Intestinal pseudoobstruction 4101155 215546976 2008-05-28T18:04:43Z Arcadian 104523 /* External links */ nav {{Infobox_Disease | Name = Intestinal pseudoobstruction | Image = | Caption = | DiseasesDB = 10868 | ICD10 = | ICD9 = {{ICD9|560.89}} | ICDO = | OMIM = 155310 | MedlinePlus = | eMedicineSubj = med | eMedicineTopic = 2699 | eMedicine_mult = {{eMedicine2|med|3570}} | MeshID = D003112 | }} '''Intestinal pseudoobstruction''' is the decreased ability of the [[intestine]]s 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]], [[multiple sclerosis]], [[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 [[nerve]]s that supply the gut. ==Treatment== Secondary pseudoobstruction is managed by treating the underlying condition. There is no cure for primary pseudoobstruction. It is important that [[nutrition]] and [[hydration]] is maintained, and [[pain relief]] is given. Drugs that increase the propulsive force of the intestines have been tried, as have different types of surgery. === Medical treatment === [[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]]. === Surgical and other procedures === [[Intestinal decompression]] by [[colonoscopy]] or tube placement in a small stoma can also be used to reduce distension and pressure within the gut. The stoma may a [[gastrostomy]], [[enterostomy]] or [[cecostomy]], and may also be used to feed or flush the intestines. Colostomy or ileostomy can bypass affected parts if they are distal to (come after) the stoma. For instance, if only the large colon that is affected, an ileostomy may be helpful. Resection of affected parts may be needed if part of the gut dies (for instance [[toxic megacolon]]), or if there is a localised area of dysmotility. Gastric and colonic pacemakers have been tried. These are strips placed along the colon which create an electric discharge intended to cause the muscle to contract in a controlled manor. There is also a transplant surgery that could be done. It includes taking out six organs which are the pancreas, stomach, small intestine, liver and duodenum. This surgery has only been performed once by Doctor Kareem Abu-Elmagd on Gretchen Miller who starred on the [[Discovery Channel]] show ''[[Surgery Saved My Life]]''. ==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 neuron]]s leading to the bowels. ==References== * {{cite book | author =Bynum TE | year = 1998 | title = Internal Medicine | chapter = Chapter 342: Intestinal Obstruction and Peritonitis | editor = Stein JH | edition = 5th ed. | publisher = C.V.Mosby | location = New York | id = ISBN 0-8151-8698-3 }} * [http://dsc.discovery.com/fansites/surgery/follow-up/six-organ/gretchen.html Discovery Channel - Multiorgan transplant] * {{cite journal |author=Connor FL, Di Lorenzo C |title=Chronic intestinal pseudo-obstruction: assessment and management |journal=Gastroenterology |volume=130 |issue=2 Suppl 1 |pages=S29–36 |year=2006 |pmid=16473068 |doi=10.1053/j.gastro.2005.06.081}} ==External links== * {{Chorus|00530}} {{Gastroenterology}} [[Category:Digestive diseases]]