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

The treatment for acute mechanical intestinal obstruction is a timely operation. A select group of patients may, however, be nutritionally supported with continual administration of elemental diet proximal to long tube decompression under two sets of circumstances: 1. while awaiting spontaneous or treatment-induced resolution of the underlying process, and 2. while reversing catabolism during evaluation prior to operation. Eleven patients with chronic intermittent bowel obstruction were studied: six with obstruction involving radiated small bowel, three with an acute exacerbation of chronic inflammatory bowel disease, one with obstruction secondary to an intra-abdominal phlegmon and one with a segmental motility problem. They received nutritional support with continual gastrointestinal administration of elemental diet proximal to long tube decompression after initial observation for signs or symptoms of altered intestinal viability and stabilization of fluid and electrolyte status. Six of the 11 patients eventually required operation. All patients maintained body weight and three gained weight. Mean nutritional input was 1,873 calories and 12.6 gm nitrogen/day. There were no complications related to the technique of proximal feeding and distal decompression because of careful patient selection and appropriate administration of elemental diet under carefully controlled guidelines.
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PMID:Distal decompression and proximal feeding for nutritional support during bowel obstruction. 10 31

It is clear that the nutritional state of patients with inflammatory bowel disease is often impaired and can be improved by the provision of nutritional support. Improvement in nutritional status can be achieved as effectively with enteral as with parenteral nutrition. Nutritional support appears to have no primary therapeutic effect in patients with ulcerative colitis. With regard to nutritional support in Crohn's disease, parenteral nutrition should be restricted to use as supportive rather than primary therapy. Available information now seems to suggest that most of the benefits of parenteral nutrition in Crohn's disease are related to an improvement in nutritional state rather than as primary therapy, and its use should be restricted to the treatment of specific complications of Crohn's disease, such as intestinal obstruction related to stricture formation or short bowel syndrome following repeated resection. Although some doubt exists over the efficacy of oligopeptide-containing elemental and polymeric enteral diets, the present evidence indicates that chemically defined free amino acid-containing elemental diets have primary therapeutic efficacy in the management of acute exacerbations of Crohn's disease. As such, these diets are worthy of therapeutic trial in patients with severe Crohn's disease involving the distal colon and rectum, particularly in those patients who are malnourished and who prove to be resistant to treatment with a combination of topical corticosteroids and 5-aminosalicylic acid-containing compounds. Clinicians should be aware, though, that the beneficial effects are likely to be restricted to the short term, with high relapse rates by 1 year, this being particularly so in patients with distal Crohn's proctocolitis (Teahon et al, 1988). Volatile fatty acid enemas clearly have potential in the management of patients with severe steroid-resistant proctitis. Finally, one of the most important observations made in recent years is the one concerning the large losses of nitrogen that will occur in patients with inflammatory bowel disease treated with corticosteroids in the absence of adequate protein intake (O'Keefe et al, 1989). Hopefully the days of treating patients with severe inflammatory bowel disease with high dose corticosteroids and a peripheral dextrose or dextrose-saline drip have passed into history.
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PMID:Medical management of severe inflammatory disease of the rectum: nutritional aspects. 131 93

Mesenteric vascular occlusion and intestinal obstruction are difficult-to-diagnose medical emergencies. We evaluated a large panel of biochemical markers as diagnostic and prognostic indicators in a rat model of intestinal infarction and partial, complete, and strangulated intestinal obstruction. After intestinal infarction and obstruction, laboratory data are distinctly abnormal. Serum urea nitrogen dramatically increased in all groups, but most rapidly in the groups with infarction and strangulated obstruction. Inorganic phosphorus proved to be a sensitive indicator of infarction, but less so for any form of obstruction. While all members in the infarct group demonstrated significant increases in the aminotransferases, creatine kinase, and alkaline phosphatase, such increases in the groups with obstruction were less pronounced. Serum maltase assays revealed decreasing activities in all members of the groups with complete and strangulated obstruction, but in only 17% of the rats with partial obstruction. Serum maltase activity increased from abnormally low values after surgery to abnormally high values in the six animals that recovered from partial intestinal obstruction. The proportion of hexosaminidase A (of total beta-N-acetylhexosaminidase, EC 3.2.1.30) was generally abnormal in rats with complete and strangulated obstruction.
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PMID:Acute intestinal infarction or obstruction: search for better laboratory tests in an animal model. 296 10

Patients with concomitant ovarian cancer and bowel obstruction were studied in an effort to find objective prognostic factors predictive of patient outcome. A total of 62 patients were followed from 31 to 354 weeks, and a total of 20 variables were considered in the analyses. At the end of the study 49 patients were dead of their disease, and 13 were alive (six disease free and seven with persistent disease). Survival probabilities of the sample were 79% at 6 weeks, 48% at 20 weeks, and 24% at 104 weeks. Univariate analyses revealed no significant difference in the survival times of medically versus surgically treated patients; age greater than 60 years at diagnosis of cancer, presence of ascites, low serum albumin levels, elevated blood urea nitrogen levels, elevated alkaline phosphatase levels, lack of previous radiotherapy (p less than 0.002 for all), advanced tumor stage, normal/ileus x-ray results, and a short diagnosis to obstruction interval (p less than 0.04 for all) resulted in lower survival probabilities.
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PMID:Bowel obstruction in patients with ovarian cancer: a search for prognostic factors. 334 1

Although once considered completely devoid of complications, it is now recognised that the misuse or inappropriate use of nitrous oxide (N2O) often results in adverse side effects. Hypoxia, particularly the entity 'diffusion hypoxia', can occur with the administration of inadequate amounts of oxygen during or immediately after a N2O anaesthetic. N2O will diffuse into air-containing cavities within the body faster than nitrogen diffuses out. This results in a temporary increase in either the pressure and/or volume of the cavity depending upon the distensibility of its walls. The magnitude of the effect is proportional to the blood supply of the cavity, the concentration of N2O inhaled and the length of time the patient is exposed to N2O. Significant morbidity or even death can result from this phenomenon. A property unique to N2O is its ability to oxidise and inactivate the vitamin B12 components of certain enzymes in both animals and man. One such enzyme, methionine synthetase is essential for normal DNA production. Animal and human studies have demonstrated that the haematological, immune, neurological and reproductive systems are each affected. These adverse effects of N2O can occur after both acute (surgical) or long term (occupational) exposure to the gas. Because of its effects on the pressure and volume characteristics of air-containing spaces, N2O should not be used for patients with bowel obstruction, pneumothorax, middle ear and sinus disease, and following cerebral air-contrast studies. Many anaesthesiologists feel that use of N2O should be restricted during the first two trimesters of pregnancy because of its effects on DNA production and the experimental and epidemiological evidence that N2O causes undesirable reproductive outcomes. Since N2O affects white blood cell production and function, it has been recommended that N2O not be administered to immunosuppressed patients or to patients requiring multiple general anaesthetics. Many anaesthesiologists believe that the potential dangers of N2O are so great that it should no longer be used at all for routine clinical anaesthesia. However, the continued use of N2O remains a controversial topic since, at present, a suitable substitute gas is not available.
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PMID:Adverse effects of nitrous oxide. 353 24

Preoperative risk calculation in children with bowel obstruction allows early therapeutic measures to improve prognosis. In a retrospective study the preoperative status was evaluated in 310 newborns and 127 children beyond the newborn period who had to be operated for bowel obstruction. Preoperative parameters were: age, birth weight (newborns), weight, body temperature, red and white blood count, electrolytes, urea-nitrogen, total serum protein, pH, PO2, PCO2 and base excess. These parameters were compared in surviving children and children who died postoperatively. In newborns a statistically significant difference between both groups was found for birth weight, rectal temperature, pH and total serum protein, whereas in children beyond the newborn age the same was true for age, weight and total serum protein. Besides well balanced electrolytes and good management of artificial respiration, total serum protein and in newborns additionally blood-pH and rectal temperature must be normalized preoperatively to reduce the risk in children with bowel obstruction.
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PMID:[Preoperative risk evaluation in juvenile ileus]. 652 47

Fifty patients undergoing extensive gastrointestinal surgery were fed through a jejunal catheter introduced during the operation. After surgery, feeding was started 48 hours, except for 10 patients who had pre-operative intestinal obstruction or a suture below the site of liquid food instillation. The decision to feed patients enterally must by taken during surgery, and the method requires a trained nursing team, but it considerably improves the patient's nitrogen balance and, accessorily, his comfort. There does not seem to be any contra-indication. The onset of enteral feeding only depends upon the type of operation performed.
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PMID:[Early jejunal catheter feeding in heavy gastrointestinal surgery (author's transl)]. 680 23

Congenital duodenal webs are rare lesions, usually detected during early infancy because of signs of high intestinal obstruction. The occasional patient escapes both symptoms and detection until adolescence or adulthood. This report concerns two cases of congenital duodenal web at different ages and with different clinical manifestations. Case 1, a six-month-old male, was admitted because of abdominal distention and vomiting. Case 2, a 13-year-old boy, was referred here for further evaluation of recurring seizure attacks, elevated blood urea nitrogen and creatinine and hyponatremia. Duodenotomy and excision of the web performed for both patients. Complete amelioration of all symptoms was then observed at Outpatient Clinic follow-up for one year.
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PMID:Congenital duodenal web in late infancy and childhood: a report of two cases. 803 46

Intravenous fluid requirements for patients with permanent end-jejunostomy syndrome often exceeds 3 L/d, making rehabilitation difficult. The effect of the somatostatin analogue, octreotide (100 micrograms TID, subcutaneously) in reducing requirements was measured in 10 patients established on home parenteral nutrition. After 10 days of treatment, 72-hour balance measurements demonstrated significant reductions in stomal fluid and electrolyte losses from (mean +/- SE) 8.1 +/- 1.8 to 4.8 +/- 0.7 L/d (p < .03), sodium from 510 +/- 71 to 340 +/- 41 mEq/d (p < .03), chloride from 533 +/- 70 to 315 +/- 32 mEq/d (p < .002), and potassium from 101 +/- 41 to 79 +/- 34 mEq/d (p < .02), permitting an average reduction in intravenous fluid requirements of 1.3 L/d (p < .0003), 118 mEq Na+/d (p < .03), 41 mEq K+/d (p < .02), and 178 mEq Cl-/d (p < .01). This meant that daytime intravenous infusions could be stopped in all patients. Fecal nitrogen losses were decreased (p < .05), but overall there was no significant change in fat and caloric absorption. In addition, hormonal stimulated gastric acid and pancreatic lipase secretions were significantly reduced (p < .05). The effect was most marked in those patients with massive stomal losses and uncontrollable thirst. Continuation of treatment for more than 1 year in 8 of the patients suggested preservation of potency and good tolerance, with the possible exception of accelerated gallstone formation and subacute intestinal obstruction. In conclusion, octreotide has the potential to improve the quality of life of those end-jejunostomy syndrome patients with massive stomal losses, resistant to conventional medical treatment.
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PMID:Octreotide as an adjunct to home parenteral nutrition in the management of permanent end-jejunostomy syndrome. 816 99

Postoperative adhesions are a significant source of morbidity, including contributions to pelvic pain, bowel obstruction, and infertility. While the mechanisms of postoperative adhesion development are complex and incompletely understood, hypoxia appears to trigger a cascade of intracellular responses involving hypoxia-inducible factors, lactate, reactive oxygen species, reactive nitrogen species, and insulin-like growth factors that results in manifestation of the adhesion phenotype. Thus, substantial evidence exists to implicate the direct role of cellular metabolism in wound repair and adhesion development.
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PMID:Review: cellular metabolism: contribution to postoperative adhesion development. 1929 32


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