Intestinal obstruction symptoms and bowel obstruction treatment

LISTEN YOUR ABDOMEN......

MALFUNCTIONING OF THE BODY THEREBY BLOCKING THE INTESTINE

Undergo HOW to prevent and Treat ?

INTESTINAL OBSTRUCTION

The mall-functioning of the body thereby blocking the gut and preventing the movement of product of digestion. Its a mechanical or  useful impediment  of the gut ,veto the normal transit of the products of digestion. it can become at some level distal to the duodenum of the small gut an is a medical emergency. Although many cases are not treated surgically , is  a surgical problem.

CLASSIFICATION

• ACUTE OBSTRUCTION : Occurs in small intestine.
• CHRONIC OBSTRUCTION :  Occur in large intestine.
• ACUTE-ON-CHRONIC OBSTRUCTION : Spreads from large gut to involved small intestine.

ETIOLOGY

DYNAMIC OBSTRUCTION

  Here an obstructive agent is present.

     LUMINAL OBSTRUCTIONFecal impaction

• Gall stone ileus
• worms eg ascariasis.

     INTRINSIC LESION OF BOWL WALL

•  Inflammatory stricture
• Malignant stricture
• Intussusception

     EXTRINSIC COMPRESSION

•  Adhesions
• Hernias
• Volvulus

ADYNAMIC OBSTRUCTION

Here's no obstructive agent is present.

PARALYTIC ILEUS

• Postoperative
• Peritonitis
• Reflex
• Uremia
• Hpokalemia

 MESENTRIC VASCULAR OCCLUSION

• Embolism
• Thrombosis

SIGNS AND SYMPTOMS

Based on the extent of impediment involved, viscus impediment can result into abdominal pain, abdominal distension, vomiting and regurgitation. (This a information where half-digested concern is remove from the gut into the stomach by contraction and muscle movement, forcefully expelled through the oesophagus and finally outside from the mouth. This is not actually faecal concern that is vomited, but it smells similar). The information of viscus impediment haw be worsen by extraction and electrolyte abnormalities (acid-base imbalance) cod to vomiting. In diminutive gut obstruction, the discompose are cramping and consistent in nature. The discompose is more central and mid-abdominal. Constipation comes after vomiting. In case of large viscus impediment , the discompose is felt in the lower conception of the abdomen. Constipation occurs first and regurgitation haw be irregular.

INVESTIGATIONS

Test that shows obstruction

• Barium enema
• Abdominal CT scan
• Upper GI and small bowl series
• Abdominal film

The field diagnostic tools are blood test, X-rays of the abdomen, CT scanning (computer tomography) and or ultra-sound. In a case of identifying mass, biopsy haw be employed to determine the nature of the mass. Radio logically viscus impediment shows viscus distension and the presence of multiple gas-fluid levels. Contrast enema, diminutive gut series or CT construe can be used to define the level of obstruction, as in either partial or complete and helping to know the cause of the obstruction. In colonoscopy,small gut are diagonalised using ingested camera,while endoscopy is an instrument used to get medical information from inside the embody and laparoscopy is a form of new technique aimed at carrying out abdominal activeness through diminutive incision.unlike the usual large surgical procedure.

TREATMENT

GASTRODUODENAL OR GASROINTESTINAL SUCTION DRAINAGE

REPLACEMENT OF FLUID AND ELECTROLYTES

RELIEF OF OBSTRUCYION BY OPERATION

ANTIBIOTICS 

The treatment for diminutive viscus impediment is both non-surgical called conservative and surgical. Non-surgical treatment involves a nasogastric tub, correction of extraction and electrolyte abnormalities. For patients with cut pain, Opioid discompose reliever haw be used. Antiemetics haw be administered to regurgitation patient. Intestinal Obstruction in Children Intestinal atresia is the main causes of fetal and neonatal viscus obstruction. This is characterised by narrowing or absence of a conception of the intestine. The atresia are usually discovered before birth via Sonagram and treated with using laporotomy after if the area infected is small, surgeon haw be able to remove the damaged conception and the gut is joined back together. In a information where the narrowing is longer and the area is damaged, a temporary stoma haw be placed.

SURGERY

The surgery is performed while you are under general anaesthesia. This means you are unconscious and pain-free .A cut is prefabricated  in your abdomen. The disease conception of the super bowl is distant and the digit healthy ends of bowl are seamed back together ( resected ).The cut is winking , if the entire colon and rectum is distant , it is titled a proctocolectomy. A bowl resection haw be performed as a traditional 'open' machine or as a minimally invasive laproscopic procedure.

PREVENTION


It depends on the cause,treatment of conditions ( such as tumor and hernias ) that are attendant to obstruction,may reduce the risk.some causes of obstruction are not preventable.

EXPECTATION

The outcome varies with the cause of obstruction.

Chronic cholecystitis treatment

ITS A LONG STANDING SWELLING AND IRRITATION OF GALL BLADDER

TREATMENT
NON SURGICAL TREATMENT  
Analgesics may be given for pain .Severe pain require opiates ,which is given along with hyoscine butylbromide ( to counteract spasm of sphincter of Oddi ).Ptient should be put on low-fat diet until cholecystectomy.
MEDICAL DISSOLUTION OF GALL STONES
Gall stone can be dissolved as long as they are radiolucent and gall bladder is functioning.Some drugs can work such as bile acids ,chenodeoxycholic acid .Ursodeoxycholic acid .
EXTRACORPOREAL LITHOTRIPSY 
Extracorporeal shock wave lithotripsy can disrupt gall stones and allow debris to pass into bile duct and beyond. It is suitable for patients with 1-3 stones in a functioning gall bladder.
SURGICAL TREATMENT
Prophylactic antibiotics e.g. 2nd generation cephalosporin should be given.Premedications.provision is made for peroperative cholangiography.

LAPAROTOMY  
Give incision in right paramedian or right subcostal incision ( Kocher's incision ) and examine all abdominal organs .inclding gall bladder.

CHOLECYSTECTOMY 
Isolate the gall bladder area with packs .Aspirate the gall bladder if it greatly distend through fundus via trocar and cannula attached to a suction apparatus.Grasp the neck of gall bladder with sponge-holding forceps.Display the junction of cystic ,common hepatic and bile ducts via dissection and identify cystic artery and its relation to common hepatic duct .Cholangiography is performed ,to confirm the anatomy of biliary tree and to check for stones in main duct .Ligate the cystic duct and then divide it .Dissect the gall bladder from its bed ,rom below and upwards .dividing the peritoneum on gall bladder. Secure hemostasis and close the abdominal wall.Drainage is not mandatory ,if used ,it should be a 3mm closed suction drain.

WITH SEVERE INFLAMMATION IN CALOT'S TRIANGLE  
Open the gall bladder ,extractall stones and bile ,and excise as much of wall of gall ladder as possible.Cystic duct opening is closed by cargut suture from within .An alternative is cholecystostomt.

OTHER SURGICAL TECHNIQUES
CHOLECYSTOSTOMY
PERCUTANEOUS CHOLECYSTOLITHOTOMY
LAPAROSCOPIC CHOLECYSTECTOMY
MINICHOLECYSTECTOMY …..... read more

Gall bladder disease symptoms or chronic cholecystitis

PROLONG FASTING AND OLDER AGE WITH GALL STONES

CAN PRECIPITATE GALL BLADDER DISEASE SYMPTOMS

CHRONIC CHOLECYSTITIS   is invariably associated with gall stones.It may develop after repeated episodes of acute cholecystitis but more often develop insidiously without any precedind clinically evident acute attacks .The gall bladder wall becomes thickened by fibrosis and relatively indistensible .The gall bladder wall is infiltrated with chronic inflammatory cells ,lymphocytes ,plasma cells and macrophages.Glandular outpouchings are formed by the lining of the mucosa and are known as Aschoff - Rokitansky sinuses. If obstructive jaundice occurs ,it is due to a stone impacted in the common bile duct.

The gall bladder does not usually distend ,as the wall is relatively rigid due to fibrosis consequent on the associated chronic cholecystitis.Mucocele ,this ocurrs when a stone impacts in the neck of the gall bladder in the absence of infection in the bile.The bile is absorbed from the gall bladder,and  mucus is secretedinto it from the mucus secreting cells of the epithelium.The lack of inflammation in the wall allowsthe gall bladder to distend to several times its normal size.The gall bladder is usually palpable below the costal margin.The wall of a mucocele is usually very thin and is easily ruptured at surgery.cholestrolosis ,this is a condition where  lipid laden macrophages accumulate in the gall bladder mucosa to produce yellowish flecks in a reddish mucosa ,appearing  like the surface of a strawberry - hence the alternative name " strawberry  gall bladder " .This is often a symptomless condition but may accompany or pedispose to cholestrole stones.

SYMPTOMS AND SIGNS  

May be asymptomatic for years,may progress  to symptomatic gall bladder disease or to acute cholecystitis ,or present with complications.PAIN in right hypochondrium ,radiate between shoulder blades is frequent .it can occur after eating but not so closely related as peptic ulcer.It begins gradually 15 - 30 minutes after meal and last for 30 -90 minutes ,its duration is several hours ,but it must be less than 12 hours.severity is varying from mild to excruciating .it can precipitated by taking fatty foods,and relieved by analgesic drugs ,associated with nausea and vomiting .

FLATULENT DYSPEPSIA it is a feeling of fullness after food associated wih belching and heartburn.It is brought on by a large or a fatty meal.

TENDERNESS present in  the right hypochondrium ,just below the tip of 9th rib where edge of rectus abdominus muscle crosses the costal margin ( gall blader  point ) .

MURPHY's SIGN  may be positive .This is elicited  by asking the patient to breathe in whilst gently pressing the gall bladder point with your thumb pointing towards feet , Patient will experience pain and catch her breath just before the zenith of inspiration.

DIAGNOSTIC INVESTIGATIONS

PLAIN X-RAY ABDOMEN show radio opaque gall stones.


ORAL CHOLECYSTOGRAPHY ( OCG ) presence of gall stones can be detected ( filling defects )

ULTRASONOGRAPHY demonstrates gall stones , as well as biliary calculi and dilatation of biliary tree.

CT SCAN useful for patients in whom U/S is difficult e,g. obese or those with excessive bowel gas.

PERCUTANEOUS TRANSHEPATIC CHOLANGIOGRAPHY ( PTC ) or PEROPERATIVE 
CHOLANGIOGRAPHY to detect associated duct stones....... read more

Peritonitis treatment

First make diagnosis for appropriate treatment

A diagnosis of rubor is based primarily on the clinical manifestations described above. If rubor is strongly suspected, then surgery is performed without further retard for another investigations. Leukocytosis, hypokalemia, hypernatremia and acidosis haw be present, but they are not specific findings. Abdominal X-rays haw expose dilated, edematous intestines, though such X-rays are mainly multipurpose to countenance for pneumoperitoneum, an indicator of gastrointestinal perforation. The role of whole-abdomen ultrasound examination is under think and is likely to expand in the future. Computed tomography (CT or CAT scanning) haw be multipurpose in differentiating causes of abdominal pain. If reasonable uncertainty ease persists, an exploratory peritoneal lavage or laparoscopy haw be performed. In patients with ascites, a diagnosis of rubor is prefabricated via paracentesis (abdominal tap) more than 250 polymorphonucleate cells per μL is considered diagnostic. In addition, Gram bactericide and culture of the peritoneal fluid can watch the microrganism responsible and watch their sensibility to antimicrobial agents.

GENERAL CARE OF PATIENT

INTRAVENOUS FLUIDS restoration of ECF volume. rebuke of ECF electrolyte balance.correction of ECF protien depletion.Hyperalimentation ( IV intake ) , if patient's recovery is delayed for more than 7 - 10 life .

NASOGASTRIC ASPIRATION intermittent aspiration is maintained ,until paralytic ileus has recovered.If the cavum is soft and non-tender and bowel-sounds return ,oral intake haw be progressively introduced.

ANTIBIOTICS paraenteral Polycillin ,gentamycin ,and antiprotozoal haw be given.

ANALGESICS narcotic analgesics haw be presented ,e.g dextropropoxyphene ,nalbuphine and diminutive dose continuing for 48 hours.

FLUID BALANCE CHARTING

VITAL SIGN MONITORING

NEUTRALIZATION OF LOCAL SOURCE
BY SURGERY this is indicated in cut appendicitis , cut diverticulitis ,perforated peptic lesion ,perforated or unhealthy cholecystitis.
BY CONSERVATIVE TREATMENT this is done in rubor due to pancreatic salpingitis , or in case of primary rubor of streptococcal or pneumococcal lineage .

PERITONEAL LAVAGE if surgery has been undertaken ,then whole peritoneal cavity should be explored with sucker and mopped dry .Through improvement of peritoneal cavity can be achieved by work with upto 10 litres of armed normal saline.Last some litres should contain a broad-spectrum antibiotic ( e.g antibacterial ).


COMPLICATIONS OF PERITONITIS these may be either systemic or local.

Local complications allow :intraperitoneal abcess e.g subphrenic and pelvic ,Wound infection ,Anastomotic breakdown ,Fistula formaton ,adhesions .
Systemic complications allow : hypovolemic damper ,septic damper ,adult respiratory disress syndrome ,disseminated intravascular coagulation ,immunological unfortunate ,multiorgan unfortunate .

PROGNOSIS

The coverall mortality in generalized rubor ,especially if it is unhealthful ,is broad .Factor affecting mortality allow :
Age __ old patients with soiled rubor hit an exceptionally broad mortality.
causation __ unhealthful causes hit a higher mortality than chemical.
Duration of symptoms.
Degree of bacterial contamination.
Concomitant disease processes e.g cardiac ,renal , and hepatic organ failure.......read more

Acute peritonitis and peritonitis symptoms

A SERIOUS CONDITION IN WHICH THE INSIDE WALL OF THE BODY BECOMES SWOLLEN AND INFECTED 

ACUTE PERITONITIS 

Peritonitis is an inflammatory or suppurative response of the peritoneal lining to direct irritation.It haw be decentralised or unspecialised bacterial or chemical.Localized peritonitis is due to transmural inflammation of aviscus ,e.g. accent appendicitis ,acute cholecystitis .acute diverticulitis .It haw remain decentralised by being contained by omentalwrapping or adhesion of conterminous structures .In some cases ,however ,it becomes unspecialised ,spreading to involve the whole peritoneum .Sudden perforation of a viscus usually results in unspecialised peritonitis.

In this case , the patient is usually seriosly ill .Hypovolemia results from large oozing into the peritoneal decay and septicemia haw result if the cause is infective .eg faecal peritonitis due to perforated diverticulitis.Chemical peritonitis results from viscus or pancreatic juice ,bile ,urine ,or blood in the peritoneal decay .Bile causes lowercase reaction if it is sterile ,but can cause a nonindulgent peritonitis if it is infected or mixed with pancreatic juice.Blood and urine ,again ,cause lowercase raction if sterile ,but a nonindulgent reaction usually results if thy are infected.

CAUSES OF PERITONITIS 

It haw be ACUTE OR CHRONIC

In Acute cases we crapper categarize BACTERIAL and CHEMICAL and we boost cypher in PRIMARY And SECONDARY. 

Primary are rare but crapper due to streptococcus ,Pneumococcus ,haematogenous spread occurs in young girls ,ascites ,nephrotic syndrome and post-splenectomy .

Secondary is common related to perforation ,infection ,inflammation or anaemia of the GIT or GU tract. In chemical culprits are  Gastric juice e.g cut gastric ulcer.
Pancreatic juice e.g accent pancreatitis .
Bile e.g cut gall bladder.
Blood e.g damaged spleen.
Urine e.g intraperitoneal break of the bladder.

In CHRONIC cases allow Tuberculosis and Starch ( medicine activity )

CLINICAL FEATURES

Most patients with rubor module hit abdominal pain and a fever. Also, they commonly already hit Ascites (a build-up of changeful within their stomach) and a distended stomach.  Peritonitis haw or haw not drive the breadbasket to be more distended than normal.

Some patients module hit nausea, vomiting, expiration of appetite, and coefficient loss.  Which of these symptoms are inform depends on the drive of the problem. Many patients with Ascites also hit liver problems.  When these patients develop peritonitis, they often undergo deterioration in mental status because of the build-up of toxic substances in their blood.

Patients with tuberculous rubor hit low-grade fever, expiration of appetite, and coefficient loss. Often, their Ascites module develop slowly.

In patients with cancer, the cancer crapper spread to the peritoneum (the abdominal cavity).  If this happens, it triggers a activity and causes the accumulation of fluid.  This crapper drive an abnormal increase in the size of the abdomen, expiration of appetite, and lack of energy. If there is a large amount of changeful within the breadbasket cavity, the enduring haw hit trouble breathing because the lungs cannot expand normally.  Also, changeful haw country the intestine and not allow food to pass through.Examination by a doctor commonly reveals compassionateness of the abdomen, and fever.

DIAGNOSTIC INVESTIGATIONS 

A diagnosis of rubor is based primarily on the clinical manifestations described above. If rubor is strongly suspected, then surgery is performed without further retard for another investigations. Leukocytosis, hypokalemia, hypernatremia and acidosis haw be present, but they are not specific findings. Abdominal X-rays haw expose dilated, edematous intestines, though such X-rays are mainly multipurpose to countenance for pneumoperitoneum, an indicator of gastrointestinal perforation. The role of whole-abdomen ultrasound examination is under think and is likely to expand in the future. Computed tomography (CT or CAT scanning) haw be multipurpose in differentiating causes of abdominal pain. If reasonable uncertainty ease persists, an exploratory peritoneal lavage or laparoscopy haw be performed. In patients with ascites, a diagnosis of rubor is prefabricated via paracentesis (abdominal tap): more than 250 polymorphonucleate cells per μL is considered diagnostic. In addition, Gram bactericide and culture of the peritoneal fluid can watch the microrganism responsible and watch their sensibility to antimicrobial agents........ read more

How to listen your body in crisis with Volvulus ?

VOLVULUS  ( Twisting of intestine )

VOLVULUS  refers to the winding of a assets of the intestine around itself or a stalk of mesentery tissue to cause an obstruction. Volvulus occurs most ofttimes in the colon, although the breadbasket and small bowel crapper also twist. The conception of the digestive grouping above the volvulus continues to function and haw swell as it fills with digested food, fluid, and gas. A condition called strangulation develops if the mesentry of the bowel is twisted so tightly that murder line is cut off and the tissue dies. This condition is called gangrene.

VOLVULUS IS A SURGICAL EMERGENCY because gangrene crapper amend quickly, cause a mess in the wall of the bowel (perforation), and become life-threatening.

ITS AXIAL ROTATION HAS DIFFERENT TYPES

Volvulus Neonatorum

Volvulus of Small Intestine

Volvulus of Cecum

Volvulus of Sigmoid Colon

VOLVULUS NEONATORUM an intestinal obstruction in a new born resulting from a twisting of the bowl caused by malrotation or nonfixation of the colon .Floating of cecum , together with whole of small intestine which has a narrow attachment ,revolves.

Arrested rotation  , in which cecum remains in left hypochondrium ,and a peritoneal band is found running from cecum to right side of abdomen and then across the 2nd part of duodenum ( transduodenal band of Ladd )

In the clinical fearures ,there is some symptoms of Repeated vomiting , which will be bile stained .can also cause abdominal distension .

It can cause some signs of Dehydration and abdominal distension.
Few diagnostic test ,that shows or revealed a diseased portion.For this reason we can do PLAIN ABDOMINAL X-RAY it reveal stomach and upper part of duodenum are greatly distended ith air ,so called 'double stomach.

This condition needs immediate surgery included :

Early Laprotomy
Whole of the midgut is delivered on to the surface .
Untwisting is done in opposite direction .
Transduodenal band of Ladd is divided .
Abdomen is closed in layers .

VOLVULUS OF CECUM  nearly always occur in a clockwise direction. First twist obstructs the ascending colon  ,if a 2nd twist occurs ,it obstructs the ileum also .Axial torsion, the most common form of volvulus, occurs with the development of a twist of 180-360^o; along the longitudinal axis of the ascending colon. This form has a high mortality rate because the obstructive process is associated with vascular compromise, which can lead to gangrene and perforation, often on the antimesenteric border, where the ischemic changes may be most pronounced.

Nonspecific abdominal symptoms occasionally occur with abnormalities of fixation. Traction on the superior mesenteric artery with partial compression of the duodenum, gallbladder, pylorus, or kidneys has been implicated. The most important complication of the abnormalities of fixation is a volvulus of the right side of the colon and/or cecum.

The common presentation of a cecal volvulus is an acute abdomen, with colicky abdominal pain of sudden onset. Most cases of cecal volvulus reportedly occur in patients with a mobile, defectively fixed right colon while they are asleep. Normal movement of the patient from side to side during sleep may result in displacement of the right colon to an ectopic or abnormal location. When gaseous distention occurs, the displaced right colon is trapped, resulting in symptomatic acute volvulus.

The diagnosis is mostly based on plain abdominal radiographic findings aided by those of single-contrast barium enema examination. CT is useful in identifying signs of ischemia, which include mural thickening, infiltration of the mesenteric fat, and pneumatosis intestinalis. Treatment is surgical, but reduction of the volvulus has been reported after barium enema examination.colonoscopy may be considered for the purpose of decompression. Simple abdominal radiographs had a low diagnostic accuracy but revealed bowel obstruction. 

TREATMENT 

Laprotomy should be done ,Deflate the ballooned cecum by insertion of a needle .Untwisting is accomplished in opposite direction ,ie anticlockwise . Cecostomy is performed  , which relieves the distension  , and fixes the organ to abdominal wall ( preventing recurrence ) ,If cecum is gangrenous ,right hemicolectomy is performed .Abdominal wound is closed .

VOLVULUS OF SIGMOID COLON  

This  is the terminal section of the colon. Two body differences can increase the risk of colon volvulus. One is an elongated or movable colon colon that is unengaged to the left sidewall of the abdomen. Another is a narrow mesentery that allows winding at its base. Sigmoid volvulus, however, can occur modify without an body abnormality.

This type of twisting in the sigmoid can occur due to Band or Adhesions ( peridiverticulitis ) ,Overloaded pelvic colon ,Long pelvic mesocolon .Narrow attachment of pelvic mesocolon.

Loop  may rotate  half a turn , in which event spontaneous rectification sometimes occur .After the loop has rotated 1 1/2 turns ,veins involved in torsion are compressed  ,and loop becomes greatly congested .if it rotates more than 1 1/2 turns ,blood supply is cut off entirely and loop becomes gangrenous .Rotation nearly always occur in anticlockwise direction .

In clinical fearures ,it can shows the sumptoms of  sudden severe abdominal pain ,often coming on while the patient is straining at stool .Abdominal distension  ,hiccough and retching occur early ,Vomiting occur late ,absolute constipation .

some sgns of abdominal distension ,abdominal guarding and tenderness

DIAGNOSTIC INVESTIGATION

PLAIN ABDOMINAL X-RAY 
A connatural stark abdominal x-ray will demonstrate a huge air filled distended bowel like the appearance of an inverted U, with the convexity of the U covering the right upper abdominal quadrant. This appearance has been described as the kidney noodle shape, coffee noodle shape, bent inner plaything shape, ace of spades or ‘Omega loop Sign’. You can wager an example down in the inventiveness section.
  

BARIUM ENEMA 

With a water solvable metal enema, the distention in the sigmoid colon can be demonstrated to be cod to a twist, as it will show an Atlantic of rank obstruction with some twisting in the so called shuttle beak or shuttle of beast sign. 

TREATMENT

DEFLATION AT SIGMOIDOSCOPY 

Sigmoidoscopy is carried out and when obstruction is reached an attempt  is made to coax a soft rectal tube into twisted gut .This will immediately deflate the gut and operation can be delayed for a few days until the patient is more fit.

OPERATION 

Laparotomy is performed ( immediately if dilation is not successful ) .Untwist the gas filled viscus in aclockwise direction .Simultaneously ,a rectal tube is passed to deflate the colon .Resection and end-to-end anastomosis is carried out .Abdominal wound is closed.

Colostomy is an artificial opening to divert faeces and flatus.

Bowel diversion surgery for artificial opening in large bowel in order to divert faces to exterior

COLOSTOMY

In simple terms, a colostomy is when the colon is cut in half and the end directive to the stomach is brought finished the surround of the abdomen and attached to the skin. The end of the colon that leads to the rectum is closed soured and becomes dormant. In other words we can say that its a artificial opening made into large bowel in order to divert feces ( & flatus ) to exterior  ,where they may be collected in an adhesive bag.

Usually a colostomy is performed for infection, blockage, or in rare instances, severe trauma of the colon. This is not an activeness to be taken lightly. It is truly quite serious and demands the close attention of both patient and doctor. A colostomy is ofttimes performed so that an incident crapper be stopped and/or the affected colon tissues crapper heal. The alternative to the colostomy is ofttimes pretty grim, death. Just be glad you are here. It is essential actualise that, with a few exceptions, you crapper look forward to having the colostomy reversed.

A colostomy is sometimes necessary for destined upbeat conditions or diseases. Some of these include cancer, diverticular disease, Crohn's disease and trauma or injury. A temporary colostomy may be necessary to allow the colon to rest and ameliorate for a period of time. A temporary colostomy may be in locate for weeks, months, or years. The temporary colostomy module eventually be closed and bowel movements module return to normal. A imperishable colostomy is usually necessary when a part of the colon staleness be distant or cannot be utilised again.

  

This is famous as a "Hartmann's Colostomy". There are other types of colostomy procedures, but this one is the most common.

It may be TEMPORARY or PERMANENT

TEMPORARY COLOSTOMY

A temporary colostomy haw be used when the conception of the colon (typically the lower section) needs to heal, such as after trauma or surgery. After the colon is healed, the colostomy can be reversed, backward the bowel function to normal. In a colostomy reversal, the digit ends of the colon are reconnected and the area where the stoma was created in the cavum is closed. The large gut is made, erst again, into a continuous tube between the small gut and the rectum. Bowel movements are eliminated through the rectum.

  

INDICATIONS to relieve a distal obstruction of sigmoid colon either by a carcinoma or diverticulitis ,vesicocolic fistula ,protection of a low colorectal anastomosis after anterior resection .To prevent fecal peritoniyis developing after traumatic injury to rectum or colon .To facilitate operative treatment of a high fistula-in-ano.

PROCEDURE

The operation usually takes between digit and four hours depending on difficulty, infection, and the severity of trauma if that is the case. Most of the reasons for a colostomy are: diverticulitis, other inflammatory bowel conditions, or cancer.

Since you are having the operation, you should discuss with your student whether or not you should hit the appendix distant at the same time, since they are going to be in there anyway. It is not a necessary organ and, if removed, it crapper never cause you problems in the future.

 It is normal practice to unstoppered the cavum with an incision from meet below track distinction to meet below the sternum. This gives unstoppered admittance to the internal organs. If you have infection, the student module suction and flush out the contaminates until you are clean.

A loop of bowel ( loop colostomy ) is brought to the surface , where it is held in place by a plastic or glass rod passed through mesentry .Bowel is opened & edges of colonic incision stitched to surrounding skin margins.When firm adhesion of colostomy to abdominal wal has taken place after 7 days , then rod can be removed.

Closure of colostomy performed ,following surgical cure of distal lesion .Done when the stoma is matured ,ie after 2 months .Usually performed by an intraperitoneal technique

PERMANENT COLOSTOMY

A imperishable colostomy (sometimes also called an end colostomy) is necessary for some conditions, including most 15% of colon cancer cases. This type of surgery is commonly utilised when the rectum needs to be removed because of disease or cancer. Most of the colon may also be removed, and the remaining assets utilised to create a stoma.

INDICATIONS after excision of rectum for a carcinoma by abdominoperineal technique ,through the lateral edge of rectus sheath 6cm above & medial to bony prominence.

PROCEDURE distal end ( end colostomy ) of divided colon is brought to surface in left iliac fossa ,where it is stitched in place immediately by sutures placed between colonic margin 7 surrounding skin .A colostomy bag is applied without impinging on bony prominence of anterior superior iliac spine.
  

 After the colostomy, squander is composed on the outside of the body with an ostomy appliance. Today’s ostomy appliances become in a variety of shapes, sizes, colors, and materials to meet the wearer’s lifestyle. The aperture and the surrounding wound (peristomal skin) will order primary care that is taught to patients post-surgery by an enterostomal therapy (ET) nurse....... read more

Colostomy products

DIFFERENT TYPES OF PRODUCTS FOR COLOSTOMY

Pouch
There are a variety of sizes and styles of colostomy pouches. Pouches are lightweight and odor-proof. Pouches have a special concealment that prevents the pouch from sticking to the body. Some pouches also have charcoal filters which release pedal tardily and support to decrease pedal odor. The mass is general aggregation most types of colostomy pouches



Stoma covers and caps
Stoma caps or covers crapper be placed on the aperture when the aperture is not active (draining). People with descending or colon colostomies who wet may use aperture covers or caps. The cover or cap is attached to the wound in the same artefact as a pouch.



COLOSTOMY CARE



Psychic activity of the enduring for the necessity of colostomy is a daylong first step toward his adjustment to experience with an artificial anus. Proper surgical positioning of the activity module assist tending of the bowel. Control of fecal property and peristaltic rate should ideally display degradation susceptible exclusive to habit or enemata. 


The goal of the enema is to display an evacuation thorough enough to prevent soiling for a day or two. The goal of fare variations is to display a manageable volume and property of fecal stream. The framework of enemas and pick of diet can be personalised when the underlying principles are understood.



COMPLICATIONS OF COLOSTOMIES



Prolapse , Retraction ,Necrosis of distal ends , Stenosis of orifice , Colostomy of hernia , Bleeding ( usually from granulomas around the margin of colostomy ) Colostomy diarrhea ( usually an infective enteritis responds to metronidazole )



Recovery at home is mostly most six weeks, although it haw be longer for patients who are very ill before surgery or who hit complications. Activity module be limited at first, and lifting, housework, and driving are not recommended. The infirmary staff module advise you most your diet when you prototypal get home, which haw be limited to low fiber. Regular appointments with your surgeon module help ensure that your cavum and the surface  around the aperture are sanative well........read more

70% adult cases of chronic pancreatitis are caused by chronic alcohol use

Main culprits are heavy alcohol consumption and gallstones for chronic pancreatitis

CHRONIC PANCREATITIS 

is a relapsing disorder which may arise  insidiously or following repeated attacks of acute pancreatitis .The most commonest cause is chronic alcohol consumption and accompanied by a protien and fat rich diet .Other causes include cystic fibrosis ,hypercalcemia ,hyperlipidemiaand a rare familial pancreatitis .Pathological changes include parenchymal destruction ,fibrosis ,loss of acini ,calculi and duct stenosis with dilatation behind the stenosis.At operation the gland feels hard and irregular and may be mistaken for carcinoma .Calcification is often seen on plain abdominal X-ray.This is thought to be due to calcification of protien precipitates in ducts .

 Pancreatic duct obstruction : due to Stricture e.g.after trauma or acute pancreatitis.Occlusion by pancreatic cancer.

 Hyperparathyroidism ,cystic fibrosis ,Hereditory pancreatitis ,Infantile malnutrition ,Idiopathic ,Stenosis of ampulla of vater . In 12 % of adults ,etiology is unknown.

 Initially pancreas may appear normal.Later pancreas enlarges and becomes hard due to sclerosis ,while the ducts become distorted and dilated with areas of ectasia .Calcified stones ,weighing from a few mg 200 g ,may form within ducts .Ducts become occluded with gelatinous protein-rich fluid and debris ,to form cysts.

Lesions affect a particular lobule producing ,Ductular metaplasia and hyperplasia ,Atrophy of acini ,Interlobular fibrosis .

In clinical features there is symptom of discompose in epigastrium ,which alter to left and correct hypochondrium and finished to back .boring discompose to biliary colic in character .duration about 3-4 days ,and exacerbated by beverage consumption.Vomiting ,anorexia ,Steatorrhea ,and Weight loss ( results from anorexia ,malabsorption steatorrhea and vomiting .It can cause some symptoms of diabetes mellitus ,these are late feature and includes polyuria ,polydipsia ,weight loss and imperfectness.

Signs of jaundice haw be present ( due to narrowing of retropancreatic bile duct ) A protective ,hard epigastric mass haw indicate formation of a sac . ( best way to palpate pancreas is to invoke the enduring to correct and hips and knees are flexed .Left costal margin is deeply palpated.This will evoke tendrness in accent and habitual pancreatitis ( Mallet-Guy's sign ).

DIAGNOSTIC INVESTIGATIONS

The identification of habitual pancreatitis is typically based on tests on pancreatic structure and function, as direct biopsy of the pancreas is thoughtful excessively risky. Serum amylase and lipase may well not be elevated in cases of advanced habitual pancreatitis, but are often utilised as markers for sleuthing pancreatic inflammation in acute pancreatitis. A secretin stimulation effort is thoughtful the gold standard functional effort for identification of habitual pancreatitis but not often utilised clinically. The observation that bi-carbonate production is impaired early in habitual pancreatitis has led to the rationale of ingest of this effort in early stages of disease (sensitivity of 95%). Other ordinary tests utilised to determine habitual pancreatitis are faecal elastase measurement in stool, serum trypsinogen, Computed tomography (CT) scans, ultrasounds, EUS, MRI's, ERCP and MRCP's. Pancreatic calcification crapper often be seen on plain abdominal X-rays, as well as CT scans.

There are other non-specific laboratory studies useful in identification of habitual pancreatitis. Serum bilirubin and alkaline phosphatase crapper be elevated, indicating stricturing of the ordinary bile funiculus cod to edema, fibrosis or cancer. When the habitual pancreatitis is cod to an autoimmune process, elevations in ESR, IgG4, rheumatoid factor, ANA and antismooth hooligan antibody may be seen. The ordinary symptom of habitual pancreatits, steatorrhea, crapper be diagnosed by two assorted studies: Sudden staining of feces or soiled fruitful organic over 24hr on a 100g fruitful diet. To check for pancreatic exocrine dysfunction, the most sensitive and specific effort is the measurement of soiled elastase, which crapper be done with a azygos crap sample, and a value of inferior than 200 ug/g indicates pancreatic insufficiency.

TREATMENT

MEDICAL TREATMENT  

Aimed at controlling discompose and malabsorption .Intermittent attacks treated like accent pancreatitis.Alcohol and super fatty meals must be avoided .Narcotics for severe discompose ,but subsequent addiction is common ,Patients unable to maintain adequate hydration should be hospitalized ,while those with milder symptoms crapper be managed on an ambulatory basis. Surgery haw curb discompose if there is a ductal stricture .Subtotal pancreatectomy haw also curb discompose but at the outlay of exocrine insufficiency and diabetes .Malabsorption is managed with a low fat diet and pancreatic enzymes equal ( 8 customary tablets or 3 viscus glazed tablets with meals ).Because pancreatic enzymes are inactivated by Elvis ,agents that turn Elvis creation ( e.g . omeperazole or sodium bicarbonate ) haw improve their efficacy ( but should not be presented with viscus glazed preparation ) Insulin haw be needed to curb serum glucose .

SURGICAL TREATMENT

Traditional Surgery for Chronic Pancreatitis tends to be divided into two areas - resectional and drainage procedures.New and proven transplantation options preclude the patient from decent diabetic following the surgical removal (resection) of their pancreas. This is achieved by transplanting backwards in the patients own insulin-producing beta cells.

DISTAL PANCREATOMY it consist of distal pancreatic resection up to portal vein ,and it is performed if head of pancreas is relatively normal .

PANCREATODUDENECTOMY it is performed if head of pancreas is mainly involved .

LONGITUDINAL  PANCREATOJEJUNOSTOMY  it is performed if pancreatic duct is grossly dilated .

COMPLICATIONS  

Vitamin B6 malabsorption in 40 % of alcohol induced and all cystic fibrosis cases.Impaired glucose tolerance .Nondiabetic retinopathy due to vitamin A and/ or zinc deficiency,Gastrointestinal bleeding ,icterus ,effusion ,subcutaneous fat necrosis and bone pain occasionally occur .Increased risk for pancreatic carcinoma .Narcotic addiction common.

Here's some information when your intestine is inactive or Paralytic ileus

PARALYTIC ILEUS 

 

It is  a state in which intestine fails to transmit peristaltic waves and is due to failure in neuromuscular mechanism and Obstruction of the gut cod to paralysis of the viscus muscles. The paralysis does not need to be complete to cause ileus, but the viscus muscles must be so inactive that it prevents the passage of food and leads to a useful closure of the intestine.

 

IN POSTOPERATIVE ETIOLOGY  

Ileus commonly follows some types of surgery, especially abdominal surgery  ,Normal lyintestinal motility and absorption returns in about 16 hours ,However ,postoperative ileus may br prolonged , if there is  Hypoproteinemia ,Latent renal failure , If gastrointestinal suction is continued beyond the point at which effective bowl sounds have returned .PERITONITIS initially as a normal response to prevent dissemination .Later bacterial toxins  prevent normal activity of nerve plexuses.

It also crapper result from certain DRUGS  like Uremia ( in renal failure ,following prostatectomy ) , HYPOKALEMIA, IN REFLEX ETIOLOGY Spinal injuries or ribs injuries, ,sometime Retroperitoneal haemorrhage , inflammation anywhere within the abdomen that touches the intestines, and diseases of the viscus muscles themselves  and Application of the plaster jacket.

Irrespective of the cause, closure causes constipation ( no passage of flatus ,for upto 48 hours after laparotomy ), abdominal distention, ( more marked and drum like tympanitic ) and sickness and vomiting ( effortless ,large volume and with dirty fluid ) Respiratory distress. On listening to the abdomen with a stethoscope, some or no bowel sounds are heard (because the bowel is inactive) after laparotomy. Also titled disfunction ileus. Also simply titled ileus.with sign of Tachycardia ,there may be wound dehiscence .

Ileus may increase bond formation, because intestinal segments have more prolonged contact, allowing fibrous adhesions to form, and intestinal distention causes serosal injury and ischemia. Intestinal distention has been shown to drive adhesions in foals . Repeat celiotomy to decompress chronically distended small gut and vanish fibrinous adhesions is also a multipurpose method of treating ileus and reducting adhesions, and it has been related with a good outcome  

DIAGNOSTIC TEST FORPARALYTIC ILEUS: 

The list of diagnostic tests mentioned in various sources as used in the diagnosis of Paralytic ileus includes:

Stethoscope Examination of the abdomen : when a doctor ty o listen with a stethoscope to the abdomen there will be few or no bowel sounds ,indicating that the intestine has stopped functioning .ileus can be confirmed by X-ray of abdomen .computed tomography scans (CT  scan ) or ultrasound .it may be necessary to do more invasive test msuch as barium enema or upper GI series if the obstruction is mechanical.Blood test also are useful in diagnosing paralytic ileus .barium enema used in some obstruction cases but it can cause few problems by increasing pressure or intestinal contents if used in ileus Also in doubtful cases with mechanical obsruction involving the gastrointestinal tract .

So its use is contraindicated in these typs of cases .but in some caes it should be used first . 

TREATMENT OF PARALYTIC ILEUS 

Always seek professional medical advice about any treatment or change in treatment plans, patients may be treated with supervised bed rest in a infirmary , and bowel rest ,where nothing is taken by representative ,and patients are feed intravaneously or finished the ingest of a nasogastric

tube .A nasogastric plaything is a plaything inserted finished the nose down to the throat and into the breadbasket.A kindred plaything can be inserted in the gut .The contents are then suctioned out .In some cases ,especially where there is a machine like obstruction ,surgery may be needed . Drug therapies that encourage intestinal motility ( ability of the gut to more spontaneously ) such as morphine or pethidine , in repeated small doses .Fluid and electrolytes balance ,especially serum K and blood urea.

PROPHYLACTIC TREATMENT 

Routine nasogastric suction and withholding fluids by representative after laparotomy until normal bowel sounds returns ,and /or passage of flatus occurs .in most of the cases ileus are not preventable  ,surgery to remove a tumr or other intestinal obstruction will help prevent a repetition .