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Safety Pharmacology and the GI Tract
Published in Shayne C. Gad, Toxicology of the Gastrointestinal Tract, 2018
The motor activity of the small intestine is less likely to be affected by drugs than in the colon. However, drugs such as phenothiazines, antiparkinsonian agents, tricyclic antidepressants, anticholinergics, opiates, loperamide, and calcium channel blockers can also inhibit the motility of the small intestine. The reduction of small bowel motility may be severe enough that it can cause paralytic ileus or pseudo-obstruction.
Postoperative care
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
Paralytic ileus may present with nausea, vomiting, loss of appetite, bowel distension and absence of flatus or bowel movements. Following laparotomy, gastrointestinal motility temporarily decreases. Treatment is usually supportive, with maintenance of adequate hydration and electrolyte levels. However, intestinal complications may present as prolonged ileus and so should be actively sought and treated.
Short answer questions (SAQs)
Published in Tristan Barrett, Nadeem Shaida, Ashley Shaw, Adrian K. Dixon, Radiology for Undergraduate Finals and Foundation Years, 2018
Tristan Barrett, Nadeem Shaida, Ashley Shaw, Adrian K. Dixon
Tinkling bowel sounds and the history imply bowel obstruction which is confirmed by the abdominal radiograph (small bowel of > 3 cm diameter is abnormal). It this case there is only small bowel obstruction described. Causes of small bowel obstruction include: Adhesions from previous surgery.Adhesions due to inflammatory strictures (Crohn’s disease) or ischaemic strictures.Paralytic ileus: post-operative, or due to sepsis (e.g. appendicitis), or metabolic (e.g. hypokalaemia).Hernias (particularly inguinal hernias).Intussusception, common in children, usually due to a mass / lesion in adults.Volvulus.Foreign bodies (ingested; or a passed gallstone, ‘gallstone ileus’).Neoplasms, rare in small bowel.
Current pharmacotherapeutic strategies for Strongyloidiasis and the complications in its treatment
Published in Expert Opinion on Pharmacotherapy, 2022
Dora Buonfrate, Paola Rodari, Beatrice Barda, Wendy Page, Lloyd Einsiedel, Matthew R. Watts
Subcutaneous administration has been the most common administration route of ivermectin in case of intolerability to the oral formulation [71,72]. This may occur particularly in advanced infection due to paralytic ileus, vomiting, malabsorption. As the oral products are the only formulations licensed for human use, the parenteral formulations that were administrated subcutaneously were veterinary preparations [71,73]. Thus, there are no specific recommendations for the dose and the schedule for parenteral administration, and in literature many different dosages were reported [71]. While 200 µg/kg given in alternate days was a frequent choice, concerns have been raised about the adequacy of dosing, even when daily, based on drug levels [71,74]. The different baseline characteristics of the patients and the delay that is often reported for obtaining the veterinary formulation (and the authorization for its off-label use) hamper the evaluation of the effectiveness of subcutaneous treatment. Moreover, there are concerns about the optimal plasma concentration of ivermectin that should be achieved, considering a proper balance between treatment effectiveness and toxicity. Indeed, in some cases the authors had concerns about the possible cause(s) of observed neurotoxicity, that could be the disseminated infection itself, its complications (including meningitis, sepsis and multiorgan failure) or abnormal ivermectin levels [73–75].
The effect of chewing gum on bowel function postoperatively in patients with total laparoscopic hysterectomy: a randomised controlled trial
Published in Journal of Obstetrics and Gynaecology, 2022
Pinar Kadirogullari, Kerem Doga Seckin, Pinar Yalcin Bahat, Zubeyde Aytufan
Post-operative ileus (POI) is the postoperative inhibition of intestinal movements and we observe a temporary arrest of gastrointestinal (GI) motility. POI is mainly observed in general surgery operations regarding the peritoneal cavity and intestines and the incidence is followed by gynaecologic operations (Mattei and Rombeau 2006). Studies show that full recovery of small intestinal functions is observed around postoperative 12–24 h, for stomach full recovery is expected at around 24–48 h and for colon, the timing is about 3 d (Artinyan et al. 2008). Delayed GI functional recovery results in abdominal distension, abdominal pain, nausea and vomiting as well as abdominal compartment syndrome in severe cases, therefore elongating in-patient admission. Postoperative paralytic ileus is a common post-operative adverse event which results in increased pain, patient discomfort, decreased mobilisation and increased hospital admission (Kehlet and Holte 2001). In general, problems regarding intestinal motility are less common after laparoscopic surgery when compared to open surgery (Leung et al. 2000).
A New Zealand White rabbit model of thrombocytopenia and coagulopathy following total body irradiation across the dose range to induce the hematopoietic-subsyndrome of acute radiation syndrome
Published in International Journal of Radiation Biology, 2021
Isabel L. Jackson, Ganga Gurung, Yannick Poirier, Mathangi Gopalakrishnan, Eric P. Cohen, Terez-Shea Donohue, Diana Newman, Zeljko Vujaskovic
Consistent with gross findings, architectural damage and inflammation evident upon histological exam suggests this is a multiorgan injury model (Figure 8). Gross exam at the time of necropsy revealed paralytic ileus in all of animals, which is a well-known gastrointestinal complication associated with radiation. Paralytic ileus is recognizable by diminished or absent bowel sounds upon clinical exam, diminished bowel production, and grossly distended stomach and intestines upon necropsy. Microscopic exam of the small and large intestine showed pathologic features consistent with the gastrointestinal-subsyndrome of ARS. Across all radiation doses, there was more damage to the small intestine than the colon, which is consistent with that previously observed in the non-human primate (MacVittie et al. 2012; Shea-Donohue et al. 2016). While the increase in blood urea nitrogen levels at the time of unscheduled euthanasia was suggestive of acute renal failure, microscopic exam showed only scatted tubular injury in animals exposed to doses of 7.5 Gy or higher. Occasionally, tubules showed cellular disorganization (e.g. 1 in 10). However, the glomeruli and blood vessels were normal.