Diet Advice to Manage a Partial Bowel Obstruction
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Inflammatory Bowel Disease Irritable Bowel Syndrome
Inflammatory Bowel Disease and Irritable Bowel Syndrome Similarities and Differences 2 www.ccfa.org IBD Help Center: 888.MY.GUT.PAIN 888.694.8872 Important Differences Between IBD and IBS Many diseases and conditions can affect the gastrointestinal (GI) tract, which is part of the digestive system and includes the esophagus, stomach, small intestine and large intestine. These diseases and conditions include inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS). IBD Help Center: 888.MY.GUT.PAIN 888.694.8872 www.ccfa.org 3 Inflammatory bowel diseases are a group of inflammatory conditions in which the body’s own immune system attacks parts of the digestive system. Inflammatory Bowel Disease Inflammatory bowel diseases are a group of inflamma- Causes tory conditions in which the body’s own immune system attacks parts of the digestive system. The two most com- The exact cause of IBD remains unknown. Researchers mon inflammatory bowel diseases are Crohn’s disease believe that a combination of four factors lead to IBD: a (CD) and ulcerative colitis (UC). IBD affects as many as 1.4 genetic component, an environmental trigger, an imbal- million Americans, most of whom are diagnosed before ance of intestinal bacteria and an inappropriate reaction age 35. There is no cure for IBD but there are treatments to from the immune system. Immune cells normally protect reduce and control the symptoms of the disease. the body from infection, but in people with IBD, the immune system mistakes harmless substances in the CD and UC cause chronic inflammation of the GI tract. CD intestine for foreign substances and launches an attack, can affect any part of the GI tract, but frequently affects the resulting in inflammation. -
General Signs and Symptoms of Abdominal Diseases
General signs and symptoms of abdominal diseases Dr. Förhécz Zsolt Semmelweis University 3rd Department of Internal Medicine Faculty of Medicine, 3rd Year 2018/2019 1st Semester • For descriptive purposes, the abdomen is divided by imaginary lines crossing at the umbilicus, forming the right upper, right lower, left upper, and left lower quadrants. • Another system divides the abdomen into nine sections. Terms for three of them are commonly used: epigastric, umbilical, and hypogastric, or suprapubic Common or Concerning Symptoms • Indigestion or anorexia • Nausea, vomiting, or hematemesis • Abdominal pain • Dysphagia and/or odynophagia • Change in bowel function • Constipation or diarrhea • Jaundice “How is your appetite?” • Anorexia, nausea, vomiting in many gastrointestinal disorders; and – also in pregnancy, – diabetic ketoacidosis, – adrenal insufficiency, – hypercalcemia, – uremia, – liver disease, – emotional states, – adverse drug reactions – Induced but without nausea in anorexia/ bulimia. • Anorexia is a loss or lack of appetite. • Some patients may not actually vomit but raise esophageal or gastric contents in the absence of nausea or retching, called regurgitation. – in esophageal narrowing from stricture or cancer; also with incompetent gastroesophageal sphincter • Ask about any vomitus or regurgitated material and inspect it yourself if possible!!!! – What color is it? – What does the vomitus smell like? – How much has there been? – Ask specifically if it contains any blood and try to determine how much? • Fecal odor – in small bowel obstruction – or gastrocolic fistula • Gastric juice is clear or mucoid. Small amounts of yellowish or greenish bile are common and have no special significance. • Brownish or blackish vomitus with a “coffee- grounds” appearance suggests blood altered by gastric acid. -
A Case Report of Fibro-Stenotic Crohn's Disease in the Middle
DOI: https://doi.org/10.22516/25007440.185 Case report A Case Report of Fibro-Stenotic Crohn’s Disease in the Middle Ileum as the Initial Manifestation Adriana Margarita Rey,1 Gustavo Reyes,1 Fernando Sierra,1 Rafael García-Duperly,2 Rocío López,3 Leidy Paola Prada.4 1 Gastroenterologist in the Gastroenterology and Abstract Hepatology Service of the Hospital Universitario Fundación Santa Fe de Bogotá in Bogotá, Colombia Crohn’s disease (CD) is an inflammatory bowel disease that can affect the entire gastrointestinal tract. The small 2 Colon and Rectum Surgeon in the Department of intestine is affected in about 50% of patients among whom the terminal ileum is the area most commonly affected. Surgery of the Hospital Universitario Fundación Intestinal stenosis is a common complication in CD and approximately 30% to 50% of patients present Santa Fe de Bogotá in Bogotá, Colombia 3 Pathologist at of the Hospital Universitario Fundación stenosis or penetrating lesions at the time of diagnosis. Because conventional endoscopic techniques do not Santa Fe de Bogotá and Professor at Universidad de allow evaluation of small bowel lesions, techniques such as enteroscopy and endoscopic video-capsule were los Andes in Bogotá, Colombia developed. Each has advantages and indications. 4 Third Year Internal Medicine Resident at the Hospital Universitario Fundación Santa Fe de Bogotá in We present the case of a patient with CD with localized fibrostenosis in the middle ileum which is not a Bogotá, Colombia frequent site for this type of lesion. Author for correspondence: Adriana Margarita Rey. Bogotá D.C. Colombia [email protected] Keywords ........................................ -
Adult Intussusception
1 Adult Intussusception Saulius Paskauskas and Dainius Pavalkis Lithuanian University of Health Sciences Kaunas Lithuania 1. Introduction Intussusception is defined as the invagination of one segment of the gastrointestinal tract and its mesentery (intussusceptum) into the lumen of an adjacent distal segment of the gastrointestinal tract (intussuscipiens). Sliding within the bowel is propelled by intestinal peristalsis and may lead to intestinal obstruction and ischemia. Adult intussusception is a rare condition wich can occur in any site of gastrointestinal tract from stomach to rectum. It represents only about 5% of all intussusceptions (Agha, 1986) and causes 1-5% of all cases of intestinal obstructions (Begos et al., 1997; Eisen et al., 1999). Intussusception accounts for 0.003–0.02% of all hospital admissions (Weilbaecher et al., 1971). The mean age for intussusception in adults is 50 years, and and the male-to-female ratio is 1:1.3 (Rathore et. al., 2006). The child to adult ratio is more than 20:1. The condition is found in less than 1 in 1300 abdominal operations and 1 in 100 patients operated for intestinal obstruction. Intussusception in adults occurs less frequently in the colon than in the small bowel (Zubaidi et al., 2006; Wang et al., 2007). Mortality for adult intussusceptions increases from 8.7% for the benign lesions to 52.4% for the malignant variety (Azar & Berger, 1997) 2. Etiology of adult intussusception Unlike children where most cases are idiopathic, intussusception in adults has an identifiable etiology in 80- 90% of cases. The etiology of intussusception of the stomach, small bowel and the colon is quite different (Table 1). -
Diagnostic Approach to Chronic Constipation in Adults NAMIRAH JAMSHED, MD; ZONE-EN LEE, MD; and KEVIN W
Diagnostic Approach to Chronic Constipation in Adults NAMIRAH JAMSHED, MD; ZONE-EN LEE, MD; and KEVIN W. OLDEN, MD Washington Hospital Center, Washington, District of Columbia Constipation is traditionally defined as three or fewer bowel movements per week. Risk factors for constipation include female sex, older age, inactivity, low caloric intake, low-fiber diet, low income, low educational level, and taking a large number of medications. Chronic constipa- tion is classified as functional (primary) or secondary. Functional constipation can be divided into normal transit, slow transit, or outlet constipation. Possible causes of secondary chronic constipation include medication use, as well as medical conditions, such as hypothyroidism or irritable bowel syndrome. Frail older patients may present with nonspecific symptoms of constipation, such as delirium, anorexia, and functional decline. The evaluation of constipa- tion includes a history and physical examination to rule out alarm signs and symptoms. These include evidence of bleeding, unintended weight loss, iron deficiency anemia, acute onset constipation in older patients, and rectal prolapse. Patients with one or more alarm signs or symptoms require prompt evaluation. Referral to a subspecialist for additional evaluation and diagnostic testing may be warranted. (Am Fam Physician. 2011;84(3):299-306. Copyright © 2011 American Academy of Family Physicians.) ▲ Patient information: onstipation is one of the most of 1,028 young adults, 52 percent defined A patient education common chronic gastrointes- constipation as straining, 44 percent as hard handout on constipation is 1,2 available at http://family tinal disorders in adults. In a stools, 32 percent as infrequent stools, and doctor.org/037.xml. -
Today's Topic: Bloating
Issue 1; August 2017 Dr. Rajiv Sharma attended medical school at Daya- nand Medical College, Punjab, India. He received his Undernourished, intelligence Internal Medicine training from Loma Linda Univer- sity, Loma Linda, California and received his Gastro- becomes like the bloated belly enterology Fellowship training from University of Rochester, Rochester, New York. Dr. Sharma trained of a starving child: swollen, under the mentorship of Dr. Richard G. Farmer, who is world renowned for his work on Inflammatory Bowel Disease. filled with nothing the body Rajiv Sharma, MD Dr. Sharma’s special interests include GERD, NERD, can use.” Inflammatory Bowel Disease (Crohn’s & Ulcerative Colitis), IBS, Acute and Chronic Pancreatitis, Gastro- intestinal Malignancies and Familial Cancer Syn- - Andrea Dworkin dromes. In an effort to share his extensive knowledge with the public, Dr. Sharma re- leased his first book, Pursuit of Gut Happiness: A Guide for Using Probiotics to Inside this issue Achieve Optimal Health, in 2014. In Dr. Sharma’s free time, he enjoys medical writing, watching movies, exercis- Differential Diagnosis 2 ing and spending time with his family. He believes in “whole person care” and the effect of mind, body and spirit on “wellness”. He has a special interest in nu- trition, exercise and healthy eating. He prides himself on being a “fact doctor” as Signs of a More Serious 2 he backs his opinions and works with solid scientific research while aiming to deliver a simple and clear message. Problem Lab Workup 2 Non-Pathological Bloating 2 Today’s Topic: Bloating Bloating may seem an odd topic to choose for our first newsletter. -
Recognizing-Consitpation-And-Bowel
Hughes Melton, MD Post Office Box 1797 Commissioner Richmond, Virginia 23218-1797 Office of Integrated Health Health & Safety Information Dr. Dawn M. Adams DNP, ANP-BC, CHC Director, Office of Integrated Health Recognizing Constipation & Preventing Bowel Obstruction 2018 Recognizing Constipation Constipation is a disorder that occurs when bowel movements become difficult or less frequent is frequently seen in many people. Individuals with developmental disabilities often have problems with chronic constipation as a result of but not limited to: Medication side effects Neuromuscular problems related to the person's disability Signs of Constipation small infrequent bowel movements hemorrhoids due to straining with bowel movements increased abdominal girth abdominal pain Chronic constipation Chronic constipation must be addressed in all individuals. This can often be a silent problem, especially for individuals who are independent in toileting activities. Without treatment, chronic constipation can lead to bowel obstruction, bowel perforation and death. Bowel Obstruction (Intestinal Obstruction) A partial or complete block of the small or large intestine that keeps food, liquid, gas, and stool from moving through the intestines in a normal way. October 2018 Hughes Melton, MD Post Office Box 1797 Commissioner Richmond, Virginia 23218-1797 Bowel obstructions may be caused by a twist in the intestines. Intestines are called the gut. The large intestine includes the appendix, cecum, colon, and rectum and is 5 feet long. It absorbs water from stool and changes it from a liquid to a solid form. The small intestine is where most digestion occurs. It measures about 20 feet and includes the duodenum, jejunum, and ileum. o Digestion is the process of breaking down food into substances the body can use for energy, tissue growth, and repair. -
Travelers' Diarrhea
Travelers’ Diarrhea What is it and who gets it? Travelers’ diarrhea (TD) is the most common illness affecting travelers. Each year between 20%-50% of international travelers, an estimated 10 million persons, develop diarrhea. The onset of TD usually occurs within the first week of travel but may occur at any time while traveling and even after returning home. The primary source of infection is ingestion of fecally contaminated food or water. You can get TD whenever you travel from countries with a high level of hygiene to countries that have a low level of hygiene. Poor sanitation, the presence of stool in the environment, and the absence of safe restaurant practices lead to widespread risk of diarrhea from eating a wide variety of foods in restaurants, and elsewhere. Your destination is the most important determinant of risk. Developing countries in Latin America, Africa, the Middle East, and Asia are considered high risk. Most countries in Southern Europe and a few Caribbean islands are deemed intermediate risk. Low risk areas include the United States, Canada, Northern Europe, Australia, New Zealand, and several of the Caribbean islands. Anyone can get TD, but persons at particular high-risk include young adults , immunosuppressed persons, persons with inflammatory-bowel disease or diabetes, and persons taking H-2 blockers or antacids. Attack rates are similar for men and women. TD is caused by bacteria, protozoa or viruses that are ingested by eating contaminated food or beverages. For short-term travelers in most areas, bacteria are the cause of the majority of diarrhea episodes. What are common symptoms of travelers’ diarrhea? Most TD cases begin abruptly. -
Patient Selection Criteria
M∙ACS MACS Patient Selection Criteria The objective is to screen, on a daily basis, the Acute Care Surgical service “touches” at your hospital to identify patients who meet criteria for further data entry. The specific patient diseases/conditions that we are interested in capturing for emergent general surgery (EGS) are: 1. Acute Appendicitis 2. Acute Gallbladder Disease a. Acute Cholecystitis b. Choledocholithiasis c. Cholangitis d. Gallstone Pancreatitis 3. Small Bowel Obstruction a. Adhesive b. Hernia 4. Emergent Exploratory Laparotomy (Refer to the ex-lap algorithm under the Diseases or Conditions section below for inclusion/exclusion criteria.) The daily census for patients admitted to the Acute Care Surgery Service or seen as a consult will have to be screened. There may be other sources to accomplish this screening such as IT and we are interested in learning about these sources from you. From this census, a list can be compiled of patients with the aforementioned diseases/conditions. The first level of data entry involves capture and entry of the patient into the MACS Qualtrics database. All patients with the identified diseases/conditions will have data entered regardless of whether or not they received an operation during admission/ED visit. The second level of data entry takes place if an existing MACS patient returns to the hospital (ED or admission) or has outcome events identified within the 30-day post-operative time frame if the patient had surgery, or within 30 days from discharge for the non-operative patients. You will see that we are capturing diagnostic, interventional, and therapeutic data that extend beyond what is typically captured for MSQC patients. -
Symptomatic Approach to Gas, Belching and Bloating 21
20 Osteopathic Family Physician (2019) 20 - 25 Osteopathic Family Physician | Volume 11, No. 2 | March/April, 2019 Gennaro, Larsen Symptomatic Approach to Gas, Belching and Bloating 21 Review ARTICLE to escape. This mechanism prevents the stomach from becoming IRRITABLE BOWEL SYNDROME (IBS) Symptomatic Approach to Gas, Belching and Bloating damaged by excessive dilation.2 IBS is abdominal pain or discomfort associated with altered with OMT Treatment Options Many patients with GERD report increased belching. Transient bowel habits. It is the most commonly diagnosed GI disorder lower esophageal sphincter (LES) relaxation is the major and accounts for about 30% of all GI referrals.7 Criteria for IBS is recurrent abdominal pain at least one day per week in the Carly Gennaro, DO1; Helaine Larsen, DO1 mechanism for both belching and GERD. Recent studies have shown that the number of belches is related to the number of last three months associated with at least two of the following: times someone swallows air. These studies have concluded that 1) association with defecation, 2) change in stool frequency, 1 Good Samaritan Hospital Medical Center, West Islip, NY patients with GERD swallow more air in response to heartburn and 3) change in stool form. Diagnosis should be made using these therefore belch more frequently.3 There is no specific treatment clinical criteria and limited testing. Common symptoms are for belching in GERD patients, so for now, physicians continue to abdominal pain, bloating, alternating diarrhea and constipation, treat GERD with proton pump inhibitors (PPIs) and histamine-2 and pain relief after defecation. Pain can be present anywhere receptor antagonists with the goal of suppressing heartburn and in the abdomen, but the lower abdomen is the most common KEYWORDS: ABSTRACT: Intestinal gas production is a normal physiologic progress. -
Small Bowel Obstruction Following Appendectomy: a Retrospective Study
New Indian Journal of Surgery21 Original Article January - March 2012, Volume 3 Number 1 Small Bowel Obstruction Following Appendectomy: A Retrospective Study Jyothi S Karegoudar*, Prabhakar PJ**, Rajashri S Patil***, VIjayanath V**** *Asso. Prof in General Surgery, ** Prof & HOD in General Surgery, ***Asst. Prof (biostatistician), S. S. I. M. S & R. C., Davangere, Karnataka State, ****MD, DNB, MNAMS, Associate Professor, Department of Forensic Medicine & Toxicology, Vinayaka Mission’s Kirupananda Variyar Medical College & Hospital, Salem,Tamil Nadu, India. Abstract appendectomy adhesive small bowel The incidence of post-operative small bowel obstruction occurs in 1 to 1.5% of all patients obstruction after standard, open appendectomy was within 14 years of the operation.[1] calculated during five year duration at S. S. Institute Appendectomy is one of the most frequently and Research Centre, Davangere, Karnataka State. performed emergency surgery, and it is Post-operative small bowel obstruction is one of associated with various short and long term the adverse effects of appendectomy but its frequency morbidities. Postoperative small bowel varies from centre to centre. The incidence of small obstruction is recognized as long term adverse bowel obstruction is significantly high in perforated effect of appendectomy.[2] appendicitis, midline incisions, and chronic appendicular pathology. The midline incision has The frequency of this complication is not increased the frequency of post-operative adhesions. well known but the reported risk ranges from This study was conducted to determine the 0.2- 10.7%.[3] The post-operative adhesions incidence of this complication among our patients are a significant problem after colorectal who had open appendectomy and identify the factors surgery. -
Colonic Ischemia 9/21/14, 9:02 PM
Colonic ischemia 9/21/14, 9:02 PM Official reprint from UpToDate® www.uptodate.com ©2014 UpToDate® Colonic ischemia Authors Section Editors Deputy Editor Peter Grubel, MD John F Eidt, MD Kathryn A Collins, MD, PhD, FACS J Thomas Lamont, MD Joseph L Mills, Sr, MD Martin Weiser, MD All topics are updated as new evidence becomes available and our peer review process is complete. Literature review current through: Aug 2014. | This topic last updated: Aug 25, 2014. INTRODUCTION — Intestinal ischemia is caused by a reduction in blood flow, which can be related to acute arterial occlusion (embolic, thrombotic), venous thrombosis, or hypoperfusion of the mesenteric vasculature causing nonocclusive ischemia. Colonic ischemia is the most frequent form of intestinal ischemia, most often affecting the elderly [1]. Approximately 15 percent of patients with colonic ischemia develop gangrene, the consequences of which can be life-threatening, making rapid diagnosis and treatment imperative. The remainder develops nongangrenous ischemia, which is usually transient and resolves without sequelae [2]. However, some of these patients will have a more prolonged course or develop long-term complications, such as stricture or chronic ischemic colitis. The diagnosis and treatment of patients can be challenging since colonic ischemia often occurs in patients who are debilitated and have multiple medical problems. The clinical features, diagnosis, and treatment of ischemia affecting the colon and rectum will be reviewed here. Acute and chronic intestinal ischemia of the small intestine are discussed separately. (See "Acute mesenteric ischemia" and "Chronic mesenteric ischemia".) BLOOD SUPPLY OF THE COLON — The circulation to the large intestine and rectum is derived from the superior mesenteric artery (SMA), inferior mesenteric artery (IMA), and internal iliac arteries (figure 1).