Intestinal pseudoobstruction
Encyclopedia
Intestinal pseudoobstruction is 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) or caused by another disease (secondary). The clinical and radiological findings are often similar to true intestinal obstruction.
It can be chronic or acute.
It can occur in conjunction with Kawasaki disease
or Parkinson's disease
.
, 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.
(esophageal motility is also impaired), myxedema
, amyloidosis
, muscular dystrophy
, multiple sclerosis
, hypokalemia
, chronic renal failure
, diabetes mellitus
, drugs (anticholinergics, opiates)
Primary (idiopathic) intestinal pseudoobstruction diagnosed based on motility studies, x-rays, and gastric emptying studies. 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.
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.
, 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
.
Use of octreotide
has been described.
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 manner.
A potential solution, albeit radical, is a multi-organ transplant. The operation involved transplanting the pancreas, stomach, duodenum, small intestine, and liver, and was performed by Doctor Kareem Abu-Elmagd on Gretchen Miller, the subject of the Discovery Channel
program Surgery Saved My Life.
Intestine
In human anatomy, the intestine is the segment of the alimentary canal extending from the pyloric sphincter of the stomach to the anus and, in humans and other mammals, consists of two segments, the small intestine and the large intestine...
s to push food
Food
Food is any substance consumed to provide nutritional support for the body. It is usually of plant or animal origin, and contains essential nutrients, such as carbohydrates, fats, proteins, vitamins, or minerals...
through, and often causes dilation of various parts of the bowel. It can be a primary condition (idiopathic or inherited) or caused by another disease (secondary). The clinical and radiological findings are often similar to true intestinal obstruction.
It can be chronic or acute.
Causes
There is some evidence of a genetic association. One form has been associated with DXYS154.It can occur in conjunction with Kawasaki disease
Kawasaki disease
Kawasaki disease , also known as Kawasaki syndrome, lymph node syndrome and mucocutaneous lymph node syndrome, is an autoimmune disease in which the medium-sized blood vessels throughout the body become inflamed. It is largely seen in children under five years of age...
or Parkinson's disease
Parkinson's disease
Parkinson's disease is a degenerative disorder of the central nervous system...
.
Clinical manifestations
People with pseudoobstruction have abdominal painAbdominal pain
Abdominal pain can be one of the symptoms associated with transient disorders or serious disease. Making a definitive diagnosis of the cause of abdominal pain can be difficult, because many diseases can result in this symptom. Abdominal pain is a common problem...
, diarrhea
Diarrhea
Diarrhea , also spelled diarrhoea, is the condition of having three or more loose or liquid bowel movements per day. It is a common cause of death in developing countries and the second most common cause of infant deaths worldwide. The loss of fluids through diarrhea can cause dehydration and...
, or constipation
Constipation
Constipation refers to bowel movements that are infrequent or hard to pass. Constipation is a common cause of painful defecation...
. In addition, their abdominal x-ray
Abdominal x-ray
An abdominal x-ray is an x-ray of the abdomen. It is sometimes abbreviated to AXR, or KUB .-Diagnostic Tool:...
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 sclerodermaScleroderma
Systemic sclerosis or systemic scleroderma is a systemic autoimmune disease or systemic connective tissue disease that is a subtype of scleroderma.-Skin symptoms:...
(esophageal motility is also impaired), myxedema
Myxedema
Myxedema describes a specific form of cutaneous and dermal edema secondary to increased deposition of connective tissue components in subcutaneous tissue as seen in various forms of hypothyroidism and Graves' disease. It is more common in women than in men...
, amyloidosis
Amyloidosis
In medicine, amyloidosis refers to a variety of conditions whereby the body produces "bad proteins", denoted as amyloid proteins, which are abnormally deposited in organs and/or tissues and cause harm. A protein is described as being amyloid if, due to an alteration in its secondary structure, it...
, muscular dystrophy
Muscular dystrophy
Muscular dystrophy is a group of muscle diseases that weaken the musculoskeletal system and hamper locomotion. Muscular dystrophies are characterized by progressive skeletal muscle weakness, defects in muscle proteins, and the death of muscle cells and tissue.In the 1860s, descriptions of boys who...
, multiple sclerosis
Multiple sclerosis
Multiple sclerosis is an inflammatory disease in which the fatty myelin sheaths around the axons of the brain and spinal cord are damaged, leading to demyelination and scarring as well as a broad spectrum of signs and symptoms...
, hypokalemia
Hypokalemia
Hypokalemia or hypokalaemia , also hypopotassemia or hypopotassaemia , refers to the condition in which the concentration of potassium in the blood is low...
, chronic renal failure
Chronic renal failure
Chronic kidney disease , also known as chronic renal disease, is a progressive loss in renal function over a period of months or years. The symptoms of worsening kidney function are unspecific, and might include feeling generally unwell and experiencing a reduced appetite...
, diabetes mellitus
Diabetes mellitus
Diabetes mellitus, often simply referred to as diabetes, is a group of metabolic diseases in which a person has high blood sugar, either because the body does not produce enough insulin, or because cells do not respond to the insulin that is produced...
, drugs (anticholinergics, opiates)
Primary (idiopathic) intestinal pseudoobstruction diagnosed based on motility studies, x-rays, and gastric emptying studies. It may be caused by problems with the smooth muscle
Smooth muscle
Smooth muscle is an involuntary non-striated muscle. It is divided into two sub-groups; the single-unit and multiunit smooth muscle. Within single-unit smooth muscle tissues, the autonomic nervous system innervates a single cell within a sheet or bundle and the action potential is propagated by...
of the intestines (hollow visceral myopathy), or may be caused by problems with the nerve
Nerve
A peripheral nerve, or simply nerve, is an enclosed, cable-like bundle of peripheral axons . A nerve provides a common pathway for the electrochemical nerve impulses that are transmitted along each of the axons. Nerves are found only in the peripheral nervous system...
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
Nutrition
Nutrition is the provision, to cells and organisms, of the materials necessary to support life. Many common health problems can be prevented or alleviated with a healthy diet....
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
MetoclopramideMetoclopramide
Metoclopramide is an antiemetic and gastroprokinetic agent. It is commonly used to treat nausea and vomiting, to facilitate gastric emptying in people with gastroparesis, and as a treatment for the gastric stasis often associated with migraine headaches.-Medical uses:Metoclopramide is commonly...
, cisapride
Cisapride
Cisapride is a gastroprokinetic agent, a drug which increases motility in the upper gastrointestinal tract. It acts directly as a serotonin 5-HT4 receptor agonist and indirectly as a parasympathomimetic. Stimulation of the serotonin receptors increases acetylcholine release in the enteric nervous...
, and erythromycin
Erythromycin
Erythromycin is a macrolide antibiotic that has an antimicrobial spectrum similar to or slightly wider than that of penicillin, and is often used for people who have an allergy to penicillins. For respiratory tract infections, it has better coverage of atypical organisms, including mycoplasma and...
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
Diarrhea
Diarrhea , also spelled diarrhoea, is the condition of having three or more loose or liquid bowel movements per day. It is a common cause of death in developing countries and the second most common cause of infant deaths worldwide. The loss of fluids through diarrhea can cause dehydration and...
or malabsorption is treated with antibiotics.
Nutritional deficiencies can be treated with oral supplements, and, rarely, total parenteral nutrition
Total parenteral nutrition
Parenteral nutrition is feeding a person intravenously, bypassing the usual process of eating and digestion. The person receives nutritional formulae that contain nutrients such as glucose, amino acids, lipids and added vitamins and dietary minerals...
.
Use of octreotide
Octreotide
Octreotide is an octapeptide that mimics natural somatostatin pharmacologically, though it is a more potent inhibitor of growth hormone, glucagon, and insulin than the natural hormone...
has been described.
Surgical and other procedures
Intestinal decompression by colostomyColostomy
A colostomy is a surgical procedure in which a stoma is formed by drawing the healthy end of the large intestine or colon through an incision in the anterior abdominal wall and suturing it into place. This opening, in conjunction with the attached stoma appliance, provides an alternative channel...
or tube placement in a small stoma can also be used to reduce distension and pressure within the gut. The stoma may a gastrostomy
Gastrostomy
Gastrostomy refers to a surgical opening into the stomach. Creation of an artificial external opening into the stomach for nutritional support or gastrointestinal compression....
, 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
Toxic megacolon
Toxic megacolon is an acute form of colonic distension. It is characterized by a very dilated colon , accompanied by abdominal distension , and sometimes fever, abdominal pain, or shock....
), 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 manner.
A potential solution, albeit radical, is a multi-organ transplant. The operation involved transplanting the pancreas, stomach, duodenum, small intestine, and liver, and was performed by Doctor Kareem Abu-Elmagd on Gretchen Miller, the subject of the Discovery Channel
Discovery Channel
Discovery Channel is an American satellite and cable specialty channel , founded by John Hendricks and distributed by Discovery Communications. It is a publicly traded company run by CEO David Zaslav...
program Surgery Saved My Life.
Related disorders
- Ogilvie syndromeOgilvie syndromeOgilvie syndrome is the acute pseudoobstruction and dilation of the colon in the absence of any mechanical obstruction in severely ill patients....
: acute pseudoobstruction of the colon in severely ill debilitated patients. - Hirschsprung's diseaseHirschsprung's diseaseHirschsprung's disease , or congenital aganglionic megacolon is a serious medical problem where the enteric nervous system is missing from the end of the bowel. The enteric nervous system is a complex network of neurons and glia that controls most aspects of intestinal function...
: enlargement of the colon due to lack of development of autonomic ganglia. - Intestinal neuronal dysplasiaIntestinal neuronal dysplasiaIntestinal neuronal dysplasia is an inherited disease of the intestine that effects one in 3000 children and adults...
: a disease of motor neuronMotor neuronIn vertebrates, the term motor neuron classically applies to neurons located in the central nervous system that project their axons outside the CNS and directly or indirectly control muscles...
s leading to the bowels. - Bowel obstructionBowel obstructionBowel obstruction is a mechanical or functional obstruction of the intestines, preventing the normal transit of the products of digestion. It can occur at any level distal to the duodenum of the small intestine and is a medical emergency...
: mechanical or functional obstruction of the bowel most commonly due to adhesions, hernias or neoplasms. - Enteric neuropathyEnteric NeuropathyEnteric neuropathy is a degenerative neuromuscular condition of the digestive system. In simple terms the gut stops functioning, due to degradation of the nerves and muscles. The condition affects all parts of the digestive tract...
: alternative name sometimes used for diagnosis in UK