Intestinal perforation

Eye damage and sclerosing peritonitis with Practolol and perforated intestines with nonsteroid anti-inflammatory drugs such as indomethacin and benzoxaprofen. 

A normochromic anemia may develop rapidly without evidence of GI blood loss, although intestinal bleeding may be contributory. Leukopenia may be reflective of a relative decrease in polymorphonuclear leukocytes. WBC counts may range from 1200 to 20,000 cells/mm . As many as one-third of the patients have elevated levels of the liver enzymes glutamic-oxaloacetic transaminase and alkaline phosphatase in serum. About 80% of patients have positive blood cultures. Bacteremia persists in about a third of cases for several weeks if not treated. Intestinal perforation, intestinal hemorrhage, thrombophlebitis, toxemia with circulatory collapse, encephalopathy, and pneumonia all contribute to a fatality rate of 1 % to 2%. Without treatment, mortality may be 10%. ... 

Gastrointestinal Ischemic colitis and complications of constipation (obstruction, perforation, intestinal ulceration, toxic megacolon, ileus, and impaction resulting in hospital admission) have been reported in association with alosetron. Alosetron was initially withdrawn from the market, but in the USA restricted access is allowed, with a risk management plan. 

Intestinal perforation Intestinal wall haemorrhages Mesenteric tears Retroperitoneal haemorrhage Solid organ damage... 

ANTIDIARRHEALS. The nurse notifies the primary health care provider if an elevation in temperature occurs or if severe abdominal pain or abdominal rigidity or distention occurs because this may indicate a complication of the disorder, such as infection or intestinal perforation. If diarrhea is severe, additional treatment measures, such as IV fluids and electrolyte replacement, may be necessary. 

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. 

Endoscopic approaches are typically used and may include colonoscopy, proctosigmoidoscopy, or possibly upper GI endoscopy in patients with suspected CD. Endoscopy is useful for determining the disease distribution, pattern and depth of inflammation, and to obtain mucosal biopsy specimens. Supplemental information from imaging procedures, such as computed tomography (CT), abdominal x-ray, abdominal ultrasound, or intestinal barium studies may provide evidence of complications such as obstruction, abscess, perforation, or colonic dilation.3... 

Diarrhea is an early symptom and occurs only in 50% of cases. Intestinal hemorrhage or perforation, leukopenia, anemia, and subclinical disseminated intravascular coagulopathy may be seen. 

Possible intestinal leak/perforation, diffuse peritonitis, sepsis, mild dehydration, and hypovolemic hypotonic hyponatremia... 

Signs and Symptoms Abdominal pain, cramps, diarrhea, fever, vomiting, tenesmus, and blood, pus, or mucus in stools. Infections also cause mucosal ulceration, rectal bleeding, drastic dehydration. Serious less frequent complications include sepsis, seizures, convulsions, rectal prolapse, toxic megacolon, intestinal perforation, renal failure, and hemolytic uremic syndrome. 

Blunt abdominal trauma with rupture of intestine Penetrating abdominal trauma Iatrogenic intestinal perforation (endoscopy)... 

Abdominal radiographs may be useful because free air in the abdomen (indicating intestinal perforation) or distension of the small or large bowel is often evident Ultrasound, CT scan, or magnetic resonance imaging may be used to locate an abscess. 

Besides causing loss of appetite and quality of life, longstanding and severe constipation can lead to diverticulosis, diverticulitis and in worst cases perforation of the large intestine with life threatening peritonitis (McConnell et al. 2003). Diverticulosis, irritable bowel syndrome and haemorrhoids are caused by chronic constipation and can lead to bleeding and anaemia. 

Speciai risk Use with caution in the following situations Nonspecific ulcerative colitis if there is a probability of impending perforation, abscess, or other pyogenic infection diverticulitis fresh intestinal anastomoses hypertension CHF thromboembolitic tendencies thrombophlebitis osteoporosis exanthema Cushing syndrome antibiotic-resistant infections convulsive disorders metastatic carcinoma myasthenia gravis vaccinia varicella diabetes mellitus hypothyroidism, cirrhosis (enhanced effect of corticosteroids). 

Gl risk NSAIDs cause an increased risk of serious Gl adverse reactions, including bleeding, ulceration, and perforation of the stomach or intestines, which can be fatal. These reactions can occur at any time during use and without warning symptoms. Elderly patients are at highest risk for serious Gl reactions. 

Speciai risk Exercise caution when considering tigecycline monotherapy in patients with complicated intraabdominal infections secondary to clinically apparent intestinal perforation. 

Renal use Use methotrexate in patients with impaired renal function with extreme caution, and at reduced dosages, because renal dysfunction will prolong elimination. Gl Diarrhea and ulcerative stomatitis require interruption of therapy hemorrhagic enteritis and death from intestinal perforation may occur. 

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 Hypokalemia, hypernatremia, intestinal obstruction or perforation... 

Fire-toxin, as a pathological product as well as a pathogenic factor, can accumulate in the intestines. Fire-toxin should be eliminated as soon as possible, especially before long-term accumulation and when the blood is not strongly disturbed, in order to prevent further development of disease, such as in chronic mild infections of the intestines, or at the primary stage of acute appendicitis, acute pancreatitis, acute cholecystitis, hepatitis and ulcer perforation and inflammation. 

The risk of gastrointestinal ulceration, bleeding and even perforation with non-steroidal anti-inflammatory drug therapy is well known (Hawkey 1994 Lanas et al. 2003). The mechanisms by which these drugs cause gastro-intestinal irritation are complex (Rains-ford 1989). Deleterious effects may result from local actions, which cause injuries to the submucosal capillaries with subsequent necrosis and bleeding, or from inhibition of the formation of protective prostaglandins. 

Q12 Irritation and damage to other structures in the abdomen may occur if the diverticulitis is not treated. Abdominal muscles may go into painful spasm and a minority of patients might have rectal bleeding. A major problem could be development of an intestinal obstruction or an abscess in the wall of the intestine. The abscess may eventually cause perforation of the intestinal wall leakage of infected material into the peritoneal cavity and then infection of the peritoneal membranes (peritonitis) may occur. Peritonitis is a very serious condition. 

If diverticulitis is not treated, there may be irritation and damage to other abdominal structures. Intestinal obstruction or perforation of the intestinal wall could develop. 

Cocaine exposure in utero can affect various fetal organs. Gastrointestinal disorders, including ten cases of necrotizing enterocolitis (291), one of intestinal atresia, and one of spontaneous colonic perforation, have been reported (292). 

History of Crohn s disease, diverticulitis, G1 perforation and/or adhesions, impaired intestinal circulation or ischemic colitis, intestinal obstruction, intestinal stricture, or toxic megacolon... 

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