Intestinal pseudo-obstruction
| Intestinal pseudo-obstruction | |
|---|---|
| Specialty | Gastroenterology  |
Intestinal pseudoobstruction is the decreased ability of the intestines to push food through, and often causes dilation of various parts of the bowel. It can be a primary condition (idiopathic or inherited from a parent) or caused by another disease (secondary). The clinical and radiological findings are often similar to true intestinal obstruction.
Clinical manifestations
People with pseudoobstruction have abdominal pain, diarrhea, or constipation. In addition, their abdominal x-ray shows dilated loops of bowel. All of these features are also seen in true mechanical obstruction of the bowel.
Diagnosis
Attempts must be made to find the underlying cause of intestinal pseudoobstruction. Secondary intestinal pseudoobstruction may be caused by scleroderma (esophageal motility is also impaired), myxedema, amyloidosis, muscular dystrophy, hypokalemia, chronic renal failure, diabetes mellitus, drugs (anticholinergics, opiates)
Primary (idiopathic) intestinal pseudoobstruction is a diagnosis of exclusion, and may be based on family history. It may be caused by problems with the smooth muscle of the intestines (hollow visceral myopathy), or may be caused by problems with the nerves that supply the gut.
Treatment
Although there is no cure for primary pseudoobstruction, certain drugs that increase the propolsive force of the intestines may be tried. Metoclopramide, cisapride, and erythromycin may be used, but they have not been shown to have great efficacy. In such cases, treatment is aimed at managing the complications. Intestinal stasis, which may lead to bacterial overgrowth, and, subsequently, diarrhea or malabsorption is treated with antibiotics. Nutritional deficiencies can be treated with oral supplements, and, rarely, total parenteral nutrition. Colonoscopic decompression can also be used.
Secondary pseudoobstruction is managed by treating the underlying condition.
Related disorders
- Ogilvie syndrome: Acute pseudoobstruction of the colon in severely ill debilitated patients.
- Hirschsprung's disease: enlargement of the colon due to lack of development of autonomic ganglia.
- Intestinal neuronal dysplasia: a disease of motor neurons leading to the bowels.
References
- Bynum TE (1998). "Chapter 342: Intestinal Obstruction and Peritonitis". In Stein JH (ed.). Internal Medicine (5th ed. ed.). New York: C.V.Mosby. ISBN 0-8151-8698-3.
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External links
- 00530 at CHORUS