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

Peritoneal adhesions were created in rats by brisk scrubbing of the terminal part of the ileum. Adhesions were graded by total number and the presence of small bowel obstruction. Adhesion prophylaxis was evaluated using dexamethasone, methylprednisolone sodium succinate, promethazine hydrochloride, and human fibrinolysin (Thrombolysin) in various combinations, doses, and routes of administration. Methylprednisolone and dexamethasone, depending on the route of administration, modified the total number of adhesions but did not modify their severity when compared to control animals. Promethazine by itself modified peritoneal adhesions in the rat. Used together, methylprednisolone and promethazine also modified adhesions, but were not substantially better than the combination of dexamethasone and promethazine. Methylprednisolone, promethazine, and human fibrinolyzin, when used in combination intraperitoneally, virtually eliminated adhesion formation.
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PMID:Prevention of peritoneal adhesions in the rat. The effects of dexamethasone, methylprednisolone, promethazine, and human fibrinolysin. 12 75

The effect on ileostomy function of codeine phosphate, Lomotil, or Isogel was tested in 20 subjects at home living a normal life, studied over two three-day periods on and off treatment. Codeine phosphate 60 mg three times daily was associated with a reduction in the mean total weight of ileostomy output and the ileostomy outputs of water, sodium, and potassium (p < 0.05). The proportion of faecal solids increased on codeine and the effluent appeared thicker but the output of faecal solids remained unchanged. Mean faecal fat increased on codeine. The transit rate from mouth to stoma was slower in four of the five subjects on codeine and a further two subjects withdrew from the trial with temporary intestinal obstruction while on the drug. Lomotil two tablets three times daily was associated with a small and statistically not quite significant fall in the mean total weight of ileostomy output and the ileostomy output of water. Sodium and potassium outputs in the effluent fell on Lomotil (p < 0.05) but the other parameters remained unchanged. Isogel 15 ml three times daily was associated with an increase in the mean total weight of ileostomy output and the ileostomy outputs of water, sodium, potassium, and faecal solids (p < 0.01). Although the effluent looked more viscid on Isogel, the proportion of faecal solids was unchanged. These results suggest that codeine phosphate has a beneficial effect on ileostomy function, reducing the loss of water and electrolytes, while Lomotil has a similar but less effective action in the dosage tested. By contrast, Isogel increases the ileostomy loss of water and electrolytes and will aggravate their depletion in patients with excessive fluid effluents. The increase in faecal fat associated with taking codeine phosphate suggests that it should be stopped before collecting specimens for faecal fat estimations.
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PMID:Effect of codeine phosphate, Lomotil, and Isogel on iileostomy function. 65 67

Most patients who undergo massive small bowel resection develop the "short bowel syndrome", which usually resolves as intestinal adaptation takes place. Some, in whom adaptation appears to be inadequate, remain severely incapacitated, and attempts have been made to improve absorption using a variety of surgical maneuvers. Successes have been recorded, but the procedures (of which reversal of a segment of small intestine to prolong the intestinal transit time has been most frequently used) are unpredictable and may actually be harmful. This study was designed to evaluate the theory that, because of the slow pattern of peristaltic activity inherent in the colon, the intestinal transit time could be safely and predictably prolonged after massive small bowel resection by transposing a segment of colon to between the jejunal and ileal remnants in an iso-peristaltic direction. The following procedures were performed, using 56 rats: (1) Resection of 80% or 90% of the small intestine. (2) Small bowel resection (80% or 90%) and iso-peristaltic jejuno-ileal colonic interposition. (3) Bowel anastomoses without resection. Intestinal function was subsequently evaluated by studying the following: (1) body weight; (2) blood count; (3) intestinal transit time (by contrast radiography); (4) intestinal absorption of sodium iodide, albumin, triolein and Vitamin B12 (using radioisotopic methods); (5) intestinal morphology. Colonic interposition did not have any significant effect following 80% small bowel resection. After 90% resection, colonic interposition increased the intestinal transit time significantly (p less than 0.001) without mortality or serious morbidity, and did not cause intestinal obstruction or prevent intestinal adaptation. Body weight and intestinal absorption were not increased significantly, but the study was too short to exclude an eventual beneficial effect in terms of body weight. It was concluded that iso-peristaltic colonic interposition is a safe and reliable method of prolonging the intestinal transit time after massive small bowel resection in the rat, thereby increasing the efficiency of absorption within the existing absorption capacity. The procedure has been found to be beneficial in dogs, and for reasons discussed, should be equally effective in man. Adjunctive surgery is not recommended at the time of resection in man, but should be considered if absorption remains severely impaired.
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PMID:Colonic interposition between the jejunum and ileum after massive small bowel resection in rats. 70

The possibility that the composition of amniotic fluid is significantly altered with fetal intestinal obstruction was examined in 15 normal, 15 sham operated and 15 ewes in which jejuno-ileal atresia was created by devascularizing a 15 cm intestinal segment in the fetus at 90--100 days gestation. Samples of amniotic fluid for osmolality, urea N, creatinine, electrolytes, amylase, lipase, bilirubin, and proteins were obtained at 100 days gestation and at C-section performed 5 days prior to the anticipated date of delivery. One sham operated and four operated fetuses aborted prior to term for an 83% overall fetal survival rate. All surviving operated animals had total intestinal obstruction with the classical appearance of jejuno-ileal atresia. The volume of amniotic fluid at term varied from gelatinous material to as much as 1.0 liter of clear yellow to dark orange fluid. Amniotic fluid composition in term animals was not significantly different from those at 100 days gestation when the creatinine was below 15 mg%. However, sodium and chloride were significantly elevated in all groups at term when the creatinine was above 15 mg%. The osmolality and urea N in the latter group was not significantly different from animals at 100 days gestation. The amylase, lipase, total proteins, albumin, total and direct, and bilirubin in control animals at term was not significantly different from sham operated and experimental subjects. This study suggests that routine amniocentesis in the "high risk" patient would not be diagnostic of fetal intestinal obstruction.
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PMID:Composition of amniotic fluid with experimental jejuno-ileal atresia. 87 26

In experimental small bowel obstruction an increased proportion of smooth endoplasmic reticulum and an increased number of lysosomes were seen in many liver cells. The occurrence of cytoplasmic vacuoles as well as the glycogen depletion were not pathognomonic and in the toxic pathogenesis the ultrastructural damage in the liver was only of a low degree and can be explained as a reactive (e.g. detoxication) phenomenon. The increase of plasma corticosterone content (stress reaction) differed only slightly from that of the controls, but a severe disturbance of fluid balance (increase of hematocrit and decrease of serum Na+ and C1-) and circulation failure were the more conspicuous findings, compared to toxic liver cell disturbance in the pathogenesis of small bowel obstruction.
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PMID:Experimental small bowel obstruction. Ultrastructural observations on liver and adrenal cortical function. 114 Feb 11

Ileostomy function was studied in 12 patients with an established ileostomy following proctocolectomy, in 6 of whom minimal amounts (less than 9 cm) and in 6 significant amounts (30-120 cm, mean 60 cm) of terminal ileum had been removed. Patients who had undergone significant ileal resection had daily faecal volumes considerably greater than those with minimal ileal resection (1202 +/- 284 ml versus 401 +/- 92 ml, P less than 0.001), and also greater daily outputs of sodium (146 +/- 53 mEq versus 43 +/- 12 mEq) and potassium (12.7 +/- 9.0 mEq versus 4.0 +/- 0.99 mEq). The percentage water content of the ileostomy fluid was greater in patients who had had the ileum resected (93.1 +/- 1.8% versus 89.8 +/- 2.5%). In addition, the sodium/potassium ratio in the urine in patients with a properly acting ileostomy after ileal resection was low. It is concluded that when recurrent inflammatory bowel disease, partial small bowel obstruction and intraperitoneal sepsis have been excluded there remains a number of patients whose high ileostomy output is due entirely to the amount of ileum resected. The management of patients with a high output ileostomy with codeine phosphate, Lomotil and oral administration of sodium chloride tablets is discussed.
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PMID:Cause and management of high volume output salt-depleting ileostomy. 117 16

Emergency equine abdominal surgery is easiest and most efficiently carried out with a team of surgeons. The surgical site should be as protected as possible by the use of sterile drapes and wound protectors. A ventral midline laparotomy incision has been found to be the most convenient approach to most equine intestinal obstructions. A standing laparotomy through the left paralumbar fossa gives adequate exposure for exploration of the abdomen and is, therefore, useful as a diagnostic tool. Horses tolerate having both ventral midline and left paralumbar laparotomy incisions well. If the cause of the intestinal obstruction is not readily apparent upon opening the abdominal cavity, a thorough systematic exploration of the abdominal cavity is necessary. If the problem cannot be found with the bowel in situ, intestine must be exteriorized for examination. The decision as to the extent of adequate bowel resection often depends on a subjective assessment of bowel function. In equivocal cases, the surgeon should choose to resect some normal bowel rather than taking a chance on leaving compromised bowel in place. Incarcerations are frequent causes of small intestinal obstructions. The small intestine may become incarcerated in the epiploic foramen, the inguinal canal or in an umbilical hernia. Thromboembolic compromise to intestinal vessels results in the longest lengths of embarrassed bowel requiring resection. Impactions are the most common obstructions associated with the caecum. Large colon torsions of 270 degrees or less may be corrected by surgical manipulation; with 360 degrees torsions of the large colon, however, vascular compromise is usually sufficient to devitalize this organ. Enterotomy of the large colon allows retrieval of most enteroliths from its lumen. Enterotomy of the right dorsal colon is also useful for removal of foreign bodies which cause obstruction of the most proximal portion of the small colon. In our Clinic a two-layer end to end anastomosis is usually utilized. Recently introduced automated stapling and ligating instruments have been useful in decreasing surgical time. Antibiotics, usually furacin and sodium or potassium penicillin in 2 litres of Normasol-R, are placed in the peritoneal cavity before closure of the abdomen. A Penrose drain is commonly placed into the abdominal cavity to provide drainage of the peritoneal cavity after surgery. The peritoneum is sutured with No 0 chromic gut in a simple continuous pattern. A second Penrose drain may be placed between peritoneum and ventral body wall, with its ends retracted through stab incisions in the skin. The linea alba is closed with simple interrupted sutures of stainless steel wire or No. 3 chromic gut. Employing the above described principles and techniques has increased the success of abdominal surgery in our Clinic.
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PMID:Surgical techniques in equine colic. 117 35

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

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

Abnormal epithelial electrolyte transport has been identified in a range of cystic fibrosis (CF) organs and appears to account for the various clinical manifestations of the disease. The aim of this study was to further define the Cl- secretion defect in CF jejunum. Excised jejunum was obtained from 11 CF patients and 12 controls. Transport studies were performed on stripped epithelium in vitro under short-circuited conditions in Ussing Chambers. 3-Isobutyl-1-methylxanthine (IBMX) (300 microM) significantly increased Cl- secretion in control (-2.3 +/- 0.6 to -3.3 +/- 0.7 mueq.cm-2.h-1; P less than 0.01, paired t test; n = 5 subjects) but not in CF jejunum (-0.5 +/- 0.3 to -0.1 +/- 0.4; n = 4). However in contrast to control jejunum, net Na+ absorption in CF jejunum was higher in the IBMX (1.3 +/- 0.5 mueq.cm-2.h-1) compared with basal periods (0.6 +/- 0.3; P less than 0.05, paired t test). IBMX stimulation of tissue adenosine 3',5'-cyclic monophosphate (cAMP) was similar in both control and CF jejunum. A range of secretagogues known to induce secretion in mammalian intestine, including dibutyryl cAMP (DBcAMP), DBcGMP, Ca2+ ionophore A23187, and the protein kinase C activator 4 beta-phorbol 12,13-dibutyrate, failed to induce secretion in CF jejunum. In conclusion, CF jejunum failed to exhibit Cl- secretion and also demonstrated abnormalities of Na+ absorption. These results support the view that the defect lies at a site distal to the intracellular messengers. Moreover, these abnormalities of intestinal electrolyte transport may account for some of the gastrointestinal manifestations of the disease such as meconium ileus and distal intestinal obstruction syndrome.
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PMID:Abnormal epithelial transport in cystic fibrosis jejunum. 170 89


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