Bowel management program setup: The basics and long-term follow-up
Onnalisa Nash, Julie M. Choueiki, Marc A. Levitt in Fecal Incontinence and Constipation in Children, 2019
In the authors’ center, the provider completes the follow-up intervals at 1 month and 3 months in clinic or over the phone and the annual follow-up in person in clinic. Prior to each follow-up appointment, the patient gets an abdominal X-ray. They also complete a questionnaire about their regimen and certain pertinent continent and quality of life scores. The scores currently used are the Baylor Social Continence Scale, Cleveland Clinic Constipation Scoring System, and Vancouver Dysfunctional Elimination Syndrome Survey with the addition of Pediatric Quality of Life at the annual visits (Figure 2.5). The provider reviews the X-ray image and the outcomes of the patient's scores and then conducts the clinic visit or the phone interview with the family. If at any time the provider feels the need to adjust the follow-up schedule, it is done while still collecting the completed scores at the predetermined intervals (Figure 2.6).
Specialist Investigation of Anorectal and Colonic Functions
Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams in Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
The three most widely accepted techniques are: (1) a ‘simple’ ROM test, which involves swallowing a single capsule containing a fixed number of markers (typically 20–50) markers on day 0, and taking an abdominal x-ray on day 5 (120 hours); (2), a ‘segmental’ ROM test,11 in which three capsules, each containing 20 markers of a different shape, are administered successively on days 0, 1 and 2, and plain abdominal x-rays are taken on days 4 (96 hours) and 7 (168 hours) (see Figure 16.1) and (3) an ‘equilibrium’ ROM test,12 where a fixed number of markers (typically ten) are ingested daily for six days (final day dose split in two, separated by 12 hours), with a plain abdominal x-ray taken on day 7. The first method is used as a screening test to differentiate normal from slow colonic transit, whereas the latter two methods enable assessment of a mathematically derived whole gut transit time, and transit times within defined colonic regions.11,12 However, such transit time calculations may be crucially flawed, as they assume transit time is a continuous variable, whereas, in reality, human bowel habits are influenced by numerous physiological and social factors, with peak defaecation frequency occurring in the morning,13 stimulated by waking response and first meal of the day.
Surgery for Necrotizing Enterocolitis
David J. Hackam in Necrotizing Enterocolitis, 2021
In essence, those studies that have shown equivalence between peritoneal drainage and exploratory laparotomy likely have reached the wrong conclusions, for several reasons. First, many of the datasets are contaminated with patients who have spontaneous intestinal perforation (SIP), a completely separate entity from NEC. SIP occurs typically in smaller babies, is characterized by the absence of pneumatosis but usually a large amount of free air on abdominal x-ray, and usually within either the first 4 days of life (see Chapter 4), or at approximately 9 to 10 days or so of age (Figure 10.8). Patients with SIP can mimic NEC in presentation (abdominal distension, septic appearing, free air) yet often respond very well to a peritoneal drain. Additional reasons for the purported equivalence of drainage with exploratory laparotomy include the relatively short follow-up in many studies, which have shown equivalence between the two approaches (21), as revealed by the fact that exploratory laparotomy is required in over half of all cases of patients with NEC who underwent upfront peritoneal drainage. In the large New England Journal of Medicine study, even though patients were randomized to exploration versus peritoneal drain, the data revealed that more patients in the study were not randomized than were randomized, indicating that the surgeon knew full well what to do (i.e., operate rather than risk being randomized to the drainage-alone group) (21).
Air under the diaphragm—perforation or Chilaiditi sign?
Published in Baylor University Medical Center Proceedings, 2022
Shobha Mandal, Sneha Singh, Barun Kumar Ray, Rahul Kumar Thakur, Anish Kumar Shah, Victor Kolade
Management depends on presentation. Patients with radiographic evidence of Chilaiditi sign without any symptoms do not require any further treatment. In symptomatic patients, an immediate meticulous abdominal examination is needed to rule out acute abdomen requiring surgical intervention. Initial management of patients includes conservative management like bowel rest, intravenous fluid, nausea, and pain control. An abdominal x-ray should be performed to look for signs of perforation. A CT scan of the abdomen can better visualize these signs in stable patients.11–13 For diagnosis, the patient must have the following findings on the abdominal x-ray or CT scan (erect position: abdomen): distended bowel, a depressed superior margin of the liver below the level of the left hemidiaphragm, and elevation of the right hemidiaphragm above the liver by the intestine in between.14 As it can easily be misdiagnosed as bowel perforation, patients are at high risk of unwarranted surgical interventions.1,13,15
Formulation, optimization, and evaluation of raft-forming formulations containing Nizatidine
Published in Drug Development and Industrial Pharmacy, 2019
Manal K. M. Darwish, Amal S. M. Abu El-Enin, Kamilia H. A. Mohammed
Six healthy volunteers participated in the study. All subjects were given their written consent for their participation in the study after having been informed of all aspects of the study. The study was approved by the ethical committee of Zi- diligence Research Laboratory, Cairo, Egypt. The study was conducted by administering two chewable tablets (equivalent to 150 mg) of Nizatidine to each subject in one session and was conducted in the fed state [31]. After overnight fasting, the volunteers were fed with a low-calorie food. Half an hour later, a BaSO4- loaded Nizatidine chewable tablets were administered orally to each volunteer. At different time intervals (0, 0.5, 1, 2, and 3 h post administration of tablet), in a standing position, the volunteers were exposed to abdominal X-ray imaging under the supervision of an expert radiologist. The source of X-rays and the subject was kept constant for all images. Thus the observations of the raft formation and movements could be easily noticed. The time elapsed before raft formation and the mean gastric residence time of raft were determined [32].
Effects of 28-day Bifidobacterium animalis subsp. lactis HN019 supplementation on colonic transit time and gastrointestinal symptoms in adults with functional constipation: A double-blind, randomized, placebo-controlled, and dose-ranging trial
Published in Gut Microbes, 2018
Alvin Ibarra, Mathilde Latreille-Barbier, Yves Donazzolo, Xavier Pelletier, Arthur C. Ouwehand
From Days -6 to -1, the participants made ambulatory visits to the clinic, where a health practitioner gave them radio-opaque markers to ensure 100% intake compliance. At the second visit, participants were randomized if they had been ≥ 80% compliant with taking the run-in placebo, 100% compliant with the consumption of radio-opaque markers, and 100% compliant with daily completion of their diaries. Then, they completed constipation-specific and ancillary questionnaires, passed an abdominal x-ray, were provided with daily diaries and 24-h food recall records, and were supplemented with randomized treatments (in a double-blind manner). From Days 22 to 27, participants made ambulatory visits to the clinic, where a health practitioner gave them radio-opaque markers to ensure 100% intake compliance. At the third visit, participants were assessed for their compliance with the treatment, consumption of radio-opaque markers, and completion of records; answered constipation-specific and ancillary questionnaires; completed a product satisfaction questionnaire; were measured for weight; and underwent the final abdominal x-ray.
Related Knowledge Centers
- Bladder
- Intussusception
- Abdomen
- Ureter
- Projectional Radiography
- Kidney
- Bowel Obstruction
- Gastrointestinal Perforation
- Foreign Body In Alimentary Tract
- Radiodensity