Ileus, gastrointestinal

Gastrointestinal involvement may present initially as small bowel obstruction shortly after birth (known as meconium ileus) due to abnormally thick meconium that cannot be passed. Older CF patients may develop distal intestinal obstruction syndrome (DIOS), formerly called meconium ileus equivalent, which occurs due to fecal impaction in the terminal ileum and cecum. 

Tsukamoto, K., Mizutani, M., Yamano, M., Suzuki, T., The relationship between gastrointestinal transit and motility in dogs with postoperative ileus, Biol. Pharm. Bull. 1999, 22, 1366-1371. 

Agents include acarbose, miglitol and voglibose. Only bacterial breakdown products of acarbose are absorbed which are then rapidly eliminated by the kidneys. Adverse events mainly consist of gastrointestinal complaints which in rare cases can be confused with ileus. Some hepatotoxicity has been reported. 

The gastrointestinal tract is the only system outside the central nervous system (CNS) with significant concentrations of opioid receptors. This reflects their common embryonic origins. Opioids increase intestinal tone and decrease propulsive peristalsis, resulting in delayed gastric emptying and constipation or ileus. Opioids increase common bile duct pressure and decrease bile production and flow, primarily because of spasm of the sphincter of Oddi. The tone of the bile duct itself is also increased. 

Acetylcholine-blocking drugs should be avoided in patients with prostatic hyperplasia, obstructive gastrointestinal disease (eg, pyloric stenosis or paralytic ileus), or angle-closure glaucoma. In parkinsonism patients receiving antimuscarinic medication, concomitant administration of other drugs with antimuscarinic properties (eg, tricyclic antidepressants or antihistamines) may precipitate some of the complications mentioned above. 

The gastrointestinal tract responds to a number of toxic substances, usually by pain, vomiting, or paralytic ileus (see Intestines, Section 6.4.5). Severe gastrointestinal pain is symptomatic of poisoning by arsenic or iron. Both of these substances can cause vomiting, as can acids, bases, fluorides, salicylates, and theophyllin. Paralytic ileus can result from ingestion of narcotic analgesics, tricyclic antidepressants, and clonidine. 

Amidotrizoate enemas are still sometimes used to treat meconium ileus or constipation, and it is important to give intravenous fluids so as to avoid dehydration. Hypomagnesemia can also occur (150). Osmotic effects lower in the gastrointestinal tract have even led to distention and cecal perforation (151). Stasis of amidotrizoate in dilated loops of bowel can cause inflammatory changes or necrosis (152,153). 

The features of vinca alkaloid-induced polyneuropathy include early loss of tendon reflexes at the ankles and distal paresthesia, followed by loss of touch, pain, and vibration sensations. Other symptoms include headache, malaise, weakness, dizziness, severe face and jaw pain, and vocal cord paralysis. The first symptoms usually occur a few days after drug administration (36). Gastrointestinal discomfort, particularly constipation, abdominal pain, and adynamic ileus, can occur through an autonomic neuropathy (5,48). 

Common symptoms of exposure include mydriasis, sinus tachycardia, hypertension or hypotension, anxiety, hallucinations, psychoses, choreoathetosis, delirium, seizures, dry mouth, flushed skin, decreased gastrointestinal motility, ileus, urinary retention, and hyperpyrexia. Anticholinergic agents may be detected in the urine, but this does not direct clinical management. Due to multiple plant variations, the alkaloid content differs greatly. 

If intravenous ciprofloxacin is not available, oral ciprofloxacin may be acceptable because it is rapidly and well absorbed from the gastrointestinal tract with no substantial loss by first pass metabolism. Maximum serum concentrations are attained 1-2 h after oral dosing but may not be achieved if vomiting or ileus are present In children, ciprofloxacin dosage should not exceed 1 g d ... 

The clinical abnormalities related to the gastrointestinal tract are not life-threatening and can be treated. In newborns with CF, intestinal obstruction (meconium ileus) can occur in 10-20% of cases due to failure of digestion of intraluminal contents due to lack of pancreatic enzymes in utero. Exocrine pancreatic enzyme deficiency is present from birth affecting both lipid and protein digestion. In general, carbohydrate digestion is not severely impaired. 

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