Constipation surgical

In a small percentage of patients presenting with complaints of constipation, surgical procedures (such as intestinal resection) are necessary. Surgery is usually necessary with most colonic malignancies and with GI obstruction from a number of causes. 

If an underlying disease is recognized as the cause of constipation, attempts should be made to correct it. GI malignancies may be removed through a surgical resection. Endocrine and metabolic derangements are corrected by the appropriate methods. 

Laxatives are used to increase stool frequency and reduce stool viscosity. Even with long-term use, bulk laxatives and pure osmolar laxatives do not predispose patients to formation of a cathartic-type colon and should be the initial agents used for chronic constipation after a structural obstructing lesion has been excluded. Laxatives are also used before radiological, endoscopic, and abdominal surgical procedures such preparations quickly empty the colon of fecal material. Nonabsorbable hyperosmolar solutions or saline laxatives are used for this purpose. Classification and comparison of representative laxatives are provided in Table 40.1. 

Huo Ma Ren is a sweet and neutral herb, and it can either promote bowel movement or tonify the Qi and blood. It is particularly suitable for treating constipation after surgical operations or delivery of a baby and in patients who suffer from chronic diseases or have a weak constitution. It can also be used to treat hemorrhoids and habitual constipation. 

Conjugated bile salts are normally absorbed in the terminal ileum. Disease of the terminal ileum (eg, Crohn s disease) or surgical resection leads to malabsorption of bile salts, which may cause colonic secretory diarrhea. The bile salt binding resins cholestyramine or colestipol may decrease diarrhea caused by excess fecal bile acids (see Chapter 35 Agents Used in Hyperlipidemia). The usual dose is 4-5 g one to three times daily before meals. Side effects include bloating, flatulence, constipation, and fecal impaction. In patients with diminished circulating bile acid pools, further removal of bile acids may lead to an exacerbation of fat malabsorption. These agents bind a number... 

Oral barium sulfate is theoretically non-toxic, but constipation and abdominal pain are not uncommon after barium meals or barium enemas (1). The main risk is that collections of barium wiU remain in the colon they can persist for 6 weeks or longer in elderly patients or cases of colonic obstruction barium fecoliths may even have to be removed surgically. Prolonged stasis of barium can occur after a barium enema into the distal loop of a colostomy. Residues in the appendix have caused appendicitis. Toxic dilatation of the colon can be aggravated by barium sulfate. 

Morphi Dex contains morphine sulfate and dextromethorphan in a 1 1 ratio. Double-blind, single-dose analgesic efficacy studies in over 800 patients with post-surgical pain have shown superior analgesic activity for the combination (60 60 mg) than separate doses of the individual components (28,29). In double-bhnd, multiple-dose studies in 321 patients with chronic pain the combination provided satisfactory pain control with a significantly lower mean daily dose of morphine sulfate. Other studies have shown similar responses (28) and an adverse events profile similar to that of a similar dose of morphine sulfate (30). The most common adverse events seen in a multiple-dose, non-placebo-controlled study in 1400 subjects were nausea, dizziness, vomiting, somnolence, confusion, and pruritus. There was a significant trend toward lower incidence of constipation with the combination than with morphine sulfate alone (31,32). 

The ability of carbohydrates and other macromolecules to imbibe large quantities of water is put to use both medicinally and industrially for example in absorbent paper and sanitary towels, incontinence pads and surgical dressings. Medically, use is made of the swelling properties in the treatment of constipation and in appetite suppression. Three properties are of importance in the in vitro evaluation of bulk laxatives ... 

These cause hypotension, mydriasis, dry mouth, anhidrosis, constipation. urinary retention and impotence. Trimetaphan is used to produce controlled hypotension during certain surgical pnx edurcs. 

Acute abdominal pain is a common complaint in the pediatric age group. A total of 10% of school-age children have recurrent abdominal pain and in only 10% of these children can etiology be detected. The majority of these children have self-limited disease. The most common associated conditions include upper respiratory tract infection, pharyngitis, viral syndrome, gastroenteritis, and constipation (Henderson et al. 1992). Therefore, it is uncommon for the underlying condition in these children to require surgical intervention. 

Although opioid dose requirements are reduced with short-term use of NSAIDs including naproxen, it remains unclear whether reductions in dose are associated with a decrease in opioid-related adverse events such as nausea, vomiting, and constipation. Like other nonselective NSAIDs, naproxen is often withheld in the peri-operative period for fear of surgical site and GI bleeding. It should be appreciated that unlike aspirin, inhibition of platelet aggregation with naproxen is reversible, and temporally related to serum drug concentration. 

Surgical acute pain amitriptyline may be beneficial for adjunctive use for pain control as well as nighttime sedation. Patients recovering from amputation, traumatic or surgical nerve injuries (intercostal nerves, branches of the brachial plexus, inguinal and genitofemoral nerve, etc.). Consider starting dose of 12.5-25 mg qhs and increase to 50 mg as tolerated. Monitor for urinary retention/constipation that may coincide with post-operative symptoms. Consider nortriptyline or desipramine to reduce side effects. 

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