Natural Remedies For Abdominal Distension
CT plays a major role in the definition of stage T4 (100 sensitivity, 92 specificity, 93 accuracy), namely in the identification of signs of infiltration of the anatomical structures and of adjacent pelvic organs (perirectal fascia, seminal vesicles, uterus vagina, prostate, pelvic muscles, bone segments, etc.) 17,20,21,24 . Two major CT signs indicate a direct involvement of pelvic organs (1) the loss of adipose cleavage planes between the neoplasm and the adjacent organ. However it should be underlined that the obliteration of the adipose plane may be due also to lymphatic or vascular problems, or cachexia, with no real infiltration 18 . In some cases, the excessive gas distension may be per se the cause of the loss of cleavage with adjacent structures 19, 27 . (2) The finding of direct infiltration by the tumour or the observation of a 'bridge' to the tumour and the adjacent organ with densitometric features similar to those of the rectal tumour.
Two reasonably large series and a compilation of other published studies (Yang and Scholten, 1977 Grendon et al., 1995) agree in finding that abdominal pain, abdominal cramping and diarrhoea are the most common findings in symptomatic patients infected with D. fragilis. Other common findings are bloating and flatulence, nausea, and pruritus and, in one group, fatigue. A wide variety of other symptoms have been reported by some patients. In comparison with a D. fragilis-free group, a significantly higher proportion of those infected had eosino-philia eosinophilia was also found in 7 11 paediatric patients in a more recent study (Cuffari et al., 1998).
The Anterior Resection Syndrome (ARS) is characterised by continence disorder, ranging from the inadvertent and uncontrollable passage of flatus to frank faecal incontinence, as well as urgency and increased frequency of evacuation. This syndrome may affect up to 90 of patients with straight colo-
Failure to pass meconium within 48 h of life. Abdominal distension and vomiting. Older children present with failure to thrive, chronic constipation, abdominal distension. Abdominal distension with tinkling bowel sounds if obstruction. PR examination may reveal a tight anal sphincter and hard stools in the rectum, and in the infant may result in sudden passage of stool and flatus, decompressing the abdomen.
A forceful dilatation of the external sphincter and puborectalis muscle results in profound and persistent fall in anal canal pressure 2 and it has been associated with severe damage to the IAS on anal ultrasonography 32 . Another factor might be that the criteria of selection probably vary in different samples as indicated by a varying mean age of the patients. In our experience the functional results after LAR are far from satisfactory when analysed in an unselected samples. During the first month the majority of the patients suffered from increased frequency, pronounced urgency and a good deal of incontinence for faeces and flatus. Although the function gradually improved during the course of one year, about 50 of our patients had permanent disturbances of continence. Finally, low colorectal or colo-anal anastomoses determine a new anatomical shape of the pelvic region characterised by an increase of the anorectal angle. This condition, in...
Meconium ileus is a low intestinal obstruction produced by impaction of abnormal meconium in the distal ileum. It almost always occurs in patients with cystic fibrosis, in which a deficiency of pancreatic enzymes causes the meconium to become abnormally viscous and thick. The effects on the gastrointestinal tract range from temporary meconium retention with delayed but spontaneous evacuation of the meconium, to complete obstruction. When obstruction occurs, the distal ileum is narrowed and contains concretions of grey inspissated meconium pellets (Garza-Cox et al. 2004). Proximal to this the ileum is grossly distended by thick, tenacious, chewing-gum-like meconium due to the viscid, abnormal mucus. Meconium ileus is the earliest manifestation of cystic fibrosis and occurs in 10 -15 of patients. A family history is often elicited. Symptoms usually commence on the first day of life and consist of bile-stained vomiting and abdominal distension. The abdomen may have a doughy feel and it...
Orlistat (Xenical) binds GI lipases in the lumen of gut, which prevents hydrolysis of dietary fat (triglycerides) into absorbable free fatty acids and monoacylglycerols (Fig. 6.2). Orlistat is an irreversible lipase inhibitor and thus decreases the amount of ingested dietary fat that is absorbed Side effects of this medication include decreased absorption of fat-soluble vitamins and nutrients, flatulence, fecal urgency and incontinence, steatorrhea, oily spotting and increased frequency of defecation.
The clinical signs are nonspecific and consist of feeding intolerance, increased gastric retention, vomiting, abdominal distension, and the presence of blood in the stools. Fig. 1.35a,b. Necrotizing enterocolitis. a Photograph of a 3-week-old premature neonate showing important abdominal distension. b Plain abdominal radiograph shows diffuse nonspecific gaseous distension of the bowel loops Fig. 1.35a,b. Necrotizing enterocolitis. a Photograph of a 3-week-old premature neonate showing important abdominal distension. b Plain abdominal radiograph shows diffuse nonspecific gaseous distension of the bowel loops
Low intestinal obstruction is defined as one occurring in the distal ileum or colon. The symptoms are vomiting, abdominal distension, and failure to pass meconium. Fig. 1.18a,b. High intestinal obstruction. a Plain radiograph of a newborn infant that shows an airless abdomen with air only in the stomach. Despite the lack of intestinal air, there is distension of the flanks and elevation of the diaphragms. b Sonography demonstrates the abdominal distension to be produced by fluid-filled intestinal loops. At surgery, a proximal ileal atresia was found Fig. 1.18a,b. High intestinal obstruction. a Plain radiograph of a newborn infant that shows an airless abdomen with air only in the stomach. Despite the lack of intestinal air, there is distension of the flanks and elevation of the diaphragms. b Sonography demonstrates the abdominal distension to be produced by fluid-filled intestinal loops. At surgery, a proximal ileal atresia was found
A R Many risk factors including obesity, abdominal distension (e.g. ascites), postop wound infection. Obstruction Constipation, colicky abdominal pain, nausea, vomiting. Richter hernias have symptoms of obstruction but still pass flatus as the bowel lumen is still patent.
Intestinal obstruction is the most common abdominal emergency in the neonatal period. It is almost always the result of a congenital anomaly of the gastrointestinal tract, which must be rectified surgically if the infant is to survive. Mortality in surgically untreated patients is close to 100 , and the rate of survival is closely related to the time of surgical intervention (Hajivassiliou 2003). The most common clinical findings are abdominal distension, vomiting, and sometimes failure to pass meconium, depending on the level of the obstruction. These findings usually prompt the clinician to consult the radiologist, who must answer three major questions Is the obstruction present What is the location of the obstruction What is the aetiology The most valuable means of determining whether or not obstruction is present is the plain abdominal radiograph. Plain radiographs are often diagnostic. When not diagnostic, they may provide important clues suggesting the subsequent most valuable...
Preventive measures and supportive therapy should be reviewed, as well as the indications for empiric antimicrobial therapy. Antimotility agents such as loperamide and diphenoxylate can improve diarrhea, but should not be used if dysentery or fever is present. Anticholinergic effects may lead paradoxically to abdominal distension, constipation, or paralytic ileus. The older traveler may be wise to begin antimicrobial therapy early in an illness in order to minimize the risk of complications. A fluoroquinolone is the treatment of choice the dose must be reduced if renal failure is present, and caution is
Severe gripping colicky pain with periods of ease, located in the central (small intestine) or lower abdomen (large intestine). Abdominal distension. Absolute constipation - failure to pass either stool or flatus. Abdominal distension with generalised tenderness. Visible peristalsis may be seen.
Diarrhea persisting for more than 2 weeks should also prompt a search for the etiologic agent. A foul odor with nonbloody but greasy-looking stool and excessive flatulence suggests a diagnosis of giardiasis. Bloody stool in a febrile child suggests a bacterial etiology such as shigello-sis. Bloody stool in an afebrile child could represent amebiasis.
Severe ovarian hyperstimulation requiring hospitalization occurs in 1-2 of women undergoing IVF. The enlarged ovaries cause pain, abdominal distension, nausea and vomiting. In severe cases ascites and pleural effusion can cause discomfort and difficulty in breathing. Thrombosis and renal impairment may occur as a result of intravascular dehydration.
These adverse effects after rectal cancer surgery on bowel function are related to sphincter or innervation damage 48 and the loss of rectal reservoir. The type of resection and the level of anastomosis may also play a role 49, 50 . Frequency of bowel motion, urgency, faecal leakage and incontinence are the most reported symptoms. Diarrhoea, constipation and flatus 51, 52 are also reported. Usually, these problems improve over time 53 , but, especially in older patients, it can take a long time 54 . In stoma patients, there is much concern about flatus and foul odour 51, 55 but intensive pre-oper-ative education about colostomy irrigation seems to reduce the incidence of these side effects.
Cellulose is a common constituent in the diet of many animals, including man, but no mammalian cell is known to produce a cellulase. Several species of bacteria in the large bowel synthesize cellulases and digest cellulose, and the major end products of digestion of this and other carbohydrates are volatile fatty acids, lactic acid, methane, hydrogen and carbon dioxide. Fermentation is thus the major source of intestinal gas. Volatile fatty acids (acetic, proprionic and butyric acids) generated from fermentation can be absorbed by passive diffusion in the colon and metabolised in the epithelial cells and liver. Short chain fatty acids remaining in the colon are neutralised by bicarbonate ions which are secreted into the lumen.
Stoma appliances Consist of a pouch and a flange (the portion that sticks to and protects the skin around the stoma). The flange may consist of one or two pieces, the second piece being left attached to the skin for a few days when the pouch is changed. Some bags also have exit drains (e.g. for ileostomies) for liquid output. Charcoal filters can be used to reduce odour of flatus. (See Fig. 28.)
A positive family history is encountered in about 10 of patients with short segment disease and in 25 of patients with total colonic aganglionosis. Hirschsprung's disease is associated with esopha-geal dysmotility syndromes, malrotation and ileal or colonic atresia. Approximately 3 of patients with Down's syndrome have Hirschsprung's disease. The disease has also been associated with other neuro-cristopathies (neuroblastoma, pheochromocytoma, MEN IIA syndrome) and is thought to be related to their common neuroblastic origin (Rescorla et al. 1992). The severity of the symptoms does not depend entirely on the length of the aganglionic segment. Abdominal distension, failure to pass meconium in the first 24 h of life, constipation, and bilious vomiting are the predominant symptoms, with the signs of obstruction appearing within a few days after birth. Functional immaturity of the colon is a common cause of neonatal obstruction, particularly in premature infants and in those whose mothers...
Pneumoperitoneum. a Massive pneumoperitoneum complicating the insertion of a rectal tube. b Pneumoperitoneum (arrows) in a newborn with ileal atresia. c Massive pneumothorax, pneumomediastinum and pneumoperitoneum (arrows) in a patient that had been supported by mechanical ventilation. d Neonate with abdominal distension following the insertion of a rectal thermometer. A supine radiograph shows a lucency occupying the entire abdominal cavity (arrows) and the falciform ligament outlined by air Fig. 1.43a-d. Pneumoperitoneum. a Massive pneumoperitoneum complicating the insertion of a rectal tube. b Pneumoperitoneum (arrows) in a newborn with ileal atresia. c Massive pneumothorax, pneumomediastinum and pneumoperitoneum (arrows) in a patient that had been supported by mechanical ventilation. d Neonate with abdominal distension following the insertion of a rectal thermometer. A supine radiograph shows a lucency occupying the entire abdominal cavity (arrows) and the falciform...
IH Failure to open bowels, constipation. Initally, abdominal distension without pain, but later symptoms may mimic those of true obstruction. History relevant to cause, e.g. recent surgery. E Abdominal distension. Bowel sounds may be reduced or absent. Mild tenderness, if guarding or rebound tenderness, peritonitis should be diagnosed. There may be faecal impaction on rectal examination. Conservative Nil by mouth, NG tube if vomiting, IV fluid replacement and correction of electrolyte imbalances. If faecal impaction, may respond to enema, manual evacuation or placement of a flatus tube for decompression. Medical Treatment of the underlying cause (e.g. infection). In the absence of mechanical obstruction, persistent paralytic ileus may respond to prokinetic agents such as metoclopramide, domperidone or erythromycin. Surgical If the bowel is severely distended and there is danger of perforation, decompression and stoma formation may be needed.
Surgical When there is failure of conservative treatment. Lateral submucous (internal) sphincterotomy involves division of fibres of the internal sphincter, at the 3 o'clock position, distal to the line of the anal valves. This is an effective procedure, but the patient needs to be warned about the risk of incontinence or flatus for a variable period afterwards. Anal stretches are no longer performed as it has often produced irreparable damage to the anal sphincter. An abscess or a subsequent fistula may develop (see Fig. 25b). Up to 15 of those undergoing surgery will experience incontinence of flatus.