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home - Colon - Colonic Motility Disorders - Ogilvies Syndrome Written by Dr Sebastian Zeki
Knowledge

Shows understanding of contemporary knowledge of the range of
factors that control gastrointestinal motility, as well as the means by
which symptoms arising from the GI tract are perceived.

In particular, can describe the enteric nervous system and
understands the ways in which drugs can modify its functioning

Can describe the brain-gut axis and the role of psychological factors
in the genesis of symptoms

Can describe the symptomatology and range of clinical presentations
of patients with irritable bowel syndrome

Knows the diagnostic criteria
Realises the importance of careful clinical assessment as well as the
need for appropriate selection of investigations

Knows the evidence-based treatment options for IBS and the
importance of a holistic and individualised approach to patient
management

Skills
Can make an accurate clinical assessment of patients with irritable
bowel syndrome

Uses investigations selectively
Communicates the diagnosis clearly and sympathetically
Appreciates the degree to which functional gut problems can impair
quality of life. Involves patients in making choice of treatment options

Can explain, where appropriate, that a psychological treatment might
be helpful and refer appropriately

Behaviours
Show a sympathetic understanding of the relevance of symptoms to
the individual and never appears dismissive

Takes time to explain nature of the condition, the treatment options
and appreciates their (often) limited effectiveness

AL

Ogilvies Syndrome

Acute colonic pseudoobstruction (Ogilvie's syndrome) Aetiology:Trauma (nonoperative) occurs-in 11 %.Infection (pneumonia, sepsis most common)-in 10 %.Cardiac (myocardial infarction, heart failure)-in 10 %.Obstetric or gynecology-in 10 %.Abdominal/pelvic surgery-in 9 %.Neurological (Parkinson disease, spinal cord injury, multiple sclerosis, Alzheimer disease) 9 %.Orthopedic surgery -in 7 %.Miscellaneous medical conditions (metabolic, cancer, respiratory failure, renal failure)-in 32 %.Miscellaneous surgical conditions (urologic, thoracic, neurosurgery)-12 %. Definition: Gross dilatation of the caecum and right hemicolon (although occasionally extending to the rectum), in the absence of an anatomic lesion that obstructs the flow of intestinal contents. Clinical Presentation and DiagnosisThis usually occurs in males>60yrs old.N&V abdo pain, constipation, and, paradoxically, diarrhoea can occur.Abdominal distention can be present.Bowel sounds are present in 90%.AXR can show a dilated colon from caecum to splenic flexure and sometimes to rectum. Supportive care:Correct all reversible problems.Ryle’s tube and rectal tube.Discontinue unnecessary medications, especially opiates, sedatives, and anticholinergics.Put patient into a prone position with hips elevated on a pillow or the knee chest position with the hips held high.Alternate patient position with right and left lateral decubitus positions each hour.Conservative therapy can be continued for 24 to 48 hours provided that there is no pain or extreme (>12 cm) colonic distension. NeostigmineThis is an acetylcholinesterase inhibitor (90% effe-tive- 1/3rd recur) .Repeated neostigmine can be given for recurrence.The median time to response is 4 mins.Neostigmine need cardiac monitoring.Lower doses (1.5 mg) may also be effective and may possibly decrease abdominal cramping, nausea, and vomiting, which can be severe.Some side-effects can be reduced (esp bradycardia and bronchoconstriction) with glycopyrrolate (anticholinergic agent with limited activity on colonic muscarinic receptors).Electrolyte imbalance and use of antimotility agents predicts a poor response.Postoperative patients tend to respond the best. SurgeryPercutaneous endoscopic cecostomy can be effective for treatment for both acute colonic pseudo-obstruction and neurogenic bowel. 24-48 hrs igmine Neost Decompression:Endoscopic decompression and placement of a decom-pression tube in transverse colon may be successful in 75%- usually try when the colon is around 11cm.If endoscopic decompression fails, try PEC placement. Written by Dr Sebastian Zeki

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