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Query: UMLS:C0042961 (volvulus)
 4,305 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Colonic pseudo-obstruction (Ogilvie's syndrome) may occur in surgical patients, particularly those who have had orthopedic or blunt trauma, have uremia or diabetes, have complex metabolic or cardiac failure, have metastatic cancer involving the lymph nodes and neural tissue, or are addicted to narcotics. Although a single true cause has not been identified by fulfilling Koch's postulates, the clinical pattern has been recognized in a variety of surgical patients, and this pattern must be distinguished from true obstruction of the colon. Tumor or internal hernia may constitute an obstruction, but the important differential diagnosis of cecal volvulus must be excluded. Ischemic colitis may be confused with Ogilvie's syndrome or may follow it. Gangrene, infarction, and perforation may ensue as colon diameter increases and particularly if cecal distention reaches above 14 cm. This arbitrary number for cecal dilatation should not be awaited before treatment is instituted if signs of devitalization of the gut or peritoneal signs have developed in the patient. Treatment has changed recently with the widespread application of colonoscopy. Endoscopy is helpful in relieving distention but may also be dangerous in the patient with a massively distended colon, particularly at the level of the thin-walled cecum. Colonoscopy also appears to be associated with a high rate of treatment failure and recurrence. Surgical decompression may take the form of cecostomy or may require exteriorization or resection of the colon if infarction has occurred. A series of 12 patients has been presented. The patients were all referred to a single surgeon in a university medical center over a 4 1/2 year period with clinical patterns not suggestive of a common cause but a similar clinical evolution of Ogilvie's syndrome. The prognosis for such patients in whom the complication is recognized early and in whom decompression is performed endoscopically or surgically is encouraging. If recognition is late and particularly if perforation and gangrene result, mortality is nearly 50 percent.
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PMID:Colonic pseudo-obstruction in surgical patients. 397 Mar 26

Vomiting is a protective reflex that results in forceful ejection of stomach contents up to and out of the mouth. It is a common complaint and may be the presenting symptom of several life-threatening conditions. It can be caused by a variety of organic and nonorganic disorders; gastrointestinal (GI) or outside of GI. Acute gastritis and gastroenteritis (AGE) are the leading cause of acute vomiting in children. Important life threatening causes in infancy include congenital intestinal obstruction, atresia, malrotation with volvulus, necrotizing enterocolitis, pyloric stenosis, intussusception, shaken baby syndrome, hydrocephalus, inborn errors of metabolism, congenital adrenal hypoplasia, obstructive uropathy, sepsis, meningitis and encephalitis, and severe gastroenteritis, and in older children appendicitis, intracranial mass lesion, diabetic ketoacidosis, Reye's syndrome, toxic ingestions, uremia, and meningitis. Initial evaluation is directed at assessment of airway, breathing and circulation, assessment of hydration status and red flag signs (bilious or bloody vomiting, altered sensorium, toxic/septic/apprehensive look, inconsolable cry or excessive irritability, severe dehydration, concern for symptomatic hypoglycemia, severe wasting, Bent-over posture). The history and physical examination guides the approach in an individual patient. The diverse nature of causes of vomiting makes a "routine" laboratory or radiologic screen impossible. Investigations (Serum electrolytes and blood gases,renal and liver functions and radiological studies) are required in any child with dehydration or red flag signs, to diagnose surgical causes. Management priorities include treatment of dehydration, stoppage of oral fluids/feeds and decompression of the stomach with nasogastric tube in patients with bilious vomiting. Antiemetic ondansetron(0.2 mg/kg oral; parenteral 0.15 mg/kg; maximum 4 mg) is indicated in children unable to take orally due to persistent vomiting, post-operative vomiting, chemotherapy induced vomiting, cyclic vomiting syndrome and acute mountain sickness.
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PMID:Management of a child with vomiting. 2334 Sep 85