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Ileus

• Definition• Intestinal obstruction

• Disruption of the propulsion and passage of intestinal contents

• Classification• ileum/jujunum/colon

• Partial/localized vs Complete/generalized

• Acute/chronic

• Mechanical vs Functional

Etiology

• Mechanical ileus• Intramural

• Tumor, inflammation, hematoma

• Extramural• Volvulus, hernia, adhesion

• Intraluminal• Stones, foreign bodies, meconium

• Functional ilues• Secondary – postoperative ileus, trauma• Metabolic causes – uremia, ketoacidosis, hypokalemia• Drugs – morphine, antacids, anticonvulsants

Epidemiology

• 1% of all hospitalizations

• Adhesion is the most common cause of small bowelileus (60%)

• Colorectal carcinoma is causing colon ileus (60%)

• Mortality 3-30%

Pathophysiology

• Unclear mechanisms

• Hypersecretion into the lumen

• Intramural inflammation

Symptoms

• Pain

• Vomiting (proximal)

• Distension (distal)

• Obstipation

Clinics

• Dg• Symptoms• Imaging (X-ray, CT)

• Air-fluid levels, dilated loops

• Biochemistry?

• Th• Conservative

• Previous surgery, malignancy, incomplete obstruction

• Surgery• Perforation, peritonitis, failure to improve

• Coffee, chewing gum

Complications

• Perforation

• Peritonitis

• Sepsis

Peptic ulcer disease

• Breaks in the gastric and duodenal mucosa

• Gastric ulcers

• Duodenal ulcers

• Zollinger-Ellison syndrome• Gastrinoma

Gastric vs duodenal ulcers

Etiopathogenesis

Etiopathogenesis

Risk factors

• Smoking

• Stress

• Alcohol

• Epidemiology• Decreased mortality in the past 20 years

Symptoms

• Pain• Gastric ulcer pain is aggravated by meals – weight loss• Pain of duodenal ulcers is relieved by meals

• Nausea

• Complications• Bleeding• Perforation• Penetration• Pyloric stenosis

Clinics

• Dg• X-ray

• Urea breath test

• Endoscopy

• Histology

• Th• Proton pump inhibitors

• H2 receptor antagonists

• Surgery – vagotomy, gastrectomy

Th

Pancreatitis

• Inflammation of the pancreas

• Autodigestion• Digestive enzymes active in the pancreas

• Acute vs chronic

• Mild vs severe

Etiology

• Alcohol

• Biliary pancreatitis

• Hyperlipidemia

• Hypercalciemia

• Trauma

• Cystic fibrosis

• Infections• Coxsackie• CMV• Legionella

Symptoms

• Epigastric pain

• Nausea

• Vomiting

• Hypotension, tachycardia

• Turner’s sign

• Cullen’s sign

Complications

• Ileus

• Renal failure

• Hemorhagic pancreatitis

• Abscess

• ARDS

• Diabetes mellitus

Clinics

• Dg• Amylase, lipase• Hyperglycemia• CT• Calcifications, steatorrhea, diabetes mellitus (chronic)

• Th• Restriction of oral intake• Analgetics• Fluids• Antibiotics (fever is not an infection)