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Innere Medizin kk: Ogilvie

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Anatomie des Dickdarmes

Ogilvie Syndrom = Intestinale  Pseudoobstruktion Extrem überblähter Dickdarm ohne klar erkennbare Ursache

Diagnostik

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  • Röntgen Abdomen oder Thorax im Stehen
  • Sono Abdomen
  • Gastrografineinlauf
  • Coloskopie + Dekompression

Therapie

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Übersicht

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  • Medikamentöse Maßnahmen:
    • Mestinon (nicht anzuwenden bei Patienten mit Muskeldystropie z.B. Duchenne)
    • Gabe von Neostigmin (ACh-Esterasehemmer)
    • Flüssigkeitsgabe intravenös
  • Darmrohr und Einläufe
  • Magensonde bei Erbrechen
  • Dekompression mittels Darmspiegelung
  • Künstlicher Darmausgang am Coecum

Darmrohr

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Donnertropf

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  • Der Donnertropf besteht aus den Bestandteilen
    • Metoclopramid (z.B. Paspertin 2ml/10mg Amp.)
    • Neostigmin (z.B. Prostigmin 1ml/0,5mg Amp.)
  • und eine entsprechende Trägerlösung (Ringer, physiologische Kochsalzlösung, G5%) mit einem Volumen von 500ml.

Zusammensetzung Der Donnertropf wird zusammengestellt aus jeweils 6 Ampullen der oben aufgeführten Bestandteile und der Trägerlösung.

Gesamtvolumen: 530ml

Infusionsgeschwindigkeit: 40-80ml/h, (entsprechend ca. 6-13 Stunden)

Der Darmtonus soll maximal angeregt werden

Medikamentöse Alternativen:

  • Ceruletid (Takus)
  • Erythromycin

Dekompression mittels Endoskopie

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Komplikationen

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Differentialdiagnose

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Risikofaktoren

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Fall

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Fragen

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Literatur

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Klassische Arbeit

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  • Ogilvie WH. Large intestine colic due to sympathetic deprivation: a new clinical syndrome. BMJ. 1948;2:671-3.

Weitere Literatur

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  • Ponec RJ, Saunders MD, Kimmey MB (1999)
    • Neostigmine for the treatment of acute colonic pseudo-obstruction.
      • N Engl J Med 341: 137–41
  • Armstrong DN, Ballantyne GH, Modlin IM. Erythromycin for reflex ileus in Ogilvie's syndrome. **Lancet. Feb 9 1991;337(8737):378.
  • Bharucha AE, Phillips SF. Megacolon: Acute, Toxic, and Chronic. Curr Treat Options Gastroenterol. Dec 1999;2(6):517-523.
  • Bode WE, Beart RW Jr, Spencer RJ, et al. Colonoscopic decompression for acute pseudoobstruction of the colon (Ogilvie's syndrome). Report of 22 cases and review of the literature. Am J Surg. Feb 1984;147(2):243-5.
  • Cherta I, Forne M, Quintana S, et al. Prolonged treatment with neostigmine for resolution of acute colonic pseudo-obstruction. Aliment Pharmacol Ther. Jun 1 2006;23(11):1678-9.
  • Datta SN, Stephenson BM, Havard TJ, et al. Acute colonic pseudo-obstruction. Lancet. Mar 13 1993;341(8846):690. [Medline].
  • Dorudi S, Berry AR, Kettlewell MG. Acute colonic pseudo-obstruction. Br J Surg. Feb 1992;79(2):99-103.
  • Fiorito JJ, Schoen RE, Brandt LJ. Pseudo-obstruction associated with colonic ischemia: successful management with colonoscopic decompression. Am J Gastroenterol. Oct 1991;86(10):1472-6.
  • Geller A, Petersen BT, Gostout CJ. Endoscopic decompression for acute colonic pseudo-obstruction. Gastrointest Endosc. Aug 1996;44(2):144-50.
  • Harig JM, Fumo DE, Loo FD, et al. Treatment of acute nontoxic megacolon during colonoscopy: tube placement versus simple decompression. Gastrointest Endosc. Jan-Feb 1988;34(1):23-7.
  • Jetmore AB, Timmcke AE, Gathright JB Jr, et al. Ogilvie's syndrome: colonoscopic decompression and analysis of predisposing factors. Dis Colon Rectum. Dec 1992;35(12):1135-42. [Medline].
  • Johnston G, Vitikainen K, Knight R, et al. Changing perspective on gastrointestinal complications in patients undergoing cardiac surgery. Am J Surg. May 1992;163(5):525-9.
  • Laine L. Management of acute colonic pseudo-obstruction. N Engl J Med. Jul 15 1999;341(3):192-3.
  • Longo WE, Vernava AM 3rd. Prokinetic agents for lower gastrointestinal motility disorders. Dis Colon Rectum. Jul 1993;36(7):696-708.
  • Lynch CR, Jones RG, Hilden K, et al. Percutaneous endoscopic cecostomy in adults: a case series. Gastrointest Endosc. Aug 2006;64(2):279-82. [Medline].
  • McNamara R, Mihalakis MJ. Acute Colonic Pseudo-Obstruction: Rapid Correction With Neostigmine In The Emergency Department.
  • Mehta R, John A, Nair P, et al. Factors predicting successful outcome following neostigmine therapy in acute colonic pseudo-obstruction: a prospective study. J Gastroenterol Hepatol. Feb 2006;21(2):459-61.
  • Nelson JD, Urban JA, Salsbury TL, et al. Acute colonic pseudo-obstruction (Ogilvie syndrome) after arthroplasty in the lower extremity. J Bone Joint Surg Am. Mar 2006;88(3):604-10.
  • Rovira A, Lopez A, Cambray C, et al. Acute colonic pseudo-obstruction (Ogilvie's syndrome) treated with erythromycin. Intensive Care Med. Jul 1997;23(7):798.
  • Saunders MD. Acute colonic pseudo-obstruction. Best Pract Res Clin Gastroenterol. 2007;21(4):671-87.
  • Saunders MD, Cappell MS. Endoscopic management of acute colonic pseudo-obstruction. Endoscopy. Aug 2005;37(8):760-3.
  • Saunders MD, Kimmey MB. Acute colonic pseudo-obstruction. Current Perspectives in Gastroenterology. 2000;3:156-62.
  • Sgouros SN, Vlachogiannakos J, Vassiliadis K, et al. Effect of polyethylene glycol electrolyte balanced solution on patients with acute colonic pseudo obstruction after resolution of colonic dilation: a prospective, randomised, placebo controlled trial. Gut. May 2006;55(5):638-42.
  • Shrestha BM, Darby C, Fergusson C, et al. Cytomegalovirus causing acute colonic pseudo-obstruction in a renal transplant recipient. Postgrad Med J. Jul 1996;72(849):429-30.
  • Sloyer AF, Panella VS, Demas BE, et al. Ogilvie's syndrome. Successful management without colonoscopy. Dig Dis Sci. Nov 1988;33(11):1391-6.
  • Stephenson BM, Morgan AR, Drake N, et al. Parasympathomimetic decompression of acute colonic pseudo-obstruction. Lancet. Nov 6 1993;342(8880):1181-2.
  • Stephenson BM, Morgan AR, Salaman JR, et al. Ogilvie's syndrome: a new approach to an old problem. Dis Colon Rectum. Apr 1995;38(4):424-7.
  • Stieger DS, Cantieni R, Frutiger A. Acute colonic pseudoobstruction (Ogilvie's syndrome) in two patients receiving high dose clonidine for delirium tremens. Intensive Care Med. Jul 1997;23(7):780-2.
  • Turegano-Fuentes F, Munoz-Jimenez F, Del Valle-Hernandez E, et al. Early resolution of Ogilvie's syndrome with intravenous neostigmine: a simple, effective treatment. Dis Colon Rectum. Nov 1997;40(11):1353-7.
  • Vanek VW, Al-Salti M. Acute pseudo-obstruction of the colon (Ogilvie's syndrome). An analysis of 400 cases. Dis Colon Rectum. Mar 1986;29(3):203-10.
  • vanSonnenberg E, Varney RR, Casola G, et al. Percutaneous cecostomy for Ogilvie syndrome: laboratory observations and clinical experience. Radiology. Jun 1990;175(3):679-82.
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