Oxford American Pocket Notes Postoperative Ileus

Helpful aids, such as patient assessment tools, medication tables, and illustrations will provide easily accessible insights.

1. Introduction


a. Definition


b. Prevalence of POI


c. Economic Burden in the Hospital Setting


d. Risk factors
2. Causes and Pathophysiology


a. Activation of inhibitory spinal reflex arcs


b. The surgical stress response


c. Generation of endocrine and inflammatory mediators


d. Surgical manipulation of the bowel


e. Stimulation of opioid receptors
3. Diagnosis and Clinical Features


a. Typical symptoms


b. Physical signs


c. Radiography, contrast and CT scan, endoscopy, blood tests


d. Differential diagnosis (ruling out bowel obstruction, sepsis and Ogilvie syndrome (pseudo-obstruction))
4. Prevention of POI - Peri-operative


a. nasogastic intubation (NGI)


b. fluid administration- goal directed, fluid restriction, type of fluid


c. surgical technique - laparoscopic


d. prokinetic agents


e. anesthetic techniques: GA vs epidural


f. anesthetic drugs


g. psychological
5. Current Pharmacological Options for Treatment and Management of POI

a. NSAIDS, other anti-inflammatory agents

b. Symptom relief with hydration and nasogastric tubes

c. Prokinetic agents (cisapride, erythromycin, and metoclopramide)

d. Laxatives

e. Mu-opioid antagonists (naloxone, natrexone and nalmefene)

f. anticholinergic or cholinergic drugs
6. Emerging Pharmacotherapies in POI

a. Peripherally-acting mu-opioid antagonists: -alvimopan -methylnaltrexone
7. Non-pharmocological therapies

a. Diet

b. Physical activity

c. fast track recovery protocol
8. Conclusion
9. Further considerations and additional resources for clinicans and patients