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intestinal pseudo-obstruction
Etiology:
1) abnormal gastrointestinal (GI) motility
- opiates
2) smooth muscle diseases
a) amyloidosis
b) mitochondrial myopathy
c) muscular dystrophy
3) connective tissue disease
a) systemic lupus erythematosus
b) scleroderma
4) neurologic disorders
a) brainstem tumor
b) dysautonomia
c) familial visceral neuropathy
d) neurofibromatosis
e) Parkinson's disease
5) systemic disorders
a) diabetes mellitus (rare)
b) hypothyroidism
6) familial syndromes
Epidemiology:
- increased frequency in developmentally disabled patients
Clinical manifestations:
1) constipation
2) abdominal distension
3) abdominal pain
4) nausea, sometimes vomiting
Radiology:
- dilated small intestine
- colon may or may not be dilated
Complications:
- intestinal perforation
- cecal diameter of > 10 cm is high suscepitble to perforation
Differential diagnosis:
1) constipation
2) ileus
3) intestinal obstruction
Management:
1) correct electrolyte disturbances, especially hypokalemia
2) nasogastric suction may help decompress the colon
3) turning patient from backside to stomach may passively move air
4) colonoscopy may successfully decompress colon
5) colectomy
Related
constipation; dyschezia
ileus
Specific
chronic idiopathic intestinal pseudo-obstruction (CIIP, CIPO)
General
intestinal disease
References
- Saunders Manual of Medical Practice, Rakel (ed),
WB Saunders, Philadelphia, 1996, pg 338
- Medical Knowledge Self Assessment Program (MKSAP) 11, 15, 16.
American College of Physicians, Philadelphia 1998, 2009, 2012
- Intestinal Pseudo-Obstruction
https://www.niddk.nih.gov/health-information/digestive-diseases/intestinal-pseudo-obstruction