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ILEUS PARALITIK

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ILEUS?
Suatu keadaan terjadinya intestinal statis atau disfungsi yang disertai pelebaran lumen dan penebalan dinding. Berdasarkan etiologinya, ileus dapat dibedakan atas dua golongan:
Obstruksi mekanis
Intra luminar obstruction, misalnya tumor intra luminar, intususepsi Ekstrinsik obstruction, misalnya adhesi, inflamasi, tumor ekstrinsik.

Obstruksi adinamik (ileus paralitik)

ILEUS PARALITIK?
Suatu keadaan akut abdomen* berupa kembung karena usus tidak berkontraksi akibat adanya gangguan motilitas
* Akut abdomen proses intraabdomen yang menyebabkan severe pain yang memerlukan perawatan di RS dan sebelumnya belum mendapat terapi/diperiksa dan mungkin memerlukan intervensi bedah

ETIOLOGI ILEUS PARALITIK


Peritonitis Ileus pasca bedah Setelah trauma abdomen Gangguan elektrolit Metastase peritoneal yang difus Obat-obatan ( obat spasmolitik )

PATOFISIOLOGI
Pembedahan abdominal ileus fisiologis hilang dalam 2-3 hari Bila ileus menetap dalam waktu lebih dari 3 hari setelah pembedahan ileus paralitik
Post operasi aktivasi refleks inhibisi dari arkus spinal hipomotilitas traktus gastrointestinal otot dinding usus terganggu gagal untuk mengalirkan isi usus akumulasi gas dan cairan dalam usus

MANIFESTASI KLINIS
Nyeri abdomen (sedang, difus) Mual, muntah Konstipasi absolut Distensi abdomen Pergerakan usus minimal, flatulence << Bunyi peristaltik kurang atau menghilang Defense muskular

PERBANDINGAN KLINIS
Macam ileus Obstruksi simple tinggi Obstruksi simple rendah Obstruksi strangulasi Nyeri Usus ++ (kolik) +++ (Kolik) ++++ (terusmenerus, terlokalisir) + Distensi + Muntah borborigmi +++ Bising usus Meningkat Ketegangan abdomen -

+++

+ Lambat, fekal +++

Meningkat

++

Tak tentu biasanya meningkat

Paralitik

++++

Menurun

Oklusi vaskuler

+++++

+++

+++

Menurun

GAMBARAN RADIOLOGIS
Terdapat distensi baik pada usus halus maupun usus besar, termasuk lambung dan rektosigmoid Air-fluid level pada usus halus dan usus besar muncul hanya jika ileus bertahan sampai 5-7 hari. Seluruh rongga usus terisi udara Preperitoneal fat menjadi tipis atau kadang menghilang Membentuk gambaran herring bone (duri ikan) atau bag of popcorn

CRITERIA
GAS DISTRIBUTION

OBSTRUKTIF
More air proximal to the obstruction than distal to it.

PARALITIK
No preferential collection of air.

BOWEL DILATATION AIR-FLUID LEVEL

Dilatation proximal to the site of obstruction.


Many dilated air-fluid levels. step ladder appearance or more orderly arrangement (resembles a bag of sausages). (+)

Generalized dilatation of all bowel.


Fewer air-fluid level that are not dilated. Herring bone or resembles a bag of popcorn (less orderly arrangement).

ARRANGEMENT OF BOWEL LOOPS

PREPERITONEAL FAT

(-)

Jika: - terdapat dilatasi lokal (mis. Usus halus saja) - terdapat pada suatu bagian usus tempat distensi berakhir (mis. Pertengahan kolon transversum) - rektum kosong tidak terisi gas

curiga obstruksi mekanis

Jika: seluruh bagian usus dan gaster dilatasi

curiga ileus paralitik

(1) ILEUS PARALITIK (7 DAY OLD FEMALE)

(1) INTERPRETASI
Gas Distribution: There are pockets of gas scattered in several areas of the abdomen. There is gas in the small bowel, colon, and rectum. Bowel Dilatation: There is mild dilation of the bowel, mostly in the colon. The dilated segment of bowel in the left upper quadrant shows relatively smooth bowel walls. However, most of the bowel does not show this. In other words, the haustra and plicae of most of the bowel are well preserved. Air-Fluid Levels: None. Arrangement of Loops: The loops are not arranged in an orderly pattern.

(2) ILEUS PARALITIK (1 MONTH OLD FEMALE)

(2) INTERPRETASI
Gas Distribution: There is a lot of gas in the small and large bowel distributed throughout the abdomen. Bowel Dilatation: The degree of bowel dilation here is proportional throughout. In other words, the large bowel is slightly dilated, as is the small bowel. Air-Fluid Levels: None. Arrangement of Loops: Disorderly arrangement of dilated bowel. This resembles a bag of popcorn rather than a bag of sausages.

(3) ILEUS PARALITIK (3 DAY OLD FEMALE)

(3) INTERPRETASI
Gas Distribution: Generalized presence of gas throughout all quadrants. Bowel Dilatation: The degree of bowel dilatation is proportional. The right lower quadrant may demonstrate some smooth bowel walls, but this is probably just the descending colon. Some of the haustra in these segments are still preserved. For the remainder of the bowel, the haustra and plicae are well preserved. Air-Fluid Levels: None. Arrangement of Loops: Disorderly arrangement resembling a bag of popcorn.

SUMBER
Livingstone AS, Sasa JL. Ileus and obstruction in Haubrich WS, Schaffner F (eds); Bockus Gastroenterology 5th ed. Philadelphia, WB Saunders Co., 1995 Sileu W. Acute intestinal obstruction. In : Isselbacher KJ, Braunwald E, Wilson JD, Martin JB, Fauci AS, Kasper DL (eds). Harrisons Principles of Internal Medicine 13th ed : New York, Mc Graw-Hill, 1994 Schuffer WD, Sinanan MN. Intestinal obstruction and pseudoobstruction in : Sleissenger MH, Fordtran JS (eds). Gastrointestinal Disease; Pathophysiology/ Diagnosis / Management 5th ed. Philadelphia, WB Saunders Co, 1993 Livingstone EH, Passoro EP. Postoperative ileus. Dig. Dis. Sci. 1990; 35 : 121-32 Saudgren JE, Mc Phee MS, Greenberger NJ. Narcotic bowel syndrome treated with clonidin. Resolution of abdominal pain and pseudoobstruction. Ann Intern Med 1990; 101 : 331-4.