Intestinal paresis
Intestinal paresis or paralytic intestinal obstruction is a serious, transient dysfunction of intestinal motility. This disease is often diagnosed after certain surgical manipulations on the intestines, when the water-electrolyte balance is disturbed. Intestinal paresis often manifests itself on the second or third day after surgery. The patient may develop intoxication of the body.
Often with intestinal paresis, a significant expansion of the stomach can be observed. Paresis can be localized in one place of the gastrointestinal tract, or it can capture all of its parts. Many factors are known that have become a progressive basis for the development of this ailment. Among them are many diseases and pathological conditions of the human body. It can be peritonitis, various tumors, hematomas, and inflammation in the intestines.
Intestinal paralytic obstruction can occur due to dangerous urolithiasis or a specific injury to the peritoneum. People who have suffered myocardial infarction and pleuropneumonia also become possible hostages of this disease.
Patients with metabolic disorders due to lack of potassium and magnesium, as well as other patients who have undergone poisoning with pesticides, can also develop intestinal paresis. Diabetes, mesenteric thrombosis, and embolism are precursors of paralytic ileus. Intestinal paresis can occur with unhealthy kidneys or dangerous lung diseases. It can be myocardial infarction, pneumonia, and various rib fractures.
This disease is characterized by disturbances in the motility of the stomach and colon after operations on the organs of the gastrointestinal tract. A significant recovery process in the colon can take three days. The functioning of the small intestine is rarely completely disrupted. It usually takes several hours to restore her motility after the operation.
There are three main stages in the development of intestinal paresis. The first stage is characterized by inhibition of peristalsis, at this stage paralytic intestinal obstruction occurs. For the second stage, intestinal stasis is characteristic, when the intraintestinal pressure increases significantly due to accumulations of gas and liquid in the intestinal lumen. The third stage is marked by progressive intoxication and severe disruption of all human organs and systems.
What is typical for intestinal paresis?
With intestinal paresis, the patient has severe pain and noticeable bloating. The patient may have vomiting, and the absence of stool and gas is possible. In some cases, you may notice uncontrolled discharge of watery stool. Significant pain sensations spread throughout the intestine, while the pain does not radiate to neighboring organs and is always bursting, there is no peristalsis.
A person has frequent vomiting of the contents of the stomach and intestines. Vomit can be mixed with blood, this often indicates that bleeding has begun from the walls of the stomach and intestines or the presence of acute ulcers. In a patient, due to a strongly distended abdomen, breathing goes into chest. Tachycardia is diagnosed and, along with this, a significant decrease in blood pressure. Many patients complain of intense thirst.
How is intestinal paresis treated?
The main therapy for intestinal paresis is constant naso-gastric aspiration (suction of the contents through a tube), the absolute exclusion of food and fluid intake through the oral cavity, intravenous transfusion, sparing prescription of psychotropic sedatives, as well as refusal from opiates.
If this dangerous disease does not stop within a week, then the cause of intestinal paresis may be mechanical. In this case, the patient may be prescribed a laparotomy.
The dynamics of the development of paresis and its transition to acute intestinal obstruction determine the course of treatment. Surgical intervention must be carried out with extreme caution, guided by the modern principles of sparing technique, then it will be possible to avoid the dangerous occurrence of postoperative paresis. If the risk of developing paresis is quite high (acute pancreatitis, severe abdominal and lumbar trauma), then the necessary naso-gastric aspiration must be performed.
In addition, it is necessary to use a special method of regional shutdown of sympathetic innervation using novocaine. Therapeutic measures of intestinal paresis include various methods of stimulating intestinal motility. For example, a special massage of the abdominal wall or all kinds of compresses. With the help of unique therapeutic enemas and artificial irritation of the rectum with a gas outlet tube, it is also possible to effectively activate the patient's intestinal motility.
If the patient is diagnosed with volvulus, then drugs and bowel stimulation will not help here. In this case, an urgent operation is required. Surgical intervention should be performed as quickly as possible, because the paralyzed part of the intestine, not receiving the required amount of blood, can atrophy.
Article author: Mochalov Pavel Alexandrovich | d. m. n. therapist
Education: Moscow Medical Institute. IM Sechenov, specialty - "General Medicine" in 1991, in 1993 "Occupational Diseases", in 1996 "Therapy".
