Antegrade continence enema procedure in children
Stanley M Goldberg in Operative Surgery of the Colon, Rectum and Anus Operative Surgery of the Colon, Rectum and Anus, 2015
The ACE (antegrade continence enema) procedure is now accepted as an established treatment for intractable fecal incontinence secondary to conditions such as spinal dysraphism and anorectal malformation. The successful use of the ACE is described in numerous reports in thousands of patients with follow-up extending to 20 years, and it has also been demonstrated that a successful ACE significantly improves quality of life. Technical modifications have been introduced over the years and these are illustrated in this chapter. It is no longer recommended to disconnect the appendix from the cecum as previously described, and the in situ appendix is now the norm for the open ACE procedure. If no other procedure is required, a laparoscopic antegrade continence enema (LACE) approach is recommended. For patients in whom constipation is a major problem, it may be best to site the conduit in the left colon rather than the cecum.
Health Effects of Low-Level X-ray Exposure
Robert J. Parelli in Principles of Fluoroscopic Image Intensification and Television Systems, 2020
This chapter aims to explain how ionizing radiation may induce somatic changes and list the somatic dose indicators such as bone marrow, skin, and thyroid. Most somatic dose indicators are based on measurements of the dose at specific locations, points, or small volumes. More specifically, the somatic dose indicators are useful in their own right as long as their limitations are understood and are indicative of the major effect. Examinations of the thorax account for approximately half of all diagnostic radiographic examinations taken but contribute only a few percent to the total Genetically Significant Dose (GSD). It can be deduced that the lower the GSD, the lower the number of mutations. As one would expect, examinations that expose the gonads/ovaries to primary x-ray beam radiation produce the highest exposures, such as during barium enema examination, IVP, lumbar spine, hips, and upper femur.
Rectal formulations
Karen Anne Gunnell, Rebecca Hayley Venables in A Practical Guide to Medicines Administration, 2018
This chapter introduces rectal formulations. It briefly discusses different rectal formulations including: suppositories, enemas and rectal solutions. This chapter provides key practice points associated with these formulations, including practice points around supply, storage and also safe and effective medicines administration techniques for the use of suppositories. Medicines administration techniques and patient advice points are provided for suppositories using a stepwise, easy-to-follow approach. These pertinent practical points and stepwise instructions are a valuable reference for: pre-registration and qualified pharmacists, trainee and qualified nurses, medical students, doctors, healthcare assistants and pharmacy support staff, both in learning environments and also when counselling and advising patients on the optimal (safe and effective) use of oral medicines. Enemas and rectal solutions have varying administration techniques depending on the product. For this reason, it is recommended that the patient checks the specific manufacturer’s guidance for information on their administration.
Intussusception in Children: A Clinical Review
Published in Acta Chirurgica Belgica, 2015
T. Charles, L. Penninga, J. C. Reurings, M. C. J. Berry
Intussusception is the most common cause of small bowel obstruction in young infants. Therefore a high index of suspicion and thorough knowledge of this condition is of major importance to be able to diagnose and treat this potentially life threatening condition. In this review we describe epdidemiology, etiology and clinical symptoms of intussuception. Furthermore, we describe diagnostic modalties, especially ultrasonography as the primary choice for diagnosis. In addition, non-operative treatment with different types of enema reduction techniques, and operative treatment by laparotomy and laparoscopy, and outcomes have been reviewed.
Role of Rectal Formulations: Enemas
Published in Scandinavian Journal of Gastroenterology, 1990
M. Campieri, P. Gionchetti, A. Belluzzi, C. Brignola, M. Tampieri, P. Iannone, A. Petronelli, M. Miglioli, L. Barbara
Clinical experience with mesalazine enemas in the treatment of ulcerative colitis is reviewed. After rectal administration, plasma mesalazine levels remain low, and 15% of the administered dose is recovered in the urine. Enemas containing 2 and 4g of mesalazine have been shown to be effective, safe, and well tolerated by patients with mild and moderate ulcerative colitis. Patients who cannot tolerate sulfasalazine and patients who do not respond to other treatments have been successfully treated with mesalazine enemas. Suppositories of mesalazine are more suitable for patients with disease confined to the distal region of the colon, whereas mesalazine enemas should be used in patients with more extensive disease. Mesalazine enemas have also been used for maintenance therapy in ulcerative colitis.
Review of organic causes of fecal incontinence in children: evaluation and treatment
Published in Expert Review of Gastroenterology & Hepatology, 2013
Lusine Ambartsumyan, Samuel Nurko
Even though fecal incontinence (FI) in children is most commonly the result of functional constipation, there are organic conditions that can be associated with incontinence. FI has a major impact on the quality of life of those children who experience it. The general objectives of any bowel program are to achieve predictability and independence. This is achieved by manipulating colonic transit and stool consistency and by producing more controlled evacuations, usually with the use of rectal interventions. Dietary interventions and medications can be used to change stool consistency or to manipulate transit by accelerating or slowing it down. Biofeedback or other interventions that increase sphincter pressure can also be used to improve anorectal function. Enemas or suppositories can be used to empty the sigmoid colon in a more controlled manner. With the recent advent of the antegrade colonic enemas, the patient can have predictable bowel movements and become independent.
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