Obstruction, intestinal

Nausea is often assumed to be a low level stimulation of the vomiting reflex. However, vomiting occurs without nausea in intestinal obstruction and in space... 

Laxatives are contraindicated in patients with known hypersensitivity and those with persistent abdominal pain, nausea, or vomiting of unknown cause or signs of acute appendicitis, fecal impaction, intestinal obstruction, or acute hepatitis. These dragp are used only as directed because excessive or prolonged use may cause dependence. Magnesium hydroxide is used cautiously in patients with any degree of renal impairment. Laxatives... 

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... 

Amylase enters the blood largely via the lymphatics. An increase in hydrostatic pressure in the pancreatic ducts leads to a fairly prompt rise in the amylase concentration of the blood. Neither an increase in volume flow of pancreatic juice nor stimulation of pancreatic enzyme production will cause an increase in senm enzyme concentration. Elevation of intraductal pressure is the important determinant. Stimulation of flow in the face of obstruction can, however, augment the entry of amylase into the blood, as can disruption of acinar cells and ducts. A functional pancreas must be present for the serum amylase to rise. Serum amylase determination is indicated in acute pancreatitis in patients with acute abdominal pain where the clinical findings are not typical of other diseases such as appendicitis, cholecystitis, peptic ulcer, vascular disease or intestinal obstruction. In acute pancreatitis, the serum amylase starts to rise within a few hours simultaneously with the onset of symptoms and remains elevated for 2 to 3 days after which it returns to normal. The peak level is reached within 24 hours. Absence of increase in serum amylase in first 24 hours after the onset of symptoms is evidence against a diagnosis of acute pancreatitis (76). 

Various conditions such as perforated peptic ulcer, cholecystitis, common bile duct and intestinal obstruction, trauma to the abdomen inducing pancreatitis and ruptured ectopic pregnancy may cause an elevated serum amylase but the levels are usually not as high as those found in acute pancreatitis. Mumps and bacterial parotitis, which block the secretion of salivary amylase are associated with mild elevations of serum amylase. 

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. 

Intestinal obstruction may be manifested as meconium ileus, distal intestinal obstruction syndrome, or intussusception on abdominal x-ray or computed tomography scan. Rectal prolapse may be noted on physical exam. 

Treatment of distal intestinal obstruction syndrome (DIOS) consists of oral or nasogastric administration of polyethylene glycol electrolyte (PEG) solutions. Enemas may also be used to facilitate stool clearance. IV fluids are often required to correct dehydration due to vomiting or decreased oral intake. Re-evaluation of enzyme compliance and dosing is essential to prevent further episodes. Patients with recurrent symptoms may require daily PEG administration (Miralax ).5 Severe presentations of DIOS or initial meconium ileus may require surgical resection. 

A similar classification scheme is used to gauge the severity of active CD.2 Patients with mild to moderate CD are typically ambulatory and have no evidence of dehydration, systemic toxicity, loss of body weight, or abdominal tenderness, mass, or obstruction. Moderate to severe disease is considered in patients who fail to respond to treatment for mild to moderate disease, or those with fever, weight loss, abdominal pain or tenderness, vomiting, intestinal obstruction, or significant anemia. Severe to fulminant CD is classified as the presence of persistent symptoms or evidence of systemic toxicity despite outpatient corticosteroid treatment, or presence of cachexia, rebound tenderness, intestinal obstruction, or abscess. 

Recurrent intestinal strictures, intestinal obstructions, type II diabetes mellitus... 

Bishop RF, Andersson CM The bacterial flora of the stomach and small intestine in children with intestinal obstruction. Arch Dis Child 1960 35 487 191. 

Summers RW, Anuras S, Green J Jejunal manometry patterns in health, partial intestinal obstruction, and pseudoobstruction. Gastroenterology 1983 85 1290-1300. 

Four liters of this solution is administered over 3 hours to obtain complete evacuation of the GI tract. The solution is not recommended for the routine treatment of constipation, and its use should be avoided in patients with intestinal obstruction. 

Other adverse reactions include nausea diarrhea pyrexia dermatitis exfoliative dermatitis urticaria alopecia sore mouth mouth ulcers fever abdominal cramping leukopenia red-orange urine priapism (causal relationship not established) paralytic ileus and intestinal obstruction from submucosal or intramural hemorrhage. 

Diabetic ketoacidoses inflammatory bowel disease colonic ulceration partial intestinal obstruction patients predisposed to intestinal obstruction chronic intestinal diseases associated with marked disorders of digestion or absorption or with conditions that may deteriorate as a result of increased gas formation in the intestine hypersensitivity to the drug or any of its components. 

Diarrhea Diarrhea may be an early symptom of incomplete intestinal obstruction, especially in patients with ileostomy or colostomy discontinue treatment. 

Use cautiously in people with acute or chronic respiratory impairment, particularly children, because phenothiazines may suppress the cough reflex. If hypotension occurs, epinephrine is not recommended because phenothiazines may reverse its usual pressor effect and cause a paradoxical further lowering of blood pressure. Because these drugs have an antiemetic action, they may obscure signs of intestinal obstruction, brain tumor, or overdosage of toxic drugs. 

Use with caution in patients with pyloric obstruction, urinary bladder neck obstruction, and in patients suspected of having intestinal obstruction. Use with special caution in the elderly or in individuals with impaired metabolic, liver, or kidney functions because of the increased likelihood of CNS effects. 

Antiemetic effects Drugs with antiemetic effect can obscure signs of toxicity of other drugs, or mask symptoms of disease (eg, brain tumor, intestinal obstruction, Reye syndrome). They can suppress the cough reflex aspiration is possible. 

Aiuminum-containing antacids - Constipation (may lead to intestinal obstruction) aluminum-intoxication osteomalacia and hypophosphatemia accumulation of aluminum in serum, bone, and the CNS (aluminum accumulation may be neurotoxic) encephalopathy. 

Hypersensitivity to any ingredient nausea, vomiting, or other symptoms of appendicitis fecal impaction intestinal obstruction undiagnosed abdominal pain patients who require a low galactose diet (lactulose). 

Contraindications Intestinal obstruction, hypersensitivity to aluminum or any component of the formulation... 

Contraindications Abdominal pain, appendicitis, intestinal obstruction, nausea, undiagnosed rectal bleeding, vomiting... 

Contraindications Intestinal obstruction, GI tract not anatomically intact patients at risk of hemorrhage or GI perforation, if use would increase risk and severity of aspiration not effective for cyanide, mineral acids, caustic alkalis, organic solvents, iron, ethanol, methanol poisoning, lithium do not use charcoal with sorbitol in patients with fructose intolerance, hypersensitivity to charcoal or any component of the formulation... 

Contraindications Intestinal obstruction, renal failure, hypersensitivity to paromomycin or any of its components... 

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