Bowel injuries

Animal studies indicate that the pathogenesis of NSAID small intestinal toxicity involves multiple interactions dependent on enterohepatic circulation, epithelial permeability, neutrophil infiltration and bacterial infection [233]. Several investigations [234-238] have suggested that bacterial flora may play a role in the pathogenesis of NSAID bowel injury and Robert and Asano [239] did show more than 25 years ago that germ-free rats are resis-... 

Bowel injuries caused by penetrating, blunt, or iatrogenic trauma that are repaired within 12 hours and intraoperative contamination of the operative field by enteric contents under other circumstances should be treated with antibiotics 24 hours. 

The second report documents the shortest interval between insertion and proven bowel injury by an intrauterine contraceptive device. 

Infarction of the bowel was formerly a very occasional complication of abdominal aortography and was due to injection of contrast medium into the mesenteric arteries. Most of these cases were due to the older media, such as acetrizoate however, small bowel injury has occurred after injection of a concentrated bolus of sodium iotala-mate (144). Ileus has been reported after mesenteric angiography in a patient with renal insufficiency (SED-12,1177) (145). 

Sewell RA, Killen DA, Foster JH. Small bowel injury by angiographic contrast medium. Surgery 1968 64(2) 459-65. 

While intravenous contrast material is undisput-edly needed in any multisystem trauma patient, the appHcation of oral contrast material is not uniformly recommended. In patients with penetrating trauma to the chest, abdomen, or pelvis, oral and rectal contrast media application increases sensitivity for the detection of hollow organ injury (Shanmuganathan et al. 2004 Sampson et ah 2006). However, installation of contrast fluids takes some time, and patients that are unable to swallow need a gastric tube before contrast material can be given. In blunt abdominal trauma, oral contrast appHcation is not imperatively necessary to rule out bowel injuries because CT without oral contrast leads... 

Khalid U, Norman AR, Andreyev HJ (2007) Elevated C-reactive protein levels are not a feature of uncomplicated radiation-induced bowel injury. Eur J Cancer Care (Engl) 16 346—350 Kleveland PM, Haugen SE, Sandvik S, Waldum HL (1987) The effect of pentagastrin on the gastric secretion by the totally isolated vascularly perfused rat stomach. Scand J Gastroenterol... 

Comparison between celecoxib and meloxicam with respect to smaU-bowel injury was done in a prospective, double-blind, randomized clinical trial among 29 healthy subjects. They were randomized to receive celecoxib (200 mg twice daily) or meloxicam (10 mg once daily) for two weeks. The incidence and number of small-bowel mucosal injuries (bleedings, ulcers and erosions) as detected by capsule endoscopy were compared between both NSAID groups. The incidence of small-bowel... 

Mizukami K, Murakami K, Yamauchi M, Matsunari O, Ogawa R, Nakagawa Y, et al. Evaluation of selective cyclooxygenase-2 inhibitor-induced smaU bowel injury randomized cross-over study compared with loxoprofen in healthy subjects. Dig Endosc May 2013 25(3) 288-94. Maehata Y, Esaki M, Morishita T, Kochi S, Endo S, Shikata K, et al. SmaU bowel injury induced by selective cyclooxygenase-2 inhibitors a prospective, double-bUnd, randomized clinical trial comparing celecoxib and meloxicam. J Gastroenterol April 2012 47(4) 387-93. 

Nazik H, Bodur S, Api M, Aytan H, Narin R. Glutaraldehyde-induced bowel injury during gynecologic laparoscopy. J Minim Invasive Gynecol 2012 19(6) 756-7. 

Retroperitoneal haemorrhage and solid organ damage are more likely to result from fragmentation (secondary injury) or displacement (tertiary injury) than from primary blast injury. Bowel injuries appear more common in the ileocaecal region. 

Box 3.18 Diagnostic peritoneal lavage findings suggestive of bowel injury... 

The theory underlying the pathophysiology of ischaemia-reperfusion injury, and the role of free radicals in this process has been discussed in detail above. The human colon contains relatively little XO (Parks and Granger, 1986) and so the arguments supporting a role for this enzyme in the pathogenesis of small bowel... 

Irritable bowel syndrome (IBS) is a disorder of the gastrointestinal tract that interferes with the normal functions of the colon. At various points in the past, IBS has been referred to as mucous colitis, spastic colon, irritable colon, or nervous stomach. IBS is generally described as afunctional disorder rather than a disease per se. A functional disorder involves symptoms that cannot be attributed to a specific injury, infection, or other physical problem. A functional disorder occurs because of altered physiologic processes rather than structural or biochemical defects and may be subject to nervous system influence. IBS is associated with frequent fluctuation in symptoms, loss of productivity, and decreased quality of life. Although IBS has been referred to as functional bowel disease, true functional bowel disease may be more indicative of widespread gastrointestinal involvement including (but not limited to) the colon. 

Neuropathic pain is defined as spontaneous pain and hypersensitivity to pain associated with damage to or pathologic changes in the peripheral nervous system as in painful diabetic peripheral neuropathy (DPN), acquired immunodeficiency syndrome (AIDS), polyneuropathy, post-herpetic neuralgia (PHN) or pain originating in the central nervous system (CNS), that which occurs with spinal cord injury, multiple sclerosis, and stroke. Functional pain, a relatively newer concept, is pain sensitivity due to an abnormal processing or function of the central nervous system in response to normal stimuli. Several conditions considered to have this abnormal sensitivity or hyperresponsiveness include fibromyalgia and irritable bowel syndrome. 

Radiation Injury. Late radiation enteropathy is associated with alterations of small intestinal motility [154], intestinal pseudoobstruction [154, 155] and Gram-negative colonization of the small bowel in patients with impaired small bowel motility [12], In patients with severe injury, alterations in the motility and microflora are of main importance for the clinical symptoms [154],... 

Selective bowel decontamination in acute pancreatitis Prevention of SBP in cirrhosis Prevention of NSAID intestinal injury Extra-GI indications Skin infections Bacterial vaginosis Periodontal disease... 

Features of central sensitization are pain in response to normally innocuous tactile stimuli, and the spread of pain sensitivity beyond the site of tissue injury. Central sensitization plays a major role in acute post-traumatic pain, and also in migraine, neuropathic pain (see below) and some diffuse chronic pain syndromes, such as fibromyalgia and irritable bowel syndrome. In these conditions, which have no detectable peripheral trigger, an autonomous central sensitization may be the pathology, increasing the gain in neuronal activity in the CNS and thereby producing abnormal responses to normal inputs. 

Mexico. Decoction of the bark and dried branches is taken orally as an abortive and for diabetes. Decoction of the dried root is taken orally by pregnant humans as an abortive and for diabetes . Infusion of the shade-dried entire plant is taken orally to treat infectious diseases ". Decoction of the dried leaf is taken orally for treatment of diabetes. Hot water extract of the dried leaf is taken orally as a blood purifier to treat kidney problems, urinary tract infections, and frigidity for gallstones, rheumatism and arthritis, diabetes, wounds, and skin injuries, displacement of the womb, and paralysis and to dissolve tumors 5 United States. Hot water extract of the dried leaf is taken orally as a stimulating expectorant and tonic, for tuberculosis, and is drank by Indians of the Southwest for bowel cramps, as a diuretic, and for venereal disease. Hot water extract of the dried leaf is used externally for wound healing . Hot water extract of the dried plant is taken orally for cancer. Effects described are from multicomponent reaction ". 

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