Conservative Management

Initial conservative management of acute pseudo-obstruction is appropriate in the absence of significant abdominal pain and peritoneal signs, and with cecal diameter < 12 cm. This approach is successful in 86 to 96% of the cases within 3 days of management. There are no controlled data available comparing the efficacy of initial conservative treatment with interventional management. Initial management aims at correcting and managing underlying clinical complications and withdrawing offending agents. A meticulous chart review and a careful history and physical examination are performed to elucidate the etiologies of pseudo-obstruction. The principles of conservative management of pseudo-obstruction are based on the knowledge of these risk factors. The following must be accomplished promptly:

1. Oral feedings discontinued, the patient admitted to the intensive care unit (ICU), and an intravenous (IV) line placed for hydration.

2. Nasogastric tube placed for gastric decompression and a rectal tube placed to decompress the rectum and the colon.

3. Rectal enemas used to liquefy the stools. This will also aid in colonic decompression and increase the visibility during endoscopy if required in the future.

4. All narcotic analgesics and opioids discontinued immediately.

5. All anxiolytics, anticholinergics, calcium channel antagonists, and antidepressant agents also are discontinued.

6. Any medication that effects the colonic motility discontinued. Common miscellaneous drugs including chemotherapeutic agents, phenothiazines and antidiar-rheal medications (eg, loperamide, diphenoxylate plus atropine) have also been implicated in the precipitation of acute pseudo-obstruction. Only essential medications are continued in the ICU.

7. All electrolyte imbalances, especially hypokalemia, cor rected promptly. Also abnormalities of calcium, magnesium, phosphate, bicarbonate, sodium and other electrolytes are potentially important in the precipitation of pseudo-obstruction.

8. All sources of infections sought and treated with appropriate IV antibiotics. If the WBC count is elevated, this should raise an index of suspicion for an underlying infection as an etiology for pseudoobstruction. A chest radiograph may aid in making a diagnosis of pneumonia in a hospitalized patient. A urine analysis will detect an underlying urinary tract infection. A diagnostic paracentesis is required in a patient with ascites and elevated WBC, fever, or peritoneal signs.

9. Analysis of cerebrospinal fluid in a patient with neurological signs and symptoms of meningitis is necessary. A two-dimensional echocardiogram of the heart in a patient with new onset murmur is justified.

10. Prolonged bed rest avoided. Frequent turning of the patient and early ambulation is desirable and encouraged.

Abdominal radiographs, metabolic panel, and a complete blood count with differential are obtained on a daily basis in the ICU. Daily abdominal radiography allows the clinician to follow the course of colonic dilatation. If the patient has no peritoneal signs and the cecum is < 12 cm, the patient is followed and observed conservatively for 48 to 72 hours in the ICU. If the caliber of colonic distension is regressing, conservative management with daily problem focused physical examination is continued. Abdominal sounds are auscultated daily to assure peristalsis and functioning bowel. The patient should be passing gas and fecal material, and improving clinically. IV fluid is continued, as are all conservative measures.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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