Bowel intestine

Short bowel Intestinal resection (e.g. for Crohn s disease, volvulus, intussusception or infarction) Jejunoileal bypass for obesity... 

Lower gastrointestinal haemorrhage shows a frequency of 10-15% some 3-5% develop in the small bowel. Intestinal bleeding as a result of liver disease is rare. The initial problem consists in the fact that (7.) numerous and different causes of bleeding must be clarified by differential diagnosis and (2.) severe blood loss together with a concurrent liver disease is always particularly hazardous. 

Although Epsom salts were not given their name until the late seventeenth century, their use as a therapy for many disorders was known at least two centuries earlier. People traveled to the Epsom area, as well as to other locations where the compound occurred in spring waters, just to drink the waters. Among its other benefits, Epsom salts was regarded as a purgative, a substance that helps empty the bowels (intestines). 

Many etiologies for protein-losing enteropathies (celiac disease, intestinal lymphangiectasis, allergic gastroenteritis, cow milk protein allergy, Crohn disease, cystic fibrosis, collagen vascular disease, short bowel, intestinal transplants and others) have been identified. 

Castor oil is a cathartic only after Hpolysis in the small intestine Hberating ricinoleic acid. Ricinoleic acid inhibits the absorption of water and electrolytes. It is commonly used for preparation of the large bowel for diagnostic procedures. 

Diarrhea is a common problem that is usually self-limiting and of short duration. Increased accumulations of small intestinal and colonic contents are known to be responsible for producing diarrhea. The former may be caused by increased intestinal secretion which may be enterotoxin-induced, eg, cholera and E. col] or hormone and dmg-induced, eg, caffeine, prostaglandins, and laxatives decreased intestinal absorption because of decreased mucosal surface area, mucosal disease, eg, tropical spme, or osmotic deficiency, eg, disaccharidase or lactase deficiency and rapid transit of contents. An increased accumulation of colonic content may be linked to increased colonic secretion owing to hydroxy fatty acid or bile acids, and exudation, eg, inflammatory bowel disease or amebiasis decreased colonic absorption caused by decreased surface area, mucosal disease, and osmotic factors and rapid transit, eg, irritable bowel syndrome. 

The hormone peptide YY (PYY) is a 36 amino acid peptide, which is closely related to neuropeptide Y and pancreatic polypeptide. PYY is predominantly synthesised and released by intestinal endocrine cells, and can also coexist with glucagon in pancreatic acini and enteroglucagon in endocrine cells of the lower bowel. It acts on the same receptors as neuropeptide Y. The endogenous long C-terminal PYY fragment PYY3 36 is a biologically active and subtype-selective metabolite. 

Because the oral aminoglycosides are poorly absorbed, they are useful to suppressing gastrointestinal bacteria The oral aminoglycosides kanamycin (Kantrex) and neomycin (Mycifradin) are used preoperatively to reduce the number of bacteria normally present in the intestine (bowel prep). A reduction in intestinal bacteria is thought to lessen the possibility of abdominal infection that may occur after surgery on the bowel. 

The a-glucosidase inhibitors are contraindicated in patients with a hypersensitivity to the drug, diabetic ketoacidosis, cirrhosis, inflammatory bowel disease, colonic ulceration, partial intestinal obstruction or predisposition to intestinal obstruction, or chronic intestinal diseases. Acarbose and miglitol are used cautiously in patients with renal impairment or pre-existing gastrointestinal (GI) problems such as irritable... 

Rice bran fiber has fructo-oligosaccharides - a pre-biotic that helps friendly bacteria to proliferate in the gastrointestinal environment and improves intestinal and colon health (Tomlin and Read, 1988). Recent studies in humans (Kahlon and Chow, 1997) have revealed that rice bran fiber not only normalizes bowel function, but also helps in conditions such as irritable bowel syndrome (IBS), inflammatory bowel disease (IBD) and Crohn s disease, and lowers the lipid levels. Rice bran fiber has been shown to significantly reduce renal stones (Jahnen et al., 1992). It is a good source of fiber in weight loss programs and therapeutic fiber diets for diabetics and heart patients. Fiber diets prevent cancer of the colon and large bowel, control obesity and improve bowel function. 

Mahida, Y.R., Wu, K.C. and Jewell, D.P. (1989). Respiratory burst activity of intestinal macrophages in normal and inflammatory bowel disease. Gut 30, 1362-1370. 

Mulder, T.P.J., Verspaget, H.W., Janssens, A.R., de Bruin, P.A.F., Pena, A.S. and Earners, C.B.H.W. (1991). Decrease in two intestinal copper/zinc containing proteins with antioxidant function in inflammatory bowel disease. Gut 32, 1146-1150. 

Fecal impaction, ischemic bowel, pancreatic insufficiency, and intestinal fistulae... 

Gastrointestinal involvement may present initially as small bowel obstruction shortly after birth (known as meconium ileus) due to abnormally thick meconium that cannot be passed. Older CF patients may develop distal intestinal obstruction syndrome (DIOS), formerly called meconium ileus equivalent, which occurs due to fecal impaction in the terminal ileum and cecum. 

Patients with intestinal obstruction may complain of abdominal pain, abdominal distention, and/or decreased bowel movements. 

Formation of strictures, abscesses, fistulae, and obstructions in patients with CD is possible. Patients with CD may develop significant weight loss or nutritional deficiencies secondary to malabsorption of nutrients in the small intestine, or as a consequence of multiple small- or large-bowel resections. Common nutritional deficiencies encountered in IBD include vitamin B12, fat-soluble vitamins, zinc, folate, and iron. Malabsorption in children with CD may contribute to significant reductions in growth and development. 

Surgical intervention is a potential treatment option in patients with complications such as fistulae or abscesses, or in patients with medically refractory disease. Ulcerative colitis is curable with performance of a total colectomy. Patients with UC may opt to have a colectomy to reduce the chance of developing colorectal cancer. Patients with CD may have affected areas of intestine resected. Unfortunately, CD may recur following surgical resection. Repeated surgeries may lead to significant malabsorption of nutrients and drugs consistent with development of short-bowel syndrome. 

Superior mesenteric artery syndrome Enteric infections Inflammatory bowel diseases Pancreatitis Appendicitis Cholecystitis Biliary colic Gastroparesis Postvagotomy syndrome Intestinal pseudo-obstruction Functional dyspepsia Gastroesophageal reflux Peptic ulcer disease Hepatitis Peritonitis Gastric malignancy Liver failure... 

Tegaserod maleate (Zelnorm) is a partial serotonin (5-HT4) receptor agonist that causes an increase in peristaltic activity and intestinal secretion and moderation of visceral sensitivity. It increases the frequency of bowel movements and reduces abdominal discomfort, bloating, and straining. It is indicated for the treatment of patients younger than 65 years of age who experience chronic idiopathic constipation. The most common adverse effects include headache, abdominal pain, diarrhea, and nausea. 

Inflammatory (or exudative) diarrhea results from changes to the intestinal mucosa that damage absorption processes and lead to an increase in proteins and other products in the intestinal lumen with fluid retention. The presence of blood or fecal leukocytes in the stool is indicative of an inflammatory process. The diarrhea of inflammatory bowel disease (e.g., ulcerative colitis) is inflammatory in nature. 

Stimulation of 5-HT3 receptors triggers hypersensitivity and hyperactivity of the large intestine. Alosetron (Lotronex) is a selective 5-HT3 antagonist that blocks these receptors and is used to treat women with severe diarrhea-predominant IBS. Eligible patients should have frequent and severe abdominal pain, frequent bowel urgency or incontinence, and restricted daily activities. Alosetron has been shown to improve overall symptoms and quality of life. Alosetron can cause constipation in some patients. 

Tegaserod maleate (Zelnorm) stimulates 5-HT4 receptors in the GI tract, thereby increasing intestinal secretion, peristalsis, and small bowel transit. It also reduces sensitivity related to abdominal distention. It has been shown to be more effective than placebo in improving global IBS symptoms and altered bowel habits in constipation-predominant IBS.21 Diarrhea is a possible adverse effect. 

Functional bowel problems (e.g., Hirschsprung s disease, neuronal intestinal dysplasia, pseudo-obstruction, proteinlosing enteropathy, microvillous inclusion disease)... 

Short-gut syndrome (e.g., intestinal artresia, necrotizing enterocolitis, intestinal volvulus, massive resection secondary to inflammatory bowel disease, tumors, mesenteric thrombosis)... 

Since there is no true excretion of iron from the body, iron-deficiency anemia occurs mostly because of inadequate absorption of iron or excess blood loss. Inadequate absorption may occur in patients who have congenital or acquired intestinal diseases, such as inflammatory bowel disease, celiac disease, or bowel resection. Achlorhydria and diets poor in iron also may contribute to poor absorption of iron. In contrast, iron deficiency also may occur in patients who exhibit a higher rate of iron loss from the body. This is manifested in... 

Risk factors for salmonellosis include extremes of age, alteration of the endogenous bowel flora of the intestine (e.g., as a result of antimicrobial therapy or surgery), diabetes, malignancy, rheumatologic disorders, human immunodeficiency virus (HIV) infection, and therapeutic immunosuppression of all types. 

The risk of colon cancer appears to be inversely related to calcium and folate intake. Calciums protective effect may be related to a reduction in mucosal cell proliferation rates or through its binding to bile salts in the intestine, whereas dietary folate helps in maintaining normal bowel mucosa. Additional micronutrient deficiencies have been demonstrated through several studies to increase colorectal cancer risk and include selenium, vitamin C, vitamin D, vitamin E, and 3-carotene however, the benefit of dietary supplementation does not appear to be substantial.11... 

Small bowel resections (greater than 100 cm of small intestine remaining, colon intact)... 

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