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An overweight patient with epigastric pain
Published in Tim French, Terry Wardle, The Problem-Based Learning Workbook, 2022
In a patient presenting with abdominal pain there are several important points to consider: the level of pain generally relates to the origin. Foregut – upper (epigastric); midgut – middle (periumbilical); hindgut – lower (suprapubic)colicky pain is produced by the stretching of a hollow viscusconstant localised pain is usually caused by peritoneal irritationassociated back pain suggests retroperitoneal pathologythere are important referred causes of abdominal pain (e.g. pneumonia, lumbar nerve root pathology and MI).
Cloaca
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Cloacal exstrophy represents the most complex of all anorectal and genitourinary malformations. The initial approach consists of the repair of the omphalocele, closure of the bladder (primarily or staged) with or without osteotomies, and the creation of an end colostomy utilizing all available colon. We then observe the patient for 3–5 years, since the ultimate goal for these patients should be to achieve dryness for urine, cleanliness for stool, and sexual function. With respect to fecal continence, most of these patients have a poor prognosis due to the presence of a dysplastic sacrum, significant vertebral defects, suboptimal anal sphincter and perineal muscle function, and different degrees of colon length, usually short, which leads to loose stool. Despite this poor prognosis, it is the capacity to form solid stool that allows for a successful bowel management program, where the child is kept clean for 24 hours with the use of one enema a day. To achieve this, it is vital that every piece of hindgut, no matter how small, is incorporated into the fecal stream, because it has been noted that these apparently useless small segments of colon will grow considerably with use and time. Only after determining the potential for bowel control should a urological reconstruction be planned.
Urology
Published in Stephan Strobel, Lewis Spitz, Stephen D. Marks, Great Ormond Street Handbook of Paediatrics, 2019
In addition to the above surgery, hindgut reconstruction to a colostomy or ileostomy is required. Pelvic osteotomy is employed to help approximate the pubic diastasis (Fig. 22.29) and support the closure.
Approaches to discern if microbiome associations reflect causation in metabolic and immune disorders
Published in Gut Microbes, 2022
Marijana Basic, Dominique Dardevet, Peter Michael Abuja, Silvia Bolsega, Stéphanie Bornes, Robert Caesar, Francesco Maria Calabrese, Massimo Collino, Maria De Angelis, Philippe Gérard, Miguel Gueimonde, François Leulier, Eva Untersmayr, Evelien Van Rymenant, Paul De Vos, Isabelle Savary-Auzeloux
Although similarities exist between species, digestive tract morphology, physiology as well as the amount and type of microbiota may vary (Table 2). Animals adapt to their environment and in particular to their food pattern.54 Omnivore species such as humans depend on food digestion and nutrient absorption in the foregut and midgut54 and on hindgut bacterial fermentation of food components that are not digestible by host enzymes. Anatomical differences of the hindgut exist between animal models used (Table 2). These differences need to be considered for translation of concepts to humans. In addition, physiological/biochemical discrepancies in the lumen environment (digestion rate, transit time, physical pressures, pH, osmolarity, enzymes, bile acids, metabolites) impact the metabolic fate of ingested nutrients and induce various selective pressure on microbiota present in the different segments of the intestine. If these concerns can be addressed partially in mammal models that present physiological similarities with humans, this is less the case in invertebrate models such as C. elegans or D. melanogaster where gut physiology, digestive processes, and nutritional habits are quite different from humans. Nevertheless, at cellular level, hydrolysis of lumen molecules by proteases, processes of metabolites absorption, lipids accumulation, endocytosis mechanisms and regulation of some metabolic pathways are partially preserved, and represent a complement, alternative and potentially more powerful option to investigate these mechanisms.55,56
Intestinal accumulation of microbiota-produced succinate caused by loss of microRNAs leads to diarrhea in weanling piglets
Published in Gut Microbes, 2022
Xihong Zhou, Yonghui Liu, Xia Xiong, Jingqing Chen, Wenjie Tang, Liuqin He, Zhigang Zhang, Yulong Yin, Fengna Li
Succinate can be produced by Prevotella, the most enriched genus in the colon.21,39 We found that this intermediate metabolite accumulated in the colon and that abundance of Prevotella was increased in diarrheal piglets. A previous study suggested that succinate accumulation in the hindgut stimulates water secretion and causes diarrhea.32 However, the major transporters or regulators involved in intestinal fluid secretion targeted by succinate have not been elucidated. Interestingly, scRNA-seq results indicated decreased expression levels of CLCA1 and ANO9 genes in epithelial cells, which encode proteins regulating transepithelial Cl− secretion and driving intestinal fluid secretion;1 whereas further detection showed increased expression levels of the proteins encoded by these two genes. Therefore, our results suggest that succinate increases colonic fluid secretion by targeting CLCA1 and ANO9 at the protein level, whereas decreased expression level of these two genes is most likely a protective mechanism to inhibit excessive fluid secretion.
Does transverse colon cancer spread to the extramesocolic lymph node stations?
Published in Acta Chirurgica Belgica, 2021
Bulent C. Yuksel, Sadettin ER, Erdinç Çetinkaya, Ahmet Keşşaf Aşlar
Although CME and CVL can be applied to all colon cancers, these procedures are slightly different in transverse colon cancers. The transverse colon shows embryological and anatomical oddities due to its midgut and hindgut origin and the location between the foregut and midgut-hindgut. The proximal 2/3 part is the end of the midgut while the distal part is the beginning of the hindgut. The proximal portion of the superior mesenteric artery and the foregut components, such as the great omentum, pancreas and lesser sac, are intertwined. This convoluted relationship suggests the possibility of an interaction between embryological areas. This relationship is even more evident in the venous drainage of the omentum and pancreas. These connections between embryological planes were described by Stelzner et al. in cadaveric studies [12]. In their prospective analysis, Perrakis et al. demonstrated tumor manifestation extending beyond this embryological area [13].