Overview
Intestinal paralysis (enteroplegia), also known as anaerobic intestinal paralysis, paralytic intestinal obstruction, is due to a variety of reasons affecting the balance of the intestinal vegetative nervous system, or affecting the intestinal local nerve conduction, or affecting the contraction of intestinal smooth muscle intestinal dilatation, peristaltic movement disappeared, and can not be caused by the intestinal contents of the intestinal pushes forward. Treatment is appropriate to find the primary disease of intestinal paralysis, targeting the cause of the disease.
Causes
1. Intestinal blood supply disorder
Secondary to severe intra-abdominal infection, retroperitoneal hemorrhage, after major abdominal surgery, or blockage of intestinal blood supply by formation of blood clots in abdominal vessels, atherosclerosis or intestinal arterial/vein injuries that cause intestinal blood supply disorders.
2. Extra-intestinal diseases
such as renal failure, pneumonia, pyothorax, hypothyroidism, ureteral colic, blood electrolyte abnormalities such as hypocalcemia or hypercalcemia, hypokalemia, hyponatremia, and certain medications.
3.Surgery
Various degrees of intestinal paralysis are often seen 24 to 72 hours after abdominal surgery.
Questions you may be concerned about
What is the main cause of intestinal paralysis
Intestinal paralysis is also known as anaerobic intestinal paralysis, paralytic intestinal obstruction. The causes of intestinal paralysis include intestinal blood supply disorders, extra-intestinal diseases, abdominal surgery, etc., which are explained as follows:
1. Disorders of intestinal blood supply, secondary to severe intra-abdominal infection, retroperitoneal hemorrhage, after major abdominal surgery, or blockage of intestinal blood supply by formation of blood clots in the abdominal vessels, atherosclerosis or intestinal arterial/vein injuries that cause intestinal blood supply disorders leading to intestinal paralysis.
2 Extra-intestinal disorders such as renal failure, pneumonia, pyothorax, hypothyroidism, ureteral colic, blood electrolyte abnormalities such as hypocalcemia or hypercalcemia, hypokalemia, hyponatremia, and certain medications can lead to intestinal paralysis.
3. 24 to 72 hours after abdominal surgery, there are often different degrees of intestinal paralysis.
Treatment should be directed at the causative cause of paralytic intestinal obstruction accordingly. Such as abdominal surgery or peritonitis caused by intestinal paralysis after gastrointestinal decompression, can make the condition greatly improved; renal colic given to antispasmodic and renal capsule around the closure, can make intestinal paralysis reduced. Other causes of intestinal paralysis will also improve when the cause is eliminated. Prompt medical attention is recommended in the presence of intestinal paralysis.
Differential diagnosis
1. Mechanical intestinal obstruction
Like mechanical intestinal obstruction, paralytic intestinal obstruction stops the movement of intestinal contents in the intestine. However, unlike mechanical intestinal obstruction, paralytic intestinal obstruction is characterized by significant abdominal distension, no paroxysmal colic and other manifestations of hyperperistalsis, instead of weakened peristalsis or disappearance of intestinal peristalsis, which seldom causes intestinal perforation. Paralytic intestinal obstruction is not sensitive to some Chinese laxatives.
2. Toxic intestinal paralysis
Toxic intestinal paralysis is mainly caused by bacteria and viruses and their toxins caused by gastrointestinal dysfunction, resulting in peristalsis weakened or disappeared, the intestinal lumen accumulates gas, pressure increases, gastrointestinal blood circulation is impaired, insufficient blood supply and oxygenation, the formation of a vicious cycle of severe abdominal distension can affect the cardiorespiratory function, the emergence of respiratory distress or aggravation.
Examination
1. X-ray examination
(1) Plain film of the abdomen ① The stomach, small intestine and colon are mildly to severely dilated with pneumoperitoneum. Small bowel pneumoperitoneum can be light or heavy, colon pneumoperitoneum tends to be more significant, often manifested as peri-abdominal total colonic pneumoperitoneum. In the standing position, it is most obvious at the liver and splenic flexure of the colon; in the lying position, gas is mostly seen in the transverse colon and sigmoid colon. Small bowel gas distribution in the mid-abdomen within the outline of the colon, identification of difficulties in lateral fluoroscopy is located in the anterior abdomen, dilatation of heavy, intestinal collaterals were continuous tube; dilatation of light, the performance of separated gas intestinal tubes. (2) In the standing plain film of the abdomen, fluid planes of different widths appear in the dilated stomach, small intestine and colon, which can be of different heights, and the fluid planes are stationary. The number of fluid planes is usually less than in mechanical intestinal obstruction. Those with acute peritonitis often show signs of peritoneal fluid accumulation in abdominal plain films, and in severe cases, blurring of the abdominal fat line may also occur. (3) Thickening of the intestinal wall due to edema and congestion, and even restriction of diaphragmatic movement and signs of pleural effusion.
(2) Gastrointestinal imaging When paralytic intestinal obstruction is mild, when the examination is repeated 3-6 hours after taking the drug, iodine can mostly enter the colon, and mechanical intestinal obstruction of the small intestine is excluded. When paralytic intestinal obstruction is more serious, the contrast agent may also travel down extremely slowly, and remain in the stomach, duodenum and upper jejunum 3 to 6 hours after taking the medicine.
2.CT scan
It can be seen that the stomach, small intestine and colon are dilated with pneumatization, and the change of colon is more obvious, and the liquid plane can be seen. Compared with mechanical intestinal obstruction, the intestinal lumen of paralytic intestinal obstruction is widely dilated, but to a lesser extent. The etiology of paralytic intestinal obstruction is complex, in addition to intra-abdominal lesions, abdominal wall lesions can also cause reflex intestinal stasis. After the treatment of those who improve, intestinal stasis dilatation are gradually reduced. If at the same time combined with intestinal wall edema, ascites, pneumoperitoneum, etc., it is often shown to be complicated by peritonitis.
3.MRI
The application of MRI is less reported. The manifestations include generalized dilatation of stomach, duodenum, small intestine and colon, pneumoperitoneum, fluid accumulation and gas-liquid plane.
Treatment principle
According to the cause of paralytic intestinal obstruction, the corresponding treatment is carried out. Such as abdominal surgery or peritonitis caused by intestinal paralysis after gastrointestinal decompression, can make the condition greatly improved; renal colic given antispasmodic and renal capsule around the closure, can make intestinal paralysis reduce; ovarian cysts, tibial torsion of the cause of the elimination of intestinal paralysis can be cured by themselves and so on.
Application of a variety of parasympathetic stimulants, such as toxic lentil alkaloids, neostigmine, pituitary hormone, etc., on the prevention and treatment of paralytic intestinal obstruction has a certain degree of efficacy. Treatment with sympathoinhibitors such as chlorpromazine is also effective. Gastrointestinal decompression is required for marked abdominal distension, which affects respiratory and circulatory function. Spinal anesthesia or lumbar sympathetic nerve block has a temporary effect without lasting efficacy.