Image result for ulcerative colitis
Ulcerative colitis (UL-sur-uh-tiv koe-LIE-tis) is an inflammatory bowel disease (IBD) that causes inflammation and ulcers (sores) in your digestive tract. Ulcerative colitis affects the innermost lining of your large intestine (colon) and rectum. Symptoms usually develop over time, rather than suddenly.
Image result for ulcerative colitis
Ulcerative colitis (UL-sur-uh-tiv koe-LIE-tis) is an inflammatory bowel disease (IBD) that causes inflammation and ulcers (sores) in your digestive tract. Ulcerative colitis affects the innermost lining of your large intestine (colon) and rectum. Symptoms usually develop over time, rather than suddenly.
Anesthesia
What are the risks and complications of anesthesia?
Stages of anesthesia
types of Anesthesia :
General ,local and Regional Anesthesia
Drugs for Anesthesia
Peptic ulcers are sores that develop in the lining of the stomach, lower esophagus, or small intestine. They're usually formed as a result of inflammation caused by the bacteria H. pylori, as well as from erosion from stomach acids. Peptic ulcers are a fairly common health problem.
Intensive insulin therapy is best defined as a comprehensive system of diabetes management with the patient and management team as partners. The system is directed at improvement of glycemia and patient well-being.
Constipation easy explanation -
Easy ppt for Student Nurses
Definition of Constipation
risk factors
Clinical manifestations of Constipation
Assessment & Diagnostic tests
Management of Constipation
Medical management of Constipation
Nursing Management of Constipation
Slides are prepared as per INC Syllabus Unit V Drugs used on Respiratory systems and it is most benefited for 2nd yr B sc Nursing students and faculty of the subject.
Constipation refers to bowel movements that are infrequent or hard to pass. Constipation is a common cause of painful defecation. Severe constipation includes obstipation (failure to pass stools or gas) and fecal impaction, which can progress to bowel obstruction and become life-threatening.
Constipation is a symptom with many causes. These causes are of two types: obstructed defecation and colonic slow transit (or hypo mobility). About 50 percent of people evaluated for constipation at tertiary referral hospitals have obstructed defecation. This type of constipation has mechanical and functional causes. Causes of colonic slow transit constipation include diet, hormonal disorders such as hypothyroidism, side effects of medications, and rarely heavy metal toxicity. Because constipation is a symptom, not a disease, effective treatment of constipation may require first determining the cause. Treatments include changes in dietary habits, laxatives, enemas, biofeedback, and in particular situations surgery may be required.
Constipation is common; in the general population rates of constipation varies from 2–30 percent. In elderly people living in care homes the rate of constipation is 50–75 percent.[4] In the United States expenditures on medications for constipation are greater than US$250 million per year.
The definition of constipation includes the following:
infrequent bowel movements (typically three times or fewer per week)
difficulty during defecation (straining during more than 25% of bowel movements or a subjective sensation of hard stools; straining in this context is a strong effort to push out stool often by holding one's breath and by pushing the respective muscles in the abdominal area hard), or
the sensation of incomplete bowel evacuation.
The Rome III criteria are widely used to diagnose chronic constipation, and are helpful in separating cases of chronic functional constipation from less-serious instances.
Another definition states that less than three bowel movements per week and straining on more than 75% of occasions represents constipation in clinical surveys.
Anesthesia
What are the risks and complications of anesthesia?
Stages of anesthesia
types of Anesthesia :
General ,local and Regional Anesthesia
Drugs for Anesthesia
Peptic ulcers are sores that develop in the lining of the stomach, lower esophagus, or small intestine. They're usually formed as a result of inflammation caused by the bacteria H. pylori, as well as from erosion from stomach acids. Peptic ulcers are a fairly common health problem.
Intensive insulin therapy is best defined as a comprehensive system of diabetes management with the patient and management team as partners. The system is directed at improvement of glycemia and patient well-being.
Constipation easy explanation -
Easy ppt for Student Nurses
Definition of Constipation
risk factors
Clinical manifestations of Constipation
Assessment & Diagnostic tests
Management of Constipation
Medical management of Constipation
Nursing Management of Constipation
Slides are prepared as per INC Syllabus Unit V Drugs used on Respiratory systems and it is most benefited for 2nd yr B sc Nursing students and faculty of the subject.
Constipation refers to bowel movements that are infrequent or hard to pass. Constipation is a common cause of painful defecation. Severe constipation includes obstipation (failure to pass stools or gas) and fecal impaction, which can progress to bowel obstruction and become life-threatening.
Constipation is a symptom with many causes. These causes are of two types: obstructed defecation and colonic slow transit (or hypo mobility). About 50 percent of people evaluated for constipation at tertiary referral hospitals have obstructed defecation. This type of constipation has mechanical and functional causes. Causes of colonic slow transit constipation include diet, hormonal disorders such as hypothyroidism, side effects of medications, and rarely heavy metal toxicity. Because constipation is a symptom, not a disease, effective treatment of constipation may require first determining the cause. Treatments include changes in dietary habits, laxatives, enemas, biofeedback, and in particular situations surgery may be required.
Constipation is common; in the general population rates of constipation varies from 2–30 percent. In elderly people living in care homes the rate of constipation is 50–75 percent.[4] In the United States expenditures on medications for constipation are greater than US$250 million per year.
The definition of constipation includes the following:
infrequent bowel movements (typically three times or fewer per week)
difficulty during defecation (straining during more than 25% of bowel movements or a subjective sensation of hard stools; straining in this context is a strong effort to push out stool often by holding one's breath and by pushing the respective muscles in the abdominal area hard), or
the sensation of incomplete bowel evacuation.
The Rome III criteria are widely used to diagnose chronic constipation, and are helpful in separating cases of chronic functional constipation from less-serious instances.
Another definition states that less than three bowel movements per week and straining on more than 75% of occasions represents constipation in clinical surveys.
Constipation is generally defined as infrequent and/or unsatisfactory defecation fewer than 3 times per week.
Patients may define constipation as passing hard stools or straining, incomplete or painful defecation. It's a symptom NOT a disease.
Constipation has many causes and may be a sign of undiagnosed disease.
Probiotics are used to help get your gut working properly, and different probiotics may serve different functions. There is a reason for the constipation, and while probiotics might not cure constipation, it can certainly help relieve it as long as you can find the underlying issues.
CME Spark and the American Gastroenterological Association developed a Case Closed CME program for gastroenterologists and other healthcare providers involved in the care of patients with short bowel syndrome (SBS) to have a case-based learning experience that focuses on guidelines and best practices.
John K. DiBaise, MD
Professor of Medicine, Division of Gastroenterology and Hepatology
Mayo Clinic
Scottsdale, AZ
complementary medicine, alternative medicine, integrated medicine, complementary and alternative health practices, acupuncture, acupressure, accupuncture, yoga, Ayurveda practices, homeopathic, why alternative medicine, why complemenatry medicine, reason for alternative or complementary medicine, reasons adult use CAM, definition , scope, how many use, prevalnce, epidemiology, mind body practices, tai chi, hypnosis, meditation,
Brachial plexus injury and Thoracic outlet syndromesBhavin Mandowara
Brachial plexus injury, etiology, pathogenesis, terminology, anatomy, cutaneous innervation of the arm and forearm, anatomical and pathological basis, symptoms and signs, neuralgic amyotrophy, neoplasm and radiotherapy, thoracic outlet syndromes, hyperabduction syndrome, costoclavicular syndrome, management
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
Contact us if you are interested:
Email / Skype : kefaya1771@gmail.com
Threema: PXHY5PDH
New BATCH Ku !!! MUCH IN DEMAND FAST SALE EVERY BATCH HAPPY GOOD EFFECT BIG BATCH !
Contact me on Threema or skype to start big business!!
Hot-sale products:
NEW HOT EUTYLONE WHITE CRYSTAL!!
5cl-adba precursor (semi finished )
5cl-adba raw materials
ADBB precursor (semi finished )
ADBB raw materials
APVP powder
5fadb/4f-adb
Jwh018 / Jwh210
Eutylone crystal
Protonitazene (hydrochloride) CAS: 119276-01-6
Flubrotizolam CAS: 57801-95-3
Metonitazene CAS: 14680-51-4
Payment terms: Western Union,MoneyGram,Bitcoin or USDT.
Deliver Time: Usually 7-15days
Shipping method: FedEx, TNT, DHL,UPS etc.Our deliveries are 100% safe, fast, reliable and discreet.
Samples will be sent for your evaluation!If you are interested in, please contact me, let's talk details.
We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
2. MANAGEMENT
Lifestyle modification
Diet and fiber
Laxatives
- Bulk forming laxatives
- Osmotic laxatives
- Stimulant laxatives
Stool softeners, suppositories, and
enemas
Other therapies for chronic
constipation
- Colonic secretagogues
- Opioid antagonists
- 5HT(4) receptor agonists
3. APPROACH CONSIDERATIONS
●
Manual disimpaction of stool should be considered only after
critical illness asocaited constipation has been ruled out
●
Medical care should focus on dietary change and exercise .
Correctionof dietary deficiency and aerobic exercise
●
Surigcal care is generally restricted to evaluation of underlying
causes or management of acute complication of
constipation.
●
4. HIGH RISK FACTORS
●
UNCERTAIN DIAGNOSIS
●
EVIDENCE OF INTRA-ABDOMINAL CATASTROPHE
●
SEVERE ABDOMINAL PAIN
●
FEVER , CHILLS
●
LOWER GI BLEED
●
INSTABILITY OF VITAL SIGNS
●
ABSENCE OF BOWEL SOUNDS
●
ACUTE RECENT CHANGE IN BOWEL SOUNDS
●
5. DIETARY AND LIFESTYLE MEASURES
●
FIBER : NATURAL -->FRUITS , VEGETABLES , AND CEREALS
●
FIBER SUPPLEMENT : WHEAT , PSYLLIUM OR METHYLCELLULOSE
●
DAILY FIBER OF ABOUT 20-25G/DAY IS RECOMMENDED
●
FIBERS ARE GOOD FOR LONG TERM USE AS COMPARED TO
STOOL SOFTNERS IN WHICH TACHYPHYLAXIS DEVELOPS .
●
FIBRES SHOULD BE GRADUALLY TITRATED UP AS TO PREVENT SIDE
EFFECTS OF FLATULENCE AND BLOATING
●
PATIENT MUST BE EXPLAINED THAT IT HAS TO BE TAKEN DAILY AS
ONSET OF ACTION MAY TAKE WEEKS .
●
INCREASE FLUID INTAKE OF ATLEAST 8 GLASSES PER DAY ,
DECREASE MILK , TEA , COFFE , ALCOHOL
●
●
6. PHARMACOLOGIC THERAPY
●
BULK FORMING AGENTS/LAXATIVES – includes psyllium
,methylcellulose , wheat dextran, act by absorbing water
and increasing fecal mass , best , least expensive but has
to be used for long term
●
EMOLLIENT STOOL SOFTNERS - eg include docusate which acts
as a surfactant . It is easier to use but lose effectiveness with
long term administeration and hence are reserved for short
term setting like post op narcotic prescription
●
RAPIDLY ACTING LUBRICANTS – includes PEG(polyethylene
glycol , bisacodyl and sodium picosulfate v , long term term
riskof habituationor toxicity is there
●
PROKINETICS – cisapride , tegaserod are 5HT4 antagonist ,
increase colonic motility and decrease transit time . They
have been withdrawn
●
●
7. LAXATIVES
●
Laxative usage in the older adults should be individualizedkeeping in
mind the patient's history (cardiac and renal comorbidities),drug
interactions, cost, and side effects
●
OSMOTIC LAXATIVES : USED IN PATIENTS NOT RESPONDING TO BULK
LAXATIVES
●
PEG: Low-dose polyethylene glycol (PEG) (17 g/day) has been
demonstrated to be efficacious and well tolerated in older
patients . However,high-dose PEG (34 g/day) is associated with
abdominal bloating, cramping,and flatulence, and older adults
may be more susceptible to these side effects
●
LACTULOSE increases stool frequency, decreases the severity of
constipation symptoms, and reduces the need for other laxatives
in older adult patients
●
SORBITOL : less expensive and better tolerated
●
8. LAXATIVES
●
Saline laxatives such as magnesium hydroxide have not been
examined in older adults, and should be used with caution
because of the risk of hypermagnesemia.
●
Stimulant laxatives — Stimulant laxatives affect electrolyte
transport across the intestinal mucosa and enhance
colonic transport and motility.
9. OSMOTIC AGENTS/COLONIC
SECRETAGOGUES
●
Lubiprostone is an oral bicyclic fatty acid that activates the
type 2 chloride channels on the intestinal epithelial
cells,thus secreting chloride and water into the gut
lumen .It is best reserved for patients with severe
constipation in whom other approaches have been
unsuccessful.
●
IT HAS BEEN APPROVED BY FDA FOR CHRONIC IDIOPATHIC
CONSTIPATION , IBS-C , OPIOD INDUCED CONSTIPATION
●
ADVERSE EFFECTS INCLUDE FLATULENCE , NAUSEA AND
DIARRHOEA
●
other agent Linaclotide is a guanylate cyclase C receptor
agonist that stimulates intestinal fluid secretion and
transit . Approved by the FDA for use in the treatment of
chronicidiopathic constipation, the long-term risks and
benefits of linaclotide,especially in older adults, remain to
be determined
10. OPIOD ANTAGONIST
●
Opioid antagonists — Two peripherally acting mu opioid
receptor antagonists, alvimopan and methylnaltrexone ,
may have a role in treatment of narcotic-induced
constipation and paralytic ileus, but data are lacking
among older adults. As these opioid receptor antagonists
act peripherally and do not cross the blood brain barrier,
they do not impair the analgesic effects of opioids.
11. SURGICAL CORRECTION OF
CAUSE AND COMPLICATIONS
●
FOR EVALUATION OF UNDERLYING CAUSE -LARGE BOWEL
OBSTRUCTION , VOLVULUS ,INTRABDOMINAL
INFECTION/ISCHEMIA , HEMORRHOIDAL THROMBUS
●
RECTAL OUTLET OBSTRUCTION , RECTOCELE , RECTAL
PROLAPSE , RECTAL INTUSSUSCEPTION
●
HYPOMOTILE COLON REFRACTORY TO MEDICAL THERAPY.
●
12. MANAGEEMNT IN SPECIAL
PATIENTS
●
PREGNANCY :
●
CAUSE : DIETARY CHANGES ,
●
ANATOMIC IMPINGEMENT BECAUSE OF LARGE UTERUS
PRESSING ON RECTOSIGMOID
●
HEMORRHOIDS BECAUSE OF VENOUS CONGESTION
●
TREATMENT : FIBRE , WATER , GENTLE EXERCISE , OCCASIONAL
LACTULOSE
●
IF HEMORRHOIDS ARE THERE THEN SUPPOSITOERY AND SITZ
BATH WILL BE REQUIRED
13. MANAGEMENT IN SPECIAL
PATIENTS
●
ELDERLY : MEDICATIONS ARE TO BE ESPECIALLY ASKED WHICH
CAUSE CONSTIPATION AND ALSO SELF REPORTED
CONSTIPATION IS HIGH
●
TREAMENT INCLUDIING DIET AND EXERCISE IS USUALLY
INSUFFICIENT AND CHRONIC LAXATIVE USE IS OFTEN
REQUIRED .
●
MENTALLY INCAPACITATED INDIVIDUALS THERE IS PATTERN OF
BOWEL RETENTION IN WHICH SHORT TERM USE OF LAXATIVE
OR STOOL SOFTENERS IS REQUIRED
●
14. MANAGEMENT IN SPECIAL
PATIENTS
●
OPIOD INDUCED CONSTIPATION(OIC)
●
40-80% EXPERIENCE CONSTIPATION
●
SOME HAVE SEVERE ENOUGH TO STOP OPIODS ALSO
●
MECHANISM: OPIOD BINDS TO PERIPHERAL OPIOD RECEPTOR
AND DECREASES GI TRACT FLUID
●
TREATMENT : LUBIPROSTONE- ADULTS WITH OIC WITH NON
CANCER PAIN INHIBITS CIC-2 CL- CHANNEL
●
OTHER AGENTS INCLUDE NALOXEGOL AND
METHYLNALTREXONE
15. SURGICAL CONSULTATION
●
LARGE BOWEL OBSTRUCTION
●
COLONIC ILEUS SECONDARY TO INTRABDOMINAL PROCESS
●
ANORECTAL COMPLICATIONS
●
HEMORRHOIDS , FISSURE
●
ACUTE HEMORRHOIDAL THROMBOSIS
●
CHRONIC NON HEALING FIISURE
●
PERIRECTAL ABSCESS AND FISTULA