The nurse monitors a patient of acute pancreatitis. Which assessment finding indicates the paralytic ileus has developed?

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Question

This question was previously asked in

SGPGI Staff Nurse Official Paper (Held On: 28 Feb, 2024 Shift 1)

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Answer 1

Correct Answer: Firm, non-tender mass palpable at the lower right costal margin

Rationale:

Acute pancreatitis is a sudden inflammation of the pancreas that can cause severe abdominal pain, digestive issues, and systemic complications. Paralytic ileus is a condition in which the normal peristaltic movements of the intestines are significantly reduced or absent, leading to obstruction-like symptoms without a physical blockage. It can be a complication of acute pancreatitis.
A firm, non-tender mass palpable at the lower right costal margin is indicative of paralytic ileus in patients with acute pancreatitis. This finding suggests that the bowel has become distended and immobile due to a loss of intestinal motility, causing gas and fluid accumulation.
Paralytic ileus often occurs due to inflammation, electrolyte imbalances, or metabolic disturbances associated with acute pancreatitis. It requires timely intervention to prevent further complications such as bowel perforation or infection.

Explanation of Other Options:

Inability to pass flatus

Rationale: While the inability to pass flatus can occur in paralytic ileus, it is a non-specific symptom and does not definitively indicate the condition. It may also be seen in other gastrointestinal obstructions or disorders.

Loss of anal sphincter control

Rationale: Loss of anal sphincter control is not a hallmark sign of paralytic ileus. This symptom is more commonly associated with neurological disorders or severe spinal cord injuries, rather than gastrointestinal complications like paralytic ileus.

Severe, constant pain with rapid onset

Rationale: Severe, constant pain with rapid onset is a characteristic symptom of acute pancreatitis itself rather than paralytic ileus. While paralytic ileus can develop as a complication, pain alone does not confirm its presence.

Firm, non-tender mass palpable at the lower right costal margin

Rationale: This is the correct answer because it reflects the physical manifestation of paralytic ileus in the form of distended and immobile bowel loops. The palpable mass results from the accumulation of gas and fluid, which is consistent with the loss of intestinal motility.

Conclusion:

Paralytic ileus is a serious complication of acute pancreatitis that requires prompt recognition and management. Among the listed options, the presence of a firm, non-tender mass at the lower right costal margin is the most definitive sign of this condition. Understanding the clinical manifestations and associated findings is essential for timely diagnosis and intervention.