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

Magnetic resonance enteroclysis (MRE) is an emerging technique for the evaluation of small bowel abnormalities. Adequate luminal distention, achieved by the administration of iso-osmotic water solution through a nasojejunal catheter, in combination with ultrafast sequences, such as single-shot turbo spin echo, true fast imaging with steady precession, half-Fourier acquired single-shot turbo spin echo, and 3D fast low-angle shot, results in excellent anatomic demonstration of the small bowel. Magnetic resonance fluoroscopy can be performed during MRE examination and might be useful in studying low-grade stenosis or motility-related disorders. Magnetic resonance enteroclysis is very promising in detecting the number and extent of involved small bowel segments in patients with Crohn's disease, and in disclosing lumen narrowing and extramural manifestations and complications of the disease. Initial experience shows that MRE is very efficient in the diagnosis of small bowel tumors and can be used in the evaluation of small bowel obstruction.
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PMID:MR enteroclysis: technical considerations and clinical applications. 1238 53

Helminths or worm infestations refer to worms that live as parasites in the human body and are a fundamental cause of disease associated with health and nutrition problems beyond gastrointestinal tract disturbances. Globally, over 3.5 billion people are infected with intestinal worms, of which 1.47 billion are with roundworm, 1.3 billion people with hookworm and 1.05 billion with whipworm. School children aged 5 - 15 years suffer the highest infection rate and worm burden that attributes to poor sanitation and hygiene. About 400 million school-age children are infected with roundworm, whipworm and hookworm worldwide, a large proportion of whom are found in the East Asia region (Cambodia, China, Lao PDR, Thailand and Vietnam). These parasites consume nutrients from children they infect, thus retarding their physical development. They destroy tissues and organs, cause abdominal pain, diarrhoea, intestinal obstruction, anaemia, ulcers and other health problems. All of these consequences of infection can slow cognitive development and thus impair learning. De-worming school children by anthelmintic drug treatment is a curative approach for expelling the heavy worm load. However, drug therapy alone is only a short-term measure of reducing worm infection and re-infection is frequent. Control measures through improved sanitation, hygiene and de-worming are needed to prevent infection and re-infection. UNICEF has supported many governments in this (and other) regions to assist in the provision of water supply and sanitary facilities and intensive hygiene education in many schools through the Water, Environment and Sanitation (WES) programme. The UNICEF supported school sanitation and hygiene education (SSHE) programme, and other programmes, could effectively enhance behaviour change in children to break the routes of worm transmission and other waterborne diseases.
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PMID:De-worming school children and hygiene intervention. 1277 91

Intestinal obstruction belongs to highly severe conditions in gastroenterology, namely from the viewpoint of quick and correct diagnosis as well as at determining rational and effective therapy. Etiological multifactorial characteristics leading to processes resulting in mechanical or dynamic obstruction of the intestine, often referred to as paralytic ileus, are undoubtedly serious factors influencing the accuracy of diagnosis and therapeutic approach. Digestive endoscopy is a mandatory method in the diagnosis of intestinal obstructions. Diagnostic endoscopy, colonoscopy in the involvement of the large intestine or enteroscopy in the case of incomplete obstruction of the small intestine are the methods indicated in the majority of obstructive intestinal lesions. Besides their diagnostic importance, they also enable an effective therapeutic approach which may immediately follow the diagnostic intervention. Besides endoscopy that--due to the nature of performance--belongs to invasive methods, the diagnosis of obstructive intestinal processes is unthinkable without the use of non-invasive imaging methods. Abdominal ultrasound examination, a widely applied method, provides--under optimal examination conditions--information, e.g., about the width of the intestinal lumen or about the intestinal wall thickness; however, the specificity of investigation is not always sufficient. Both specificity and sensitivity of exploration are increased by a plain X-ray of the abdomen supplementing the ultrasound examination. Better results are achieved when the abdominal cavity is inspected by means of spiral CT examination that is nowadays not fashionable but highly effectively applied in the modification of the so-called CT enteroclysis or CT colonography. The usage of magnetic resonance (e.g. virtual colonography) is similar, but its efficacy is lower than that of CT examination. From a gastroenterologist's perspective, endoscopic examination is the fundamental diagnostic and therapeutic method. However, endoscopic examination is initially limited by the cardiopulmonary state of the patient--in a number of cases, first the cardiopulmonary condition must be stabilized, dysbalance of water and mineral state must be restored, and only then can endoscopic investigation be carried out. The application of enteroscopy in small intestine disorders is only suitable in cases where air must be aspirated from the region of the stomach and mainly small intestine as it happens, for example, in acute intestinal pseudo-obstruction. The success of complex conservative therapy in these states is reached in 80% of the cases. In acute and complete intestinal obstruction, a surgical treatment performed in time is the only method. In these cases, the importance of identification of obstruction and timing of the intervention performance from the viewpoint of the patient's survival is explicitly the principal and life-saving concern. In acute intestinal obstructions developing in patients with malignant affection of the intestine, it is necessary to choose--according to the obstruction location and general state of the patient--either urgently performed surgery or palliative endoscopic intervention which is the reduction of the intestinal lumen of the growing tumor mass and following insertion of a drain. This method also concerns lesions localized in the left half of the abdominal cavity, i.e. in the region of the rectosigmoid and descending part of the colon. Most patients in whom acute intestinal obstruction developed on the basis of malignant disease are risk and polymorbid subjects, and acute surgical intervention may be either impracticable or highly stressing. In such cases it is therefore helpful to insert a drain and to bridge the obstructed area after restoring the cardiopulmonary state including adjustment of the aqueous and mineral environment. Later, the performance of an elective surgical intervention is safer. Another alternative before inserting a drain is the dilatation of the stenotic site by means of a balloon, followed by stenting. Up until today, various types of intestinal drains have been introduced--they have always been self-expanding metallic stents. Just the application of self-expanding stents in patients with malignant intestinal obstruction and the endoscopic possibility of dilatations of benign intestinal obstructions with dilatation balloons are the most significant therapeutic contributions of digestive endoscopy in these states.
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PMID:Intestinal obstruction and perforation--the role of the gastroenterologist. 1283 2

Due to genetic defects in apical membrane chloride channels, the cystic fibrosis (CF) intestine does not secrete chloride normally. Depressed chloride secretion leaves CF intestinal absorptive processes unopposed, which results in net fluid hyperabsorption, dehydration of intestinal contents, and a propensity to inspissated intestinal obstruction. This theory is based primarily on in vitro studies of jejunal mucosa. To determine if CF patients actually hyperabsorb fluid in vivo, we measured electrolyte and water absorption during steady-state perfusion of the jejunum. As expected, chloride secretion was abnormally low in CF, but surprisingly, there was no net hyperabsorption of sodium or water during perfusion of a balanced electrolyte solution. This suggested that fluid absorption processes are reduced in CF jejunum, and further studies revealed that this was due to a marked depression of passive chloride absorption. Although Na+-glucose cotransport was normal in the CF jejunum, absence of passive chloride absorption completely blocked glucose-stimulated net sodium absorption and reduced glucose-stimulated water absorption 66%. This chloride absorptive abnormality acts in physiological opposition to the classic chloride secretory defect in the CF intestine. By increasing the fluidity of intraluminal contents, absence of passive chloride absorption may reduce the incidence and severity of intestinal disease in patients with CF.
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PMID:Abnormal passive chloride absorption in cystic fibrosis jejunum functionally opposes the classic chloride secretory defect. 1284 66

Experiences with a mixture of two different contrast media for radiography in acute small bowel obstruction are reported. Due to different physical and chemical properties, barium sulfate and a water-soluble, high-osmolar contrast medium provided high contrast density in all segments of the small bowel and a shortening of the transit time to the colon. This method proved to be effective and accurate in predicting which patients with suspected small bowel obstruction required surgical intervention. No complications caused by the contrast media were observed intraoperatively or in the postoperative period.
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PMID:[Barium sulfate and water-soluble contrast medium--a suitable mixture for contrast radiography in acute small bowel obstruction]. 1286 56

A new definition of intestinal failure is of reduced intestinal absorption so that macronutrient and/or water and electrolyte supplements are needed to maintain health or growth. Severe intestinal failure is when parenteral nutrition and/or fluid are needed and mild intestinal failure is when oral supplements or dietary modification suffice. Treatment aims to reduce the severity of intestinal failure. In the peri-operative period avoiding the administration of excessive amounts of intravenous saline (9 g NaCl/l) may prevent a prolonged ileus. Patients with intermittent bowel obstruction may be managed with a liquid or low-residue diet. Patients with a distal bowel enterocutaneous fistula may be managed with an enteral feed absorbed by the proximal small bowel while no oral intake may be needed for a proximal bowel enterocutaneous fistula. Patients undergoing high-dose chemotherapy can usually tolerate jejunal feeding. Rotating antibiotic courses may reduce small bowel bacterial overgrowth in patients with chronic intestinal pseudoobstruction. Restricting oral hypotonic fluids, sipping a glucose-saline solution (Na concentration of 90-120 mmol/l) and taking anti-diarrhoeal or anti-secretory drugs, reduces the high output from a jejunostomy. This treatment allows most patients with a jejunostomy and > 1 m functioning jejunum remaining to manage without parenteral support. Patients with a short bowel and a colon should consume a diet high in polysaccharides, as these compounds are fermented in the colon, and low in oxalate, as 25% of the oxalate will develop as calcium oxalate renal stones. Growth factors normally produced by the colon (e.g. glucagon-like peptide-2) to induce structural jejunal adaptation have been given in high doses to patients with a jejunostomy and do marginally increase the daily energy absorption.
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PMID:The medical management of intestinal failure: methods to reduce the severity. 1469 5

Intussusception represents the most common abdominal emergency in infancy. The classical clinical triad, consisting of abdominal colics, red jelly stools and a palpable mass, is only present in approximately 50% of cases, 20% of patients are symptom free at clinical presentation. Primary imaging modality of choice is ultrasound scanning, which enables the diagnosis or exclusion of an intussusception at a sensitivity of 98-100%, specificity of 88% and a negative predictive value of 100%. In emergency cases, additional plain films are necessary to detect potential intestinal perforation, to identify intestinal obstruction or other diseases mimicking the clinical presentation. Once the diagnosis of an intussusception is established, non-surgical reduction (NSR) is used. A surgical approach is chosen in patients with signs of perforation, shock or peritonitis. Depending on the choice of guiding imaging technique, different contrast media are used for NSR. Barium suspension or air with fluoroscopic guidance, or saline only or mixed with water-soluble contrast under sonographic guidance, has to be used. Regardless of the used contrast medium, NSR is an effective technique, being successfully employed in more than 90% of cases.
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PMID:Management of intussusception. 1475 70

A wide spectrum of congenital anomalies may cause obstruction in the upper and lower gastrointestinal tract. Neonates with complete upper intestinal obstruction do not usually require further radiological evaluation after radiography. Barium studies are sometimes needed. Barium studies and other comprehensive methods such as ultrasonography, computed tomography and magnetic resonance imaging are usually complementary procedures which are not usually helpful and may even delay surgery, resulting in some complications and death. The decision to perform a given imaging examination should be considered carefully to avoid unnecessary radiation exposure to the patient. The diagnosis of low intestinal obstruction is usually apparent at abdominal radiography because of the presence of many dilated loops. The differentiation between ileal and colonic obstruction can be made with a contrast enema study. Dilute ionic, water-soluble contrast agents and non-balloon tip catheter of appropriate size is preferred for neonatal contrast enemas. Barium sulphate suspensions typically should not be used because of their potential to exacerbate the impaction of meconium plugs in meconium ileus, whereas water-soluble enemas can be therapeutic.
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PMID:[Congenital gastrointestinal tract obstructions (pictorial essay)]. 1505 9

Intestinal obstruction is the most common surgical emergency in newborn infants. We report a case of cecal duplication cyst (CDC) as a cause of intestinal obstruction in a newborn infant. Prenatal ultrasonography (US) had shown an intra-abdominal cyst that was confirmed by the first postnatal US. Water-soluble contrast enema and a repeat US showed an intracecal cyst, however, the diagnosis of CDC was only established at laparotomy. CDC should be considered in the differential diagnosis of intestinal obstruction in an infant with an intra-abdominal cyst on US and a palpable right iliac fossa mass.
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PMID:Cecal duplication cyst: a cause of intestinal obstruction in a newborn infant. 1566 44

In cholangiocytes, bile salt (BS) uptake via the apical sodium-dependent bile acid transporter (ASBT) may evoke ductular flow by enhancing cAMP-mediated signaling to the cystic fibrosis transmembrane conductance regulator (CFTR) anion channel. We considered that ASBT-mediated BS uptake in the distal ileum might also modulate intestinal fluid secretion. Taurocholate (TC) induced a biphasic rise in the short circuit current across ileal tissue, reflecting transepithelial electrogenic ion transport. This response was sensitive to bumetanide and largely abrogated in Cftr-null mice, indicating that it predominantly reflects CFTR-mediated Cl- secretion. The residual response in Cftr-null mice could be attributed to electrogenic ASBT activity, as it matched the TC-coupled absorptive Na+ flux. TC-evoked Cl- secretion required ASBT-mediated TC uptake, because it was blocked by a selective ASBT inhibitor and was restricted to the distal ileum. Suppression of neurotransmitter or prostaglandin release, blocking of the histamine H1 receptor, or pretreatment with 5-hydroxytryptamine did not abrogate the TC response, suggesting that neurocrine or immune mediators of Cl- secretion are not involved. Responses to TC were retained after carbachol treatment and after permeabilization of the basolateral membrane with nystatin, indicating that BS modulate CFTR channel gating rather than the driving force for Cl- exit. TC-induced Cl- secretion was maintained in cGMP-dependent protein kinase II-deficient mice and only partially inhibited by the cAMP-dependent protein kinase inhibitor H89, suggesting a mechanism of CFTR activation different from cAMP or cGMP signaling. We conclude that active BS absorption in the ileum triggers CFTR activation and, consequently, local salt and water secretion, which may serve to prevent intestinal obstruction in the postprandial state.
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PMID:Activation of CFTR by ASBT-mediated bile salt absorption. 1603 45


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