Ileus

[SBURNSTEVEN]

I had a patient that came in with Pancreatitis. By day 2, Lipase and Amylase were trending down, and the patient didn't complain of pain. They went into respiratory distress and had a distended abdomen. (large abdomen made it difficult to breath). Abdominal X-ray showed an Ileus. Patient has absent bowel sounds......Was the Ileus narcotic induced (patient had hydromorphone 0.5 mg q3h for 5 doses), or could it be associated with the pancreatitis? Also, the NGT placed to "decompress" I believe is to remove the gas from the intestines and not the gastric contents (acids) which do also come out with the NGT? Patient has been NPO since arrival. The NGT to LCWS had only made his abdomen go down a small amount.....how long until his abdomen goes down or the Ileus resolves?

[padre]

I am an RN in an ICU and am going to reply not based upon what I have seen - but from personal experience. In 2012, I had surgery to remove my right kidney. I developed an ileus and had an NG to remove gastric contents (even though was NPO). Weeks later, I had a doctor change my diet and told me to order a steak - cut a piece each tv commercial - and chew it 100 times. The chewing action (could be gum for that matter) signals the digestive system to kick in. If your patient is A&O, have them practice chewing.

[NPOaftermidnight, MSN, RN, NP]

The NGT is providing symptomatic relief, decreasing discomfort/nausea/vomiting, so this definitely does include gastric contents. The narcotics certainly could have contributed to the patient's ileus, or it could have been caused by the pancreatitis (I know this is especially common in patients with severe pancreatitis who develop peritonitis). I'm not sure I can give you a great answer as to how long this will last given the information here, but assuming the patient's condition is continuing to improve and he is being treated appropriately I would imagine it would resolve within a week or so, barring any additional complications.

Pancreatitis can make for a long, eventful hospital stay. These patients seem to face one complication after another. I've taken care of a couple patients lately who have been in the hospital for months with pancreatitis being their initial diagnosis. Hopefully you get this guy out the door sooner rather than later!