Intestinal obstruction vs paralytic ileus
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(1) Mechanical obstruction
① small intestine: adhesion (m/c), hernia, volvulus, crohn disease, intestinal Tb, radiation enteritis, neoplasm
② large intestine: carcinoma (m/c, Lt>Rt), diverticulitis, volvulus, hernia
(2) Paralytic ileus: Peritonitis, post-op, retroperitoneal hematoma, lower lobe pneumonia, rib Fx, MI, hypokalemia, hypocalcemia, hypomagnesemia, morphine, intestinal ischemia, appendicitis
임상양상
(1) Mechanical obstruction: Cramping abdominal pain, vomiting (not colon obstruction), gas passage (-), fluid & Elctro loss (small bowel 때 더 심함.)
(2) Paralytic ileus: Pain 보다는 distension으로 인한 discomfort
치료
fluid and electrolyte balance, L-tube insertion, simple abdomen f/u, therapeutic NPO, 48시간 이상 호전 없을 때는 op 고려