare conditions

Put any two — or three — conditions side by side, adult or pediatric, to spot the look-alike differences fast, row by row.

Ileus

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In one line

·The bowel's muscle waves stop — food, gas, and fluid pile up inside, even though there is no blockage.

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Normal physiology

·The bowel is a long tube wrapped in smooth muscle that squeezes in waves (peristalsis) to push food, fluid, and waste from the stomach to the anus. The gut's nervous system (the enteric nervous system, a network of nerves in the bowel wall) fires signals every few seconds, telling the muscle to squeeze in coordinated waves. This keeps everything moving forward, like a hand squeezing toothpaste. Normal gut muscle tone, balanced body salts (especially potassium and magnesium), and steady nerve signals all work together to keep the waves going.

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What goes wrong

·The bowel's nerve signals or muscle power turn off, so the squeezing waves stop. Nothing is physically blocking the tube — the motor just quits running.

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Hallmark signs

·The belly is bloated and feels tight
·No bowel movements or gas comes out
·Belly pain that is crampy or achy
·Nausea and vomiting
·No appetite or feeling full very quickly
·Belly sounds are very quiet or silent when the doctor listens
·Fever
·Severe, sharp belly pain that keeps getting worse

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Red flags · escalate now

·Fever above 100.4°F (38°C) — may mean infection or a leak in the gut
·Severe, sharp belly pain that keeps getting worse — may mean the gut is tearing or dying
·Vomiting material that looks like poop or is dark green — means a very high blockage or the gut is working backward
·Signs of shock: fast heartbeat, very low blood pressure, confusion, or cold, clammy skin — means the body is failing and needs emergency care

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Workup

·Basic metabolic panel (BMP) with potassium and magnesium
·Complete blood count (CBC)
·Serum lactate
·Abdominal X-ray (kidney-ureter-bladder or KUB view)
·CT scan of the abdomen and pelvis with IV contrast
·Serum lipase or amylase

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Treatment

·NPO (nothing by mouth) and place a nasogastric (NG) tube if the patient is vomiting or the belly is very swollen
·Replace low potassium and magnesium through IV fluids
·Cut down opioid pain medicines; switch to non-opioid pain control like acetaminophen, NSAIDs, ice packs, or nerve blocks
·Treat the root cause: IV antibiotics for infection, drain an abscess, or go back to surgery if there is a leak or complication
·Get the patient moving: sit up in bed, stand, and walk as soon as it is safe
·Give alvimopan (Entereg) if the patient just had bowel surgery, or metoclopramide (Reglan) to boost bowel squeezing

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NCLEX trap

·Keep the patient NPO (nothing by mouth) when a stalled gut (ileus) is happening. The bowel is not squeezing or moving food forward. Anything you put in will just sit there, back up into the stomach, cause vomiting, and stretch the bowel even more. Wait until you hear bowel sounds returning and the patient passes gas or stool before trying food.
·A stalled gut (Ileus) is temporary paralysis — the bowel muscle is asleep and not squeezing, but nothing is blocking the tube. A mechanical obstruction is a kink, scar tissue, or tumor that physically closes off the pipe. On X-ray a stalled gut shows swollen loops of bowel filled with air and fluid but no clear cut-off point, while obstruction shows a specific spot where everything stops. A stalled gut is treated by fixing the root cause (low potassium, infection, too much pain medicine) and waiting for the bowel to wake up. Obstruction often needs surgery to remove the blockage.
·Low potassium (hypokalemia) and low magnesium (hypomagnesemia) are upstream breaks that directly cause a stalled gut (ileus). Bowel muscle cells need these minerals to contract and squeeze. If the levels are low, the bowel cannot wake up no matter what else you do. You must check the labs and replace what is missing, or the a stalled gut will not resolve.
·An NG tube (a tube through the nose into the stomach) drains the backed-up fluid and gas, stops vomiting, relieves pressure, and makes the patient feel better. It also prevents the belly from swelling so much that the bowel wall tears or ruptures. Place it early when a stalled gut (ileus) is clear — do not wait for the belly to become dangerously tight.
·Very quiet or absent bowel sounds in the hours after surgery are the first warning sign of a stalled gut (ileus) starting. Do not wait for vomiting or a huge bloated belly. Listen to the belly early, check potassium and magnesium, and get ready to place an NG tube if the bowel stays silent.
·Opioid pain medicines (like morphine, oxycodone, hydromorphone) slow down the bowel by blocking signals in the enteric nervous system (the nerve network in the gut wall that controls squeezing). In a stalled gut (ileus) they are part of the upstream break. You must lower the dose or switch to other pain control methods (ice packs, repositioning, acetaminophen, nerve blocks) so the bowel can wake up. Do not just add more laxatives and keep the opioids high — that will not fix the problem.

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