Ileus

J has had increasing nausea over the last 12 hours.  He has thrown up three times (but I'll spare you the details).  He has used his pain pump much less over the last 12 hours than he had before, so we're probably finally doing well with pain control.  But the nausea.  Just won't stop.  He lies in bed with his had leaning way over to the side and the little throw up bin cuddled under his chin.  It's pretty sad to watch.  His belly is bulging out this morning.  This is what ileus looks like.


During surgery, the surgeons pull out a neat device called a stun gun.  Before they start to operate they blast all the bowels with this gun so that it won't move.  It's pretty effective, and everyone gets bloated after surgery.  OK, so they don't really blast it with a stun gun, but something about opening up the abdomen results in the bowels stopping their normal, rhythmic movement, necessary to push the food through.  Add to this the effects of anesthesia as well as the common use of narcotics (both of which can slow down the bowels) and you have ileus.  When you listen to the bowel sounds with a stethoscope, you can hardly hear anything.  When you look at x-rays of the gas within the bowels, there's a lot of dilated bowel.  It looks a lot like bowel when it is obstructed, but there are a couple differences.  In an actual obstruction, when you listen to the bowel sounds, it sounds like the belly is going into overdrive trying to push through the obstruction (not that I've listened to an obstructed belly for 8 years).  When you look at the x-rays, you see the same effect of the bowels trying to push everything through, which results in unequal distribution of the fluid within the bowels, as opposed to ileus where everything just kind of equalizes throughout the belly, because there is no attempt to move anything anywhere.

What can we do about it?

J can start moving.  The more movement he makes with his body, the more he helps allow things to move through in his belly.  Oh, and this is one of those times where passing gas is so helpful (if you are ever in the hospital suffering from ileus, don't be polite, let it go, you will feel much better).

J can do nothing (which he wants to do).  With enough time, the bowel will wake up.  (Sadly that puts you behind from a physical therapy stand point).

We can put a tube through his nose and down into his stomach and start relieving the pressure on his bowels.  This would help relieve his symptoms, but we would still have to give him time to start waking his bowels up.  This is the tube that he was gagging on constantly after the first surgery Tuesday.

We can take away his narcotics.  He is on morphine.  Great for pain control, but it slows the bowels down.  Always a balance to decide how essential the narcotic is for pain control compared to how significant the side effects will be.

I haven't seen any lab results yet to know how well we did with the transfusion yesterday.

Goals for today.  Out of bed and into the chair.  Start a liquid diet.