Intestinal obstruction vs paralytic ileus

원인

(1) Mechanical obstruction

① small intestine: adhesion (m/c), hernia, volvulus, crohn disease, intestinal Tb, radiation enteritis, neoplasm

② large intestine: carcinoma (m/c, Lt>Rt), diverticulitis, volvulus, hernia

(2) Paralytic ileus: Peritonitis, post-op, retroperitoneal hematoma, lower lobe pneumonia, rib Fx, MI, hypokalemia, hypocalcemia, hypomagnesemia, morphine, intestinal ischemia, appendicitis

임상양상

(1) Mechanical obstruction: Cramping abdominal pain, vomiting (not colon obstruction), gas passage (-), fluid & Elctro loss (small bowel 때 더 심함.)

(2) Paralytic ileus: Pain 보다는 distension으로 인한 discomfort

치료

fluid and electrolyte balance, L-tube insertion, simple abdomen f/u, therapeutic NPO, 48시간 이상 호전 없을 때는 op 고려