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

The significance of pica and geophagia as a public health problem is well known. The objective radiographic diagnosis of geophagia depends on the abnormal opacification of the bowel as an immediate manifestitation of the condition. The chance of detectability of geophagia is highest in the colon and can be improved by using low penetration films, particularly for smaller amounts of ingested clay. Other radiologic changes frequently associated with the prolonged practice of geophagic are an atonic pattern of the colon, secondary radiographic changes due to iron-deficiency anemia and bone-age retardation. The occurrences of intestinal obstruction due to pica in the presence of preexisting bowel stricture is demonstrated.
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PMID:Radiological changes in pica. 118 Feb 44

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

Reduced iron, B.P. 1932, an old form of medicinal metallic iron powder, was given by mouth to albino rats. Measurable toxic effects were not produced until the dose reached 10 g./kg. body weight, which is 10 times the LD(50) of iron similarly given as ferrous sulfate. Death occurred at three days and after from doses of 60 to 100 g./kg. and was due to hemoconcentration and vascular congestion of the liver and kidneys resulting from absorption of iron through an inflamed gastrointestinal mucosa. Larger doses produced death in one to three days from bowel obstruction due to impaction of iron in the stomach and intestines. The results suggest that reduced iron is the least toxic of all iron medicinal preparations and that re-investigation of its therapeutic value is warranted.
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PMID:Studies on the low toxicity of reduced iron, B.P. 1932. 602 63

An 18-month-old boy ingested approximately 18 g FeSO4, equivalent to 336 mg/kg elemental Fe. He rapidly developed severe gastroenteric symptoms, obtundation, and transient hypotension. The serum iron level two hours after ingestion was 6,798 micrograms/dL. He was treated with deferoxamine intravenously, enterally, and as a lavage solution. His hospital course was notable for lack of severe neurologic, hepatic, metabolic, or cardiovascular complications acutely with apparent complete recovery, although he returned six weeks after ingestion with intestinal obstruction due to a jejunal stricture.
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PMID:Severe iron poisoning treated with enteral and intravenous deferoxamine. 662 82

This study describes small bowel push enteroscopy in routine clinical practice, using a purpose designed instrument (Olympus SIF-10). Fifty six patients had a total of 60 procedures over a two and a half year period. The median (range) depth of small intestine intubated was 45 (15-90) cm. Procedure time varied from 10-45 minutes. Most enteroscopies were performed during routine gastroscopy lists. The technique was comparatively easy for experienced endoscopists to learn. Forty two procedures were for diagnostic purposes. Eleven patients had gastrointestinal bleeding where the source was obscure, or where early investigations had suggested a small bowel source: a specific diagnosis was made in 45% of these cases. Of seven iron deficient anaemic patients using non-steroidal anti-inflammatory drugs (NSAIDs), only one had a lesion detected in the upper small bowel. Nine patients had abnormal small bowel barium studies. Small bowel abnormalities were seen in six cases and were definitively diagnostic in three of these; in three patients the barium study appearances were confirmed as artefact. Fifteen patients were investigated for abdominal symptoms suggesting small bowel obstruction or malabsorption: a diagnosis was made in five cases. Fifteen patients underwent enteroscopy for therapeutic purposes, including successful treatment of difficult enteral feeding problems by nasojejunal tubes or by cutaneous endoscopic jejunostomies, polypectomy for Peutz-Jeghers syndrome, and dilatation of strictures. Additionally, bleeding lesions detected in patients during investigation of anaemia were successfully treated at the time by YAG laser or bipolar diathermy. In conclusion, push enteroscopy is a practical and valuable clinical service, which should probably become available on a subregional basis.
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PMID:Diagnostic and therapeutic push type enteroscopy in clinical use. 759 Apr 29

A 52-yr-old lady with RA on long term NSAIDs developed an iron-deficiency anaemia and subsequently presented with subacute intestinal obstruction. After intensive investigation, a diagnosis of diaphragm disease of the small intestine was made at laparotomy. The features of diaphragm disease and the difficulties with diagnosis and management of the condition are discussed.
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PMID:Non-steroidal anti-inflammatory induced diaphragm disease of the small intestine: complexities of diagnosis and management. 805 10

Conventional imaging studies are now being closely scrutinized for clinical utility. Some, like the skull film, are obsolete while others have secured an enduring place for themselves. The plain film of the abdomen occupies a middle ground with its role supplanted by other studies for many conditions but its value is still appreciated for the assessment of intestinal obstruction and perforation. Today, its special capabilities for the evaluation in diverticulitis and iron therapy have been under emphasized. In the future, the plain film will have a narrower focus but when combined with CT both examinations can be enhanced.
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PMID:The abdominal plain film. What will be its role in the future? 821 Mar 53

Occult intestinal bleeding was diagnosed in a patient who underwent a distal small bowel resection. The resection was required for small bowel obstruction. She developed iron deficiency anemia four years later. Clinically she presented with melena. Colonoscopy, gastroscopy were unsuccessful in making the diagnosis. But a 99 mass Technetium (99m Tc) Labeled Red Blood Cell (RBC) scintigraphy, established the bleeding site in the gastrointestinal tract. Laparotomy identified an ulcerative lesion at the surgical side-to-side anastomosis. Histology demonstrated focal ulceration with chronic inflammation but did not show crypt abscesses, or granulomata. Medical therapy, including iron and Histamine-antagonists were ineffective. She was treated with resection of the anastomosis. Gastrointestinal bleeding due to anastomotic ulceration appears to be a late complication of small bowel resection with side-to-side anastomosis.
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PMID:Chronic anemia secondary to side-to-side distal small bowel anastomosis. 847 Apr 38

In preparing this Position Statement, all relevant scientific literature was identified and reviewed critically by acknowledged experts using agreed criteria. Well-conducted clinical and experimental studies were given precedence over anecdotal case reports and abstracts were not usually considered. A draft Position Statement was then produced and subjected to detailed peer review by an international group of clinical toxicologists chosen by the American Academy of Clinical Toxicology and the European Association of Poisons Centres and Clinical Toxicologists. The Position Statement went through multiple drafts before being approved by the boards of the two societies and being endorsed by other societies. The Position Statement includes a summary statement for ease of use and is supported by detailed documentation which describes the scientific evidence on which the Statement is based. Whole bowel irrigation (WBI) should not be used routinely in the management of the poisoned patient. Although some volunteer studies have shown substantial decreases in the bioavailability of ingested drugs, no controlled clinical trials have been performed and there is no conclusive evidence that WBI improves the outcome of the poisoned patient. Based on volunteer studies, WBI may be considered for potentially toxic ingestions of sustained-release or enteric-coated drugs. There are insufficient data to support or exclude the use of WBI for potentially toxic ingestions of iron, lead, zinc, or packets of illicit drugs; WBI remains a theoretical option for these ingestions. WBI is contraindicated in patients with bowel obstruction, perforation, ileus, and in patients with hemodynamic instability or compromised unprotected airways. WBI should be used cautiously in debilitated patients, or in patients with medical conditions that may be further compromised by its use. A single dose of activated charcoal administered prior to WBI does not appear to decrease the binding capacity of charcoal or to alter the osmotic properties of WBI solution. Administration of charcoal during WBI appears to decrease the binding capacity of charcoal.
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PMID:Position statement: whole bowel irrigation. American Academy of Clinical Toxicology; European Association of Poisons Centres and Clinical Toxicologists. 1119 53

The hitherto small number of reports of toxic effects of non-steroidal anti-inflammatory drugs (NSAIDs) to the small bowel may reflect primarily a lack of diagnostic tools. In fact, a host of small bowel manifestations have now been documented, ranging from strictures causing dramatic small-bowel obstruction and severe bleeding to low-grade NSAID 'enteropathy', a syndrome comprising increased intestinal permeability, low-grade inflammation with blood and protein loss. The enteropathy, although not dramatic, may add to existing complications, for example in rheumatic patients, and contribute to iron-deficiency anaemia or hypoalbuminaemia. Enteroscopy can be used to detect erosive or haemorrhagic lesions in a small number of patients, but, in general, functional methods are applied to detect the NSAID enteropathy. Permeability markers and white and red blood cell labelling have been successfully applied, and recently, calprotectin faecal shedding has been shown to detect early inflammatory changes in the gut. We still have insufficient knowledge about the pathogenic mechanism, but prostaglandin synthesis inhibition may be less vital than in the gastroduodenal mucosa, and local luminal aggressors may play a role. Apart from stopping or reducing the dose of the NSAID, we so far have few therapeutic alternatives for NSAID enteropathy. However, the ongoing research has brought us important new insight, and helped bring this prevalent problem in focus.
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PMID:Small-bowel side-effects of non-steroidal anti-inflammatory drugs. 1032 53


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