Main description:

Ileus is a general functional inhibition of the propulsive bowel activity in the absence of mechanical bowel obstruction. Postoperative ileus (POI) is a more specific condition which is a transient cessation of coordinated bowel motility after surgery, preventing effective transit of intestinal content. Depending on the type of surgery, and especially when the bowels are involved in the surgery, the incidence can be high, affecting 4 to 20 percent of abdominal surgery patients. Typically, in the small intestine, it can last up to 24 hours; in the stomach, between 24 and 48 hours; and in the colon, between 48 and 120 hours. During this time, the patient is prohibited from eating and drinking, often requiring nasogastric suction and parenteral feeds until passage is restored. Until then, the patient cannot be discharged from the hospital. POI is the most common reason for delays in discharge after abdominal surgery and can greatly increase the cost of healthcare. It is estimated that the healthcare costs as a result of complications of postoperative ileus may be as high as one billion dollars per year.Though there is some available literature on POI, there is a dearth in new, up-to-date information on the latest management trends and emerging pharmacological therapies.
Accelerating recovery of gastrointestinal function improves clinical outcomes, enhances patient comfort, and has a positive economical effect in that it shortens the length of hospital stay and reduces hospital cost. Treatment options include pharmacological as well as non-pharmacological approaches, specifically epidural anesthesia and traditional, non-steroidal, anti-inflammatory drugs, as well as other opioid sparing analgesics. Part of the new Oxford American Pocket Notes series, this very concise guide presents a brief overview of the diagnosis, prevention, and management of postoperative ileus. A valuable resource in the hospital setting for surgeons, anesthesiologists, gastroenterologists, OB/GYNs, pharmacists, physician assistants, nurse practitioners, recovery nurses and other members of the hospital staff, this practical, up-to-date volume includes sections on the pathophysiology and clinical features of POI as well as on traditional and emerging therapies.Uniquely compact and affordable, this book provides helpful guidelines for fast track recovery in the hospital setting. In addition, it includes sections on differential diagnosis and non-pharmacological treatments.
Helpful aids, such as patient assessment tools, medication tables, and illustrations will provide easily accessible insights.

Contents:

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