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Bowel disorders
Published in Henry J. Woodford, Essential Geriatrics, 2022
‘Faecal impaction' is a term for a mass of hard faeces within the rectum that cannot be easily passed (i.e. large hard stools). The mechanism that provokes FI appears to be a reduced rectal sensation capacity secondary to the faecal mass rather than the faecal mass affecting internal anal sphincter function.59 The causes are those of constipation (see page 275) and frail older people are particularly susceptible. It is often associated with multi-morbidity, polypharmacy and the prescription of constipating medications (see Table 12.1).60 It should be suspected when such a person has an unexplained clinical deterioration, especially when bowel habit alters.61 Specific presenting symptoms include nausea, vomiting, abdominal pain, paradoxical diarrhoea and subsequent FI, but non-specific presentations, such as delirium, are well recognised. The faecal bulk may precipitate urinary retention or incontinence (see page 257). Rarely, pressure on the intestinal wall may provoke ulceration, bleeding or perforation. It is usually managed with a combination of laxatives and enemas. Infrequently, failed medical therapy necessitates manual evacuation. A regimen of high-dose polyethylene glycol/electrolyte solution for up to three days has been shown to be effective in resolving impaction with minimal adverse effects.62
Treatment of distal intra-articular/extra-articular tibial fractures
Published in Peter V. Giannoudis, Thomas A. Einhorn, Surgical and Medical Treatment of Osteoporosis, 2020
Vasileios P. Giannoudis, Peter V. Giannoudis
Several approaches have been developed over the years to allow reconstruction of distal tibial fractures (3). It is essential for the surgical team to study carefully the CT scan findings and to do preoperative planning when deciding in advance how the existing fragments can be approached and reduced anatomically. Impaction injuries can only be visualized by the CT scan images as well as soft tissue entrapment within the fracture locations. Approaches that can be utilized include direct medial, direct lateral, anteromedial, anterolateral, direct anterior, posteromedial, and posterolateral. Each approach has its own advantages and limitations.
Unexplained Fever Associated with Diseases of the Gastrointestinal Tract
Published in Benedict Isaac, Serge Kernbaum, Michael Burke, Unexplained Fever, 2019
On physical examination, the following features should be noted: general, mental, and nutritional condition and especially, state of hydration. In a severely dehydrated patient, restoration of fluid and electrolyte balance is a medical emergency and takes precedence over making a diagnosis. Abdominal findings may include tenderness, a mass, fullness due to matted loops of bowel (as occurs in Crohn’s disease), hepatosplenomegaly, and ascites. Rectal examination may reveal a mass or fecal impaction. General examination may disclose flushing (suggestive of carcinoid syndrome), goiter, and lymphadenopathy (lymphoma, Whipple’s disease), signs of advanced atherosclerosis (possibly accompanying mesenteric ischemia), evidence of collagen-vascular disease (mesenteric arteritis), fistulae (Crohn’s disease), jaundice, clubbing of the fingers, and skin rashes.
Bilateral Tapia’s syndrome secondary to cervical spine injury: a case report and literature review
Published in British Journal of Neurosurgery, 2023
Alexandros G. Brotis, Jiannis Hajiioannou, Christos Tzerefos, Christos Korais, Efthymios Dardiotis, Kostas N. Fountas, Kostantinos Paterakis
TS is associated with orotracheal intubation, nasopharyngeal packing, and anterior cervical spine surgery. Admittedly, the present patient was repeatedly intubated after failure to maintain the patency of his upper respiratory pathways. In addition, it can be associated with the classical anterolateral Smith – Robertson approach for the stabilization of the cervicothoracic junction. However, in such cases it is unilateral and it is related to extensive retraction during surgery. In the present case there was a bilateral nerve involvement. However, we believe that the injury occurred by the fall of the patient, during the severe impaction on the ground. This is further underpinned by the presence of speech impairment by the time the patient had reached the hospital, despite his clear sensorium. Undoubtedly, it is difficult to pinpoint the exact time that the two CN were injured in our patient.
Effect of constipation on outcomes in mechanically ventilated patients
Published in Baylor University Medical Center Proceedings, 2022
Hassam Ali, Rahul Pamarthy, Swethaa Manickam, Shiza Sarfraz, Mitra Sahebazamani, Hossein Movahed
We built a hierarchical multivariate linear and logistic regression model to adjust for the confounding variables by using only variables associated with the outcome of interest on univariable regression analysis at P < 0.2 or known potential confounders despite a P value indicating no significance. Continuous variables were compared using the Student t test, and categorical variables were compared using the chi-square test. Our analysis used 0.05 as the threshold for statistical significance, and all P values were two-sided. All outcomes were adjusted for patient and hospital-level characteristics, including age, race, sex, insurance type, residential region, Elixhauser Comorbidity Index score, hospital teaching status, and hospital bed size, as previous studies have utilized them as well.10 We also adjusted for constipation-related sequela such as diverticulosis, diverticulitis, fecal impaction, urine retention, peritonitis, bowel perforation, sedative or opiate analgesia use, and vasopressor support. ICD 10 codes are shown in the Supplementary Material.
Evaluation and treatment of urinary incontinence in the aging male
Published in Postgraduate Medicine, 2020
Performance of a comprehensive physical examination is similarly important [46]. Examination should assess the neurologic system (gait and balance, mobility, ability to transfer between positions, cognitive impairment), abdomen (scars, hernias, tenderness to palpation, suprapubic distension), genitals (perineal sensation, tissue quality/breakdown), rectum (fecal impaction, rectal masses, rectal tone, prostate nodularity), and extremities (peripheral edema) [9]. The examination for UI is preferably performed with a comfortably full bladder so as to allow for observation of UI [47]. Observation of urine leakage from the urethra with coughing or Valsalva or as a result of a sudden, compelling desire to void, strongly suggests SUI and UUI, respectively [48]. Figure 2 summarizes the physical examination.