Prevalence and Updated Management of Paralytic Ileus: A Simple Review

The study aims to summarize the updated evidence regards, epidemiology, causes, clinical manifestations, and management of paralytic ileus. Lower abdominal surgical procedure, particularly big open cuts and increased bowel operations, is linked with an increased hazard of bowel obstruction. Though, numerous risk issues have been revealed to upsurge the probability and resistance of intestinal obstruction, such as prolonged abdominal / pelvic surgery, lower gastrointestinal (GI) surgery, open surgery, retroperitoneal spine surgery, opioid use, cancer peritoneal, intra-abdominal inflammation (sepsis / peritonitis), delayed enteral nutrition or nasogastric (NG) tube placement, and hypokalemia. Signs of intestinal obstruction are tachycardia caused by any interruption of movement, absence of abdominal pain, abdominal distention and tenderness, shortness of breath, and hypovolemia. Bowel sounds disappear and flatulence is not discharged, leading to gastric stasis, which can cause hiccups, discomfort, and easy vomiting. Preventive measures include avoiding unnecessary exposure and over-processing of the intestine or traction of the mesentery. Treatment is conservative, as this condition is mostly self-limited. Pharmacologic Therapy have little place, but there are some exceptions of adequate values.

PRIMITIVE MESENTERIC CLAMP SYNDROME : UNUSUAL CAUSE OF UPPER GASTROINTESTINAL OBSTRUCTION

The syndrome of the mesenteric clamp or Wilkies syndrome is defined by a compression of the third duodenum between the superior mesenteric artery, and the aorta . The symptoms are variable and non specific. Management is based first on medical treatment with recourse most often to surgery if failure. We report a review of the literature by reporting an observation of a case. Observation: This is a 27-year-old patient with a history of intermittent chronic vomiting since the age of 16, unexplored, who for the past 1 year has been worsening vomiting becoming persistent with epigastralgia. gravity, evolving in a context of deterioration of the general state and slimming. A high gastrointestinal endoscopy that showed significant gastric stasis, injected abdominal CT found a disparity in caliber against D3. An upper gastrointestinal fluoroscopy showed gastric stasis with a stomach reaching the pelvis. The management consisted in a surgical treatment after failure of the medical treatment with good evolution. The mesenteric forceps syndrome is a rare and benign condition. Positive diagnosis is hard on the scanner. The treatment is medical in the first place but the use of surgery is common.

Features of the small intestinal atresia clinical manifestation in newborns in the first minutes of their life

Clinical signs of small bowel atresia, which are widely described in the literature, usually develop after the first day of life. Studies on the clinical manifestations of intestinal atresia in newborns in the first minutes of their lives are still lacking. Purpose — to identify clinical signs of different types of intestinal atresia which can be detected by physical examination of the newborn, immediately after birth. Materials and methods. A retrospective study of 77 newborns with congenital small intestinal obstruction (SIO) who underwent surgical management at the Neonatal Surgery Center for Congenital Malformations and their Rehabilitation SI «Institute of Pediatrics, Obstetrics and Gynecology named after acad. E.M. Lukyanova of the NAMS of Ukraine» was conducted. The clinical manifestations of SIO in patients with duodenal (n=44), jejunal (n=14) and ileal (n=19) atresia were studied and a statistical analysis was performed. Results. There was no significant difference in the volume of gastric stasis, abdominal bloating and meconium discharge in patients with different types of duodenal obstruction (P>0.05). It was found that patients with duodenal and jejunal obstruction, immediately after birth, have a significantly higher volume of gastric stasis (38.0±23.9 ml and 42.3±20.0 ml, respectively) compared with patients who had ileal atresia (14.7±12.8 ml), (P<0.05). There were no significant differences in the incidence of abdominal bloating and meconium discharge (P>0.05). Conclusions. Duodenal and jejunal atresia are associated with excessive gastrostasis, but meconium discharge may be normal. Abdominal bloating always occurs in duodenal atresia and may be absent in jejunal and ileal atresia. In patients with ileal atresia, there may be no signs of intestinal obstruction immediately after birth. Level of evidence. Level III. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of an participating institution. The informed consent of the child's parents was obtained from the studies. No conflict of interest was declared by the authors. Key words: atresia, small intestine, clinical manifestations, newborns.

Thrombin action on astrocytes in the hindbrain of the rat disrupts glycemic and respiratory control

Severe trauma can produce a postinjury “metabolic self-destruction” characterized by catabolic metabolism and hyperglycemia. The severity of the hyperglycemia is highly correlated with posttrauma morbidity and mortality. Although no mechanism has been posited to connect severe trauma with a loss of autonomic control over metabolism, traumatic injury causes other failures of autonomic function, notably, gastric stasis and ulceration (“Cushing’s ulcer”), which has been connected with the generation of thrombin. Our previous studies established that proteinase-activated receptors (PAR1; “thrombin receptors”) located on astrocytes in the autonomically critical nucleus of the solitary tract (NST) can modulate gastric control circuit neurons to cause gastric stasis. Hindbrain astrocytes have also been implicated as important detectors of low glucose or glucose utilization. When activated, these astrocytes communicate with hindbrain catecholamine neurons that, in turn, trigger counterregulatory responses (CRR). There may be a convergence between the effects of thrombin to derange hindbrain gastrointestinal control and the hindbrain circuitry that initiates CRR to increase glycemia in reaction to critical hypoglycemia. Our results suggest that thrombin acts within the NST to increase glycemia through an astrocyte-dependent mechanism. Blockade of purinergic gliotransmission pathways interrupted the effect of thrombin to increase glycemia. Our studies also revealed that thrombin, acting in the NST, produced a rapid, dramatic, and potentially lethal suppression of respiratory rhythm that was also a function of purinergic gliotransmission. These results suggest that the critical connection between traumatic injury and a general collapse of autonomic regulation involves thrombin action on astrocytes.

In-vitro Comparative Study of Different Brands of Metoclopramide Hydrochloride Tablets Marketed in Saudi Arabia

: Metoclopramide hydrochloride (MCP) a derivative of paraminobenzoic acid, freely soluble drug, rapidly absorbed from the gastrointestinal tract and is used in the management of gastrointestinal disorders such as gastric stasis, gastroesophageal reflux and for the prevention of cancer chemotherapy induced emesis. Many different brands of MCP are available in Saudi Arabia. Objectives: The objective of present study was to evaluate the four brands of MCP 10mg tablets (Premosan, Primperan, Maxolon and Metoclopramide) purchased from the retail pharmacy outlet in Abha, Riyadh and Jeddah, Saudi Arabia to choose the best brand. Methods: The study was done by quality control tests on branded tablets like; weight variation, hardness, friability, hardness, disintegration and dissolution. The results of all marketed products complied with the official specifications. The best brand was chosen depended on the quality control results. Results: The results showed that all parameters MCP tablets are in accordance with the USP limits. All the tested four brands were bioequivalent and complying with the official tests for weight variation, friability, disintegration and dissolution tests. The friability test was within the specified limit. All formulations were disintegrated within 2-6 min. The percentage content of active ingredient of four brands of MCP tablets showed values within the monograph specifications (95-105%). Conclusion: All the four brands evaluated in the present work could be considered bio pharmaceutically equivalent and therefore, patients can safely switch from one brand to another when there is unavailability of particular brand.

Gastrointestinal disorders

This chapter discusses gastrointestinal (GI) disorders and includes discussion on vomiting and gastric stasis/gastroparesis, gastric erosions, diarrhoea, upper GI haemorrhage (non-variceal), bleeding varices, intestinal perforation, intestinal obstruction, lower GI bleeding, colitis, pancreatitis, acute acalculous cholecystitis, splanchnic ischaemia, and abdominal hypertension (IAH) and abdominal compartment syndrome. The aim is to provide a summary of the extensive complex abdominal pathologies that can present to an intensive care clinician. Where appropriate, descriptions are provided on clinical presentation, epidemiology, diagnosis (including investigations), and management. Of note, the conditions covered can arise on the ward environment with subsequent requirement for intensive care, but they can also arise de novo on the intensive care unit itself, highlighting the need for intensive care clinicians to maintain a broad knowledge and understanding of their presentation and management.

Gastroparesis in carcinoma gallbladder: a scintigraphic study

Background: Gastroparesis is characterized by delayed gastric emptying in the absence of mechanical gastric outlet obstruction. There is strong association of gastroparesis with carcinoma gallbladder. The aim of the study was to find out the incidence of delayed gastric emptying in carcinoma gallbladder and its correlation with symptoms of stasis and stage of the disease.Methods: Patients diagnosed with carcinoma gallbladder and their matched controls were included in this study. Patients with mechanical gastric outlet obstruction were excluded. All patients underwent contrast enhanced computer tomography scan and radio labeled (Technitium 99) solid meal Scintigraphy study. Normal gastric emptying time was calculated from control group as Mean +2SD.Results: 30 patients were matched with 20 controls after obtaining informed consent. Upper limit of gastric emptying time is 55.09 minutes. Adenocarcinoma was the commonest histological subtype (50%), abdominal pain was the commonest symptom (86.7%) and hepatomegaly was the commonest sign (46.7%), GETt1/2 for patients was 66.72±26.52 minutes while it was 40.53±7.28 minutes in controls (p <0.05). Gastroparesis increased with advancing stage of carcinoma gallbladder (p <0.05). Symptoms of gastric stasis were seen only in 15.6% of patients.Conclusions: Patients with carcinoma gallbladder can have gastroparesis without obvious symptoms of delayed gastric emptying. This delay in gastric emptying can be documented reliably using solid meal scintigraphic study even in patients without symptoms of gastroparesis. The pathophysiology of gastroparesis needs further study. It may be prudent to remember that while performing palliative bypass surgery for gastric outflow obstruction, that in patients with carcinoma gallbladder, the gastrojejunostomy may not function as expected due to delayed gastric emptying.