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Query: UMLS:C0021843 (bowel obstruction)
 9,927 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Elemental enteral alimentation (EEA) is an alternative to parenteral nutrition in patients with a functioning gastrointestinal tract and increased caloric requirements or in whom regular oral feeding is impossible or impractical. EEA is given by nasogastric, jejunostomy, or gastrostomy tube. It is useful in cases of short-gut syndrome, pancreatic disease, partial intestinal obstruction, colitis, neuropsychiatric cachexia, trauma, fistula, vascular insult, and renal and liver disease, as well as in patients being prepared for surgery or requiring hyperalimentation after surgery or abdominal irradiation. Strict attention must be paid to fluid and electrolyte status and to blood and urine glucose levels in patients receiving EEA. With use of a nasogastric tube, infection of the middle ear is a possible but uncommon complication.
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PMID:Meeting exceptional nutritional needs. 2. Elemental enteral alimentation. 10 Jul 74

Using an experimental model in rats a hyperosmolal glucose solution was introduced into the intestinal lumen to simulate and magnify the accumulation of fluid seen in simple small intestinal obstruction. Efforts to modify the extent and rate of this fluid flux by administering parenteral solutions of varying osmolality produced no result. When hypoosmolal or iso-osmolal infusion solutions were used, the intraluminal dilution process displayed mathematical characteristics in agreement with those of a simple dilution process, while at the same time normal blood volume was maintained. On the other hand, when a hyperosmolal glucose solution was infused, very great demands were made on the extravascular compartment, because a severe diuresis equal in volume to the fluid given parenterally took place, while at the same time there was marked hemodilution. Despite this the organism delivered as much fluid to the intestine as when hypo-osmolal or iso-osmolal infusions were given. Thus in principle the flow of fluid into the intestinal lumen could not be modified by giving parenteral solutions of any osmolality.
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PMID:Experimental studies on fluid pathophysiology in small intestinal obstruction in the rat. II. Effects of intraluminal hyperosmolality and simultaneous intravenous infusions. 63 42

This article examines the effects of experimental prenatal intestinal obstruction on the growth and blood composition of chick embryos. Intestinal atresia (IA) was produced by bipolar bowel electrocoagulation in fertile eggs on the 14th day of incubation. The chicks killed on the 19th day were measured, weighed, and blood-sampled. Twenty-three control, 10 sham-operated, and 11 IA chicks were studied. Animals with IA were severely undernourished by weight (43.4 +/- 4.7 v 70.3 +/- 7.6% of egg weight, P < .001) and length (15.3 +/- 1.1 v 18.1 +/- 0.9 mm tibial length, P < .001) in comparison with sham-operated ones. Their hematocrit was slightly lower, and total protein increased. Prealbumin was absent in their sera and albumin, alpha and beta globulins were significantly decreased, whereas gamma-globulin was greatly increased. Sodium, potassium chloride, urea, and glucose remained within normal limits. The lack of placenta in the avian embryo precludes any supply of nutrients by this route and the ingestion of amniotic fluid, which is protein-rich after the 13th day of incubation, when the opening of the seroamniotic connection allows albumen to be mixed with it, becomes the main source of nutrients until hatching. Obstruction of the main incoming avenue by IA induces severe malnutrition in this model which relies on this route to a greater extent than the human fetus. In spite of the obvious biological differences between the avian embryo and the human fetus, the present evidence supports the hypothesis that prenatal interruption of the amniotic fluid transit contributes to fetal undergrowth in IA.
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PMID:The nutrition of the fetus with intestinal atresia: studies in the chick embryo model. 140 14

Repeated or prolonged organic obstruction of the small intestine in the neonatal period can lead to severe refeeding problems, despite a transient ostomy. These problems are thought to result from a postobstructive enteropathy (POE) of the apparently normal small intestine segment above the obstruction. Ten infants with a POE, characterized by limited oral caloric and carbohydrate intakes and increased ostomy effluent, were compared with 8 controls with an enterostomy and a normal postoperative refeeding pattern. There was no statistical difference in the histomorphometric appearance of the mucosa or its digestive or absorptive capacity (brush-border hydrolases, glucose transport) between the two groups. The effluent and duodenal floras of the two groups were similar. However, all POE patients showed significant abnormal peristalsis characterized by barium and carmin transit times. This suggests that repeated or prolonged obstruction in the neonatal period could lead to a POE, caused by chronic motricity abnormalities of the small intestine above the obstruction. Although this POE is more frequent after small bowel atresia, it may also occur with other conditions causing prenatal and postnatal intestinal obstruction.
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PMID:Postobstructive enteropathy in infants with transient enterostomy: its consequences on the upper small intestinal functions. 147 4

We report a 3-year analysis (1986 to 1989) of the management of 63 home parenteral nutrition patients, 40 with short-bowel syndrome and 23 with chronic intestinal obstruction with or without intestinal resection. Intravenous fluid requirements varied from 0.9 to 6 L/day, and the content of glucose varied between 46 and 531 g/day, protein varied from .0 to 85 g/day, fat from .0 to 100 g/day, sodium from 37 to 695 mEq/day, potassium from 30 to 220 mEq/day, chloride from 60 to 760 mEq/day, and acetate from 0 to 200 mEq/day. Body weight was normalized and well maintained in the majority of patients, but using the strict definition of deficiency as the presence of one abnormal value during 3 years, more than half had abnormal plasma chloride, glucose, alkaline phosphatase, serum glutamic oxaloacetic transaminase, total protein, albumin, selenium, and iron concentrations, and more than a third had low calcium, magnesium, vitamin D, and vitamin C levels. Normochromic anemia was seen in 73% and high blood creatinine associated with low urine volumes in 42%. Most (78%) returned to relatively normal lifestyles, but employability was occasionally impaired by loss of third-party insurance coverage resulting from a therapy that may cost $100,000 per year. Overall mortality was low (5% per year), but 73% needed readmission to hospital, mainly for suspected catheter sepsis. The results indicate that home parenteral nutrition has allowed many patients to survive gut failure and return to work but problems with chronic fluid, electrolyte and micronutrient deficiencies, catheter sepsis, and insurance coverage often restrict optimal rehabilitation.
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PMID:Home parenteral nutrition--a 3-year analysis of clinical and laboratory monitoring. 850 44

Two patients, both with short bowel syndrome, presented with severe D-lactic acidosis associated with subacute small bowel obstruction and bizarre neurological signs. In neither patient were D-lactic acid-producing organisms isolated from the upper intestine. In both, upper intestinal aspirates yielded a glucose-fermenting yeast, Torulopsis glabrata. Although intestinal aspirates from both contained significant quantities of ethanol alcohol could not be detected in concomitant blood samples. A glucose load test produced a rise in blood D-lactic acid in both. One patient has evidence of mild persisting renal tubular damage. The same patient responded to oral antibiotics but the other relapsed frequently despite continuous antibiotic treatment. He was shown to be thiamine deficient and since the administration of oral thiamine he has had no recurrence of symptoms or of D-lactic acidosis.
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PMID:D-lactic acidosis in short bowel syndrome--an examination of possible mechanisms. 234 85

Functional intestinal mucosa, termed neomucosa, will grow in patched intestinal defects, but intestinal patching does not result in significantly increased intestinal surface area. Our aim was to determine if neomucosal growth would occur longitudinally in serosa-lined tunnels and to evaluate the optimal type of tunnel construction. Thirty rabbits had serosa-lined intestinal tunnels 1.5 cm in diameter and 5 cm in length interposed in the ileum. Group I (n = 5) had the tunnel formed from adjacent colon segments. Group II (n = 15) had a similar tunnel created with placement of an intraluminal latex stent. Group III (n = 5) had the tunnel formed by imbricating the cecum. Group IV (n = 5) had the tunnel formed by imbrication plus the intraluminal stent. Only Group II animals survived beyond 7 days (12 of 15 vs 0 of 5, P less than 0.05) and were sacrificed at 1 week (n = 3), 2 weeks (n = 3), 3 weeks (n = 2), 4 weeks (n = 2), and 6 weeks (n = 2). All other animals died from intestinal obstruction or peritonitis. Neomucosal growth occurred from proximal and distal margins. Forty percent of the tunnel was epithelialized at 6 weeks and the 5 cm tunnel contracted to 3 cm. In vitro glucose uptake was similar in neomucosa and normal mucosa but disaccharidase activity (sucrase and maltase) was significantly less in neomucosa at 6 weeks (28 +/- 35 vs 84 +/- 12 and 72 +/- 51 vs 471 +/- 84, P less than 0.05). Although not clinically obstructed, the survivors lost 15% body weight and proximal intestinal diameter increased.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Neomucosal growth in serosa lined intestinal tunnels. 235 86

The results of studies on disaccharidase activities and on intestinal absorption in cases of complete and incomplete congenital small bowel obstruction are presented. Assays of the activities of maltase, isomaltase, sucrase, trehalase, and lactase have been performed on biopsy specimens taken at the time of surgery. In specimens taken from above the site of obstruction, the activities are reduced for all disaccharidases, and are particularly low for trehalase and lactase. There was no difference between the cases with complete and incomplete obstruction. Distal to a complete obstruction, trehalase and lactase were reduced, whereas in cases of incomplete obstruction, the activities of all disaccharidases were within what is considered normal in the reference material. Two months after surgery, the disaccharidase activities were found to be normal. One month after surgery, the absorption of glucose and vitamin A was markedly impaired in cases with complete obstruction, whereas that of D-xylose was not significantly reduced from normal. In cases with incomplete obstruction, the results did not differ from those found in normal infants. The fact that failure to thrive is common during the first months after birth in patients with congenital intestinal atresia, even when surgery is successful, may be explained by deficient intestinal absorption, particularly in patients with complete obstruction.
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PMID:Disaccharidase activities and intestinal absorption in infants with congenital intestinal obstruction. 312 31

Small bowel neomucosa has been grown on a variety of surfaces. The purpose of this study was to compare the rate of growth and function of neomucosa on colon serosa (CS) and abdominal wall muscle (AM) in New Zealand white rabbits. The terminal ileum was incised for 5 cm and patched with either adjacent CS (23 animals) or AM (19 animals) to create a 2 X 5-cm defect. Gross and histologic examinations of the specimens at 1, 2, 4, and 8 weeks revealed that the rate of growth was similar in both groups. There was minimal lateral ingrowth at 2 weeks, nearly complete coverage of the defects at 4 weeks, and complete coverage of the defect at 8 weeks in more than 85% of animals with mature villi and muscularis mucosae. The ileal diameter at the site of patching increased in both groups from 11.9 +/- 2.6 to 16.3 +/- 3.2 mm in the CS group and 11.3 +/- 2.5 to 15.1 +/- 1.8 mm in the AM group (P less than 0.01). Glucose uptake was similar in both groups being 65.4 +/- 24.1% of control in the CS group and 73.9 +/- 29.8% in the AM group. Brush border enzyme activity of sucrase, maltase, and lactase was similar to controls in the AM group but in the CS group activity of sucrase and maltase were significantly less than controls (P less than 0.01). Average body weight was increased postoperatively in both groups. There was one anastomotic leak in each group and two cases of partial intestinal obstruction in the abdominal wall group.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Comparison of techniques for growing small bowel neomucosa. 623 14

Canine pancreata obtained at total pancreatectomy were cannulated via the ducts and perfused with collagenase to prepare a tissue suspension that was isografted into the spleen (preparation congruent to 2 h, mean graft vol = 10 +/- 1 ml containing 24% of the B-cell mass/pancreas). In 13 dogs the tissue was implanted by reflux into terminal splenic veins: two died postoperatively, and in two the intrasplenic vein wall was inadvertently punctured during cannulation. In the remaining nine, mean fasting blood glucose (BG) was less than or equal to 150 mg/dl initially; one was killed at 2 wk (distemper) and one at 6 wk (sepsis, diabetes), and one died at 9 wk (intestinal obstruction). Mean BG was 94 +/- 4 mg/dl at 1 mo and remained in this range until the dogs were killed at 5 mo (91 +/- 13 mg/dl). During glucose-tolerance testing 1 wk preimplantation and 1 mo and 2-3 mo postimplant, mean values were: K (decline in glucose concentration, %/min), 3.4 +/- 0.2, 1.4 +/- 0.1, and 1.5 +/- 0.1; peak insulin (microU/ml), 50 +/- 5, 12 +/- 1, and 11 +/- 2; fasting serum glucagon (pg/ml), 33 +/- 3, 59 +/- 12, and 53 +/- 9, with no change in the glucagon response. Histologically, the spleens contained prominent islets. In five other dogs, the tissue was injected into the splenic pulp: mean BG rose to greater than or equal to 250 mg/dl at 2 wk (compared with initial series, P less than 0.001) and remained elevated until death at 6 wk, when histologic examination of the spleens showed severe fibrosis and no islets. Apancreatic controls (N = 4) survived 10 +/- 3 days; BG was 343 +/- 11 mg/dl terminally. We conclude that this modified method for collagenase perfusion of a single large-mammal pancreas via the ducts provides sufficient viable islets to induce prolonged normoglycemia (5 mo) and preserve the response to glucose challenge. Reflux of pancreatic fragments into splenic veins appears more efficient than intrapulp implantation.
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PMID:Normoglycemia after reflux of islet-containing pancreatic fragments into the splenic vascular bed in dogs. 640 80


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