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Ileus Disusun Oleh :Fini AmaliaKarimah Ihda HusnayainMagista Vivi AnisaStevan Wedi Kurniawan

Pembimbing:dr. Pirma Hutauruk., Sp.B(K)Trauma

ANATOMY & PHYSIOLOGY DIGESTIVE TRACTThe Digestive Organs and the PeritoneumLined with serous membrane consisting ofSuperficial mesothelium covering a layer of areolar tissueSerosa, or visceral peritoneum:covers organs within peritoneal cavityParietal peritoneum:lines inner surfaces of body wallPeritoneal FluidIs produced by serous membrane liningProvides essential lubricationSeparates parietal and visceral surfacesAllows sliding without friction or irritation

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Histological Structure of the Digestive (GI) Tract

The MucosaIs the inner lining of digestive tractIs a mucous membrane consisting ofEpithelium, moistened by glandular secretionsLamina propria of areolar tissueThe Digestive Epithelium Mucosal epithelium is simple or stratifiedDepending on location, function, and stresses: oral cavity, pharynx, and esophagus:mechanical stresseslined by stratified squamous epitheliumstomach, small intestine, and most of large intestine:absorptionsimple columnar epithelium with mucous (goblet) cellsThe Digestive Epithelium Enteroendocrine cellsAre scattered among columnar cells of digestive epitheliumSecrete hormones that:coordinate activities of the digestive tract and accessory glands

5Peristalsis

Peristaltic MotionCircular muscles contract behind bolus:While circular muscles ahead of bolus relaxLongitudinal muscles ahead of bolus contract:Shortening adjacent segmentsWave of contraction in circular muscles:Forces bolus forward

6Small Intestine90% of absorption occurs in the small intestine

ILEUSObstructive ileusClassification Simple mechanical obstruction Bowel lumen is obstructed No vascular compromise Closed loop obstruction Both ends of a bowel loop are obstructed Results in strangulated obstruction if untreated Rapid rise in intraluminal pressure Strangulated obstructionBowel lumen and vascular supply is compromised

Classification Intrinsic bowel lesions Extrinsic bowel lesions Idiopathic bowel lesions Intrinsic bowel lesions Congenital anomalies (Pediatric) Atresia Stenosis Bowel duplicationStrictures

Intrinsic bowel lesions StricturesInflammatory Bowel DiseaseColon CancerIntussusception Gallstones that have entered the bowel lumen BezoarBarium Ascaris infection Tuberculosis Actinomycosis Diverticulitis

Extrinsic bowel lesions Adhesion Abdominal or pelvic surgery Presence of peritonitis or trauma

Hernia (higher risk for strangulation) Inguinal hernia (direct ,indirect) Internal hernias via mesenteric defectsObturator hernia

Small bowel volvulus Rare compared to colon volvulus Occurs in intestinal malrotation or adhesions

Symptoms Frequent and recurrent Generalized Abdominal Pain

Duration: Seconds to minutes Character: Spasms of crampy abdominal painFrequency Intermittent pain initially Every few minutes in proximal obstruction Constant pain suggests ischemia or perforation Symptoms Stool passage Initially may be present despite complete obstruction Later, obstipation (no stool) in complete obstruction

Symptoms more severe in proximal obstruction Severe, colicky abdominal pain Constant pain suggests ischemia or perforation Develops over hours and occurs every few minutes Bilious Emesis Mild abdominal distention

Signs Bowel sounds Initial: High pitched, hyperactive bowel sounds Later: hypoactive or absent bowel sounds

Tender abdominal mass Closed loop Bowel Obstruction may be palpable

Abdominal distention and tympany on percussion Indicates distal obstruction

Rectal examination for blood

Darm contour

Radiology: abdominal X-Ray Bowel distention proximal to obstruction Bowel collapsed distal to obstruction Upright or decubitus view: Air-fluid levels Supine view findings Sharply angulated distended bowel loops Step-ladder arrangement or parallel bowel loopsString of pearls sign (specific for obstruction)Pseudotumor Sign

Small Bowel Gas Pattern Centrally locatedSoft tissue across entire lumen

Colon Gas Pattern Peripheral LocatedMostly not overlappingHaustra markings24

Herring Bone

Coffee Bean

Step Ladder

Dilated Loops of Small Bowel with Air-Fluid levels Area of non-dilated small bowel. Absence of Air in the Colon.30Management: Conservative Therapy Fluid replacement

Bowel decompression Nasogastric TubeLong intestinal tube (eg. Cantor) offers no advantage

Antibiotic Indications (Not for routine use) Surgery planned Bowel ischemia or infarction Bowel perforation Cover Gram Negatives and AnaerobesSecond-generation CephalosporinManagement: surgical interventionSimple correctionBy-passEntero-cutaneus fistuleBowel ressection

OBSTRUCTIVE ILEUSPredictors of resolution without surgery Early postoperative bowel obstructionAdhesive obstruction (prior laparotomy) Crohn's diseaseIndications for surgery Inadequate relief with Nasogastric tube placement Persistant symptoms >48 hours despite treatment (strangulation)Neoplasms

Complications Intestinal Ischemia or infarction Bowel necrosis, perforation and bacterial peritonitis Hypovolemia Complications of surgical intervention if needed

Prognosis: Recurrence of obstruction due to adhesionsRisk after first episode: 53% Risk after more than one episode: 83%

ReferenciesSouba Wiley. ACS Surgery : Principles and practice. 6th EditionGerard M. Doherty: CURRENT DiaGNOSIS & Treatment: Surgery, 13th EditionThank For Your Attentions!!!