Instant Natural Colic Relief

Instant Natural Colic Relief

Natural colic relief bowen refers to the steps by steps guide designed by Dr. Carlyn Goh to naturally put an end to all means of discomfort for your baby. This is a safe, gentle, easy and an effective natural guide, we mean without drugs to miraculously ease your babys discomfort. This step-by-step guide complete with videos, will teach you how to treat colic in your baby. The Bowen Technique is a very gentle, safe and simple therapy that is highly effective at easing discomfort in babies. Bowen acts to rebalance the nervous system. This is extremely important in all babies as birth is a traumatic experience for them. By re-balancing the nervous system you will feel the immediate effects of calmness and serenity in your baby and the causes of his discomfort will fade away. The result is a happy, healthy and balanced baby. Read more here...

Instant Natural Colic Relief Summary


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Preparation of the jejunal loop using the retrocolic route

Retrocolic Gastrojejunostomy

The window (wide enough to allow comfortable sliding of both afferent and efferent jejunal loops) is made in an avascular plane of the mesocolon left to the middle colic vessels. The ligament of Treitz is identified by lifting up the transverse colon, and the jejunal loop is brought up through the mesocolic window in apposition to the greater curvature (now free from omental vessels). The length of the afferent jejunal limb should not exceed 20 cm.

Signs symptoms diagnosis and investigations

In patients with cancer, compression of the bowel lumen develops slowly and often remains partial. As a consequence of the partial or complete occlusion to the lumen and or dysmotility, the accumulation of the unabsorbed secretions produces nausea, vomiting, intermittent or complete constipation, pain, and colicky activity to surmount the obstacle that causes colicky pain. Abdominal distension may be absent in high obstruction that is, of the duodenum or proximal jejunum and when the bowel is plastered down by extensive mesenteric spread.

Cynthia W Ko MD MS and Sum P LeeMD PhD

Gallstones are commonly found but are often asymptomatic. In general, the risk of developing biliary colic in asymptomatic patients is low, but once a person develops symptoms, the risk of ongoing biliary colic or more serious complications of cholelithiasis is substantial (Gracie and Ransohoff, 1982). However, serious complications of cholelithiasis, such as cholecystitis, cholangitis, or acute pancreatitis, are frequently preceded by attacks of biliary colic. Therefore, in patients with gallstones who are otherwise asymptomatic, treatment is not recommended. However, once symptoms or complications develop, treatment of cholelithiasis, either surgical or medical, should be strongly considered (Table 132-1). In general, chole-cystectomy is the treatment of choice for symptomatic or

Anatomy of the Lower GI System

The SMA and inferior mesenteric artery (IMA) are the primary visceral trunks responsible for lower GI bleeding (Defreyne et al, 2003). The SMA is located caudal to the celiac axis (ie, immediately inferior to the celiac axis or usually within 2 cm). The SMA supplies a portion of the duodenum and pancreas (via the inferior pancreaticoduodenal arcade), the entire small bowel, the appendix, ascending colon, and approximately two-thirds to three-fourths of the transverse colon. The IMA arises from the ventral surface of the aorta between the levels of L2 to L4, most commonly at the L3 to L4 disc space level. The IMA supplies the distal most transverse colon, the descending and sig-moid colon, and the rectum. A rich collateral blood supply is found between the SMA and IMA via the middle colic (from the SMA) and the left colic (from the IMA). Another rich collateral network is found between the IMA (superior hemorrhoidal branches) and the internal iliac artery branches. Additional...

Constipation in Pregnancy

Of the stimulant laxatives, senna is both safe and effective when combined with bulk-forming agents in pregnancy. Cascara is also mild and produces little or no colic. Although bisacodyl is safe for use in pregnancy, it tends to produce more colic than the anthraquinone laxatives, especially when administered orally.

Postoperative Management

Of the material used and other personal factors, and will vary between 30 and 1000 ml. The evacuation period may last between 10 and 120 min. Enema frequency may also vary from once a day to once a week. Dietary management, including medications that slow intestinal motility, is necessary as adjuvant therapy in almost all patients. If fecal incontinence continues despite conservative measures, the volume of enema should be increased, and the frequency decreased. Anal stenosis should be considered in cases with frequent but small-volume incontinence. Colicky abdominal pain is initially noted in 50 of cases, but this resolves spontaneously within a couple of months. Antispasmodic drugs have been found to be effective in these cases 103 . Some patients have reported spontaneous initiation of colonic motility simply with catheter insertion and no washouts 84 . Concentrated enemas leading to colonic evacuation through bowel irritation may lead to hyperphospha-temia, while high-volume...

STEP 2Separation of the greater omentum from the entire transverse colon

The entire gastrocolic omentum is separated from the transverse colon by scissors dissection through the avascular embryonic fusion plane. It is tremendously helpful to be alert of the difference in texture and color of the fat in the epiploic appendices of the colon and that of the omentum. Bleeding will be avoided by keeping this important plane of dissection between these two different structures. The next step is to elevate the mobilized omentum from the transverse colon and to expose the anterior surface of the pancreas. As the omentum is mobilized, the venous branch between the right gastroepiploic and middle colic veins is identified and ligated.


Surgical treatment of biliary colic in pregnant patients is usually deferred until the postpartum period unless symptoms are too severe or there is gestational weight loss. When cholecystectomy is to be undertaken, the second trimester is typically the preferred time. Miscarriage rates are lower in the second than the first trimester and preterm labor rates are lower in the second than third trimester. Modern series of pregnant patients with biliary pancreatitis, however, have challenged the notion that the second trimester should be the preferred time for biliary surgery or that it should carry significant maternal or fetal risk. Cholecystectomy may prove to be a safe procedure at any time during pregnancy so long as obstetric involvement is obtained early and fetal monitoring is performed (22).

Preoperative abnormalities

Hepatic cysts occur most frequently in the right lobe. Bacterial infection may result in a liver abscess. Rupture into a bile duct, or bile duct obstruction, can occur and produce biliary colic.There may be jaundice.The number and location of the cysts are shown on CT scan or ultrasound.

Initial Management of the Newborn

There might be an urgent need for surgical intervention, but there is always time for detailed ultrasonography prior to laparatomy, which could reveal hydro-metrocolpos, an enlarged rectum, renal abnormalities, and tethered cord syndrome. The preliminary intervention should consist of a colostomy at the hepatic flexure, keeping in mind that the left colic and the sig-moidal arteries are essential for later reconstructive pullthrough procedures. A diverting pigtail catheter drainage should be introduced in the bladder and or vagina in case of hydrometrocolpos if intermittent catheterization is not possible. After the recovery of the baby, further detailed studies are necessary, particularly by endoscopy, with the introduction of stents in all visible urethral, vaginal, and rectal openings. These probes are important for a detailed x-ray studies immediately after the endoscopy. In addition, magnetic resonance imaging of the spine, intravenous pyelogram if necessary, scintigraphic...

Determination of the essential length

The black bars show alternative lines for transection of the colon. Resection of bluish margins on the right flexure of the transverse colon between the middle and the right colic artery should be performed under preservation of the paracolic arcades. Following this procedure, a better mobilization of the colonic segment can be obtained. To perform the pharyngocolostomy in carcinomas of the upper third of the esophagus, a fairly long colonic segment is required. Therefore parts of the sigmoid colon have to be used and the first (and probably the second) sigmoid artery has to be ligated close to the inferior mesenteric artery. Prior to dissection of the vessels, a clamp is provisionally applied to prove the sufficiency of the vascular supply. Dark arrows point to the vascular resection margins. The arcade between the right and middle colonic artery should be preserved for a better vascular supply of the colonic segment chosen for interposition (B).

Access and mobilization

Complete dissection of the anterior and right lateral aspect of the superior mesenteric vein is done. All the vessels from the uncinate process of the pancreas (variable in length, diameter and distribution) are carefully dissected and ligated. The dissection is continued cephalad to the neck of the pancreas. The middle colic vein is ligated. Caudally, the dissection is continued down to the confluence of the ileocolic branch (which in many instances can be preserved). In some instances the ileocolic artery crosses over at this level it can usually be retracted, but if necessary it can be ligated. It is necessary to dissect free the mesenteric vein 4-5cm in length. Also, it is important to dissect the whole circumference of the vessel in order to comfortably place the vascular clamp.

Hepatic metastatic disease

In the ascending colon, near the ileocecal valve location, an annular mass is noted (arrows). This represented gradual circumferential invasion from an extrinsic ovarian peritoneal implant in the colic gutter. Fig. 8. In the ascending colon, near the ileocecal valve location, an annular mass is noted (arrows). This represented gradual circumferential invasion from an extrinsic ovarian peritoneal implant in the colic gutter.

Clinical Presentations of PUD

Trolled gastric acid hypersecretion is diarrhea, abdominal pain, and, occasionally, upper GI bleeding from postbulbar ulcerations. Classically, patients presenting with PUD will experience a burning or gnawing pain in the epigastrium, or occasionally the hypogastrium, that occurs several hours after meals and typically improves with food ingestion. Presumably acid secretion that is stimulated by meals leads to the pain symptom and the ingestion of food results in buffering of gastric acidity. The pain will be similarly alleviated by the ingestion of antacids or histamine-2 receptor antagonists (H2RAs). Pain related to PUD can be frequently confused with the characteristic pain related to gastroesophageal reflux disease (GERD). In the latter, however, the patients are more likely to report that there is movement of the pain from the epigastrium into the esophagus. The pain related with both PUD and GERD may be improved with meal ingestion, antacids, or H2RAs. A careful history should...

General Technical Notes Upper and Lower GI Bleeding

In the case of a patient with lower GI bleeding, if the IMA and SMA arteriograms fail to identify a bleeding site, a celiac arteriogram should be performed. Rarely, the middle colic artery (normally arising from the SMA) may have an anomalous origin from the celiac axis arterial distribution. Therefore, a transverse colonic bleeding site would not be detected in such a patient if only the IMA and SMA arteriograms were performed.

Clinical Manifestations of Distal Aortic Dissection

Malperfusion and ischemic damage of the viscera or extremities occur in one-fourth of patients with distal aortic dissection. Extrinsic compression of the true lumen by the enlarging false lumen causes distal ischemia and is called pseudocoarctation. Although the false lumen usually occupies the left perimeter of the aorta, any arterial branch can be compromised. Disruption of intercostal arteries causes spinal cord ischemia in 2-6 of patients neurologic findings can vary from minor sensory deficits to frank paraplegia. The origin of the left renal artery is disrupted in 5-25 of patients, whereas the visceral and right renal arteries usually arise from the true aortic lumen. Abdominal pain and tenderness suggest mesenteric ischemia. Compromise of renal arterial blood flow may cause flank pain and hematuria, mimicking the signs usually associated with ureteral colic. Beyond the aortic bifurcation, the false lumen can expand and compromise the true lumen of the iliac artery, thereby...

Specific Syndromes of Mesenteric Ischemia Acute Arterial Occlusion

Laparotomy should then follow directly, the leg having been prepared to provide access to a saphenous vein. The SMA is best approached by following the middle colic vessels to the root of the transverse mesocolon. Most emboli lodge just proximal to this junction. Embolectomy or thrombectomy is attempted through a transverse arteri-otomy with a Number 3 Fogarty catheter. If free inflow (and backflow) are obtained, this may be sufficient. The artery is usually closed with a transverse suture line. If free inflow is not obtained, with or without the removal of an embolus, a bypass is probably required. In cases of advanced atherosclerosis of the orifice of the SMA, with or without an embolus, an endarterectomy is rarely successful, and a bypass from the aorta below the renal arteries to the distal SMA may be necessary. Saphenous vein is the preferred material, but expanded polytetrafluoroethylene (GoreTex) may also be used. In recent years, aortic throm-boendarterectomy has been...

Indications and Evaluation

Currently, the Centers for Disease Control and Prevention estimates 600,000 to 750,000 cholecystectomies are performed annually in the United States. Cholecystectomy is classically indicated to treat signs, symptoms, and complications of gallstones. Despite the relatively low risks associated with laparoscopic cholecystectomy, the procedure should be limited to symptomatic patients. These patients are at increased risk of developing complications including acute cholecystitis, common bile duct obstruction, cholangitis, and pancreatitis. Evidence exists that these complications seldom develop at initial presentation, so asymptomatic patients are generally treated with watchful waiting. Laparoscopic chole-cystectomy is also indicated for patients without gallstones but typical biliary colic. These patients may have acalculous cholecystitis or biliary dyskinesia diagnoses made by quantitative gallbladder emptying or radio-nucleotide study.

Laparoscopic Cholecystectomy for Expanded Indications

Finally, pregnancy remains a controversial setting to treat symptomatic gallstones. Conservative nonsurgical therapy is frequently considered in mild cases of biliary colic or acute cholecystitis to reduce risk to the patient and fetus. Although, laparoscopic cholecystectomy is a safe procedure in all three trimesters, the second trimester remains the preferred timing for any elective surgical intervention. A lower risk of spontaneous abortion during the first trimester and lower risk of preterm labor during the third trimester favor the laparoscopic approach over the open technique, if surgery is indicated during those time periods.

Regions of the Abdominal Wall

Planes Dividing Regions The Abdomen

Fines the zone immediately distal to the umbilical region and contains the ileum and sigmoid colon. The hypochondriac regions flank the epigastrium and are occupied on the right side by the liver, gallbladder, right colic flexure, descending duodenum, right kidney and suprarenal gland. On the left side these regions contain the spleen, left kidney and suprarenal gland, tail of the pancreas, left colic flexure, and fundus of the stomach. Most of the hypochondriac and parts of the epigastric regions are protected by the lower ribs. Areas immediately to the right and left of the umbilical region are designated as the right and left lumbar (lateral) regions, containing the ascending and descending colon, respectively. The right and left iliac regions surround the hypogastrium. The right iliac region contains the appendix and cecum, and the left iliac region corresponds to locations of the sigmoid colon and left ureter.

Hepatic Portal Veins Trunk Veins

Veine Intercostal

Most of the blood of the body returns to the heart by capillaries flowing into venules and finally into veins before reaching the heart. In a portal system blood moves from one capillary system to another capillary system before reaching the heart. The hepatic portal system takes blood from the capillary beds of many of the abdominal organs and carries it to the liver where metabolic processing takes place. The hepatic portal vein receives blood from various veins including the splenic vein, the gastroepiploic vein, the left gastric vein and the colic veins which take blood to the superior mesenteric and inferior mesenteric veins. Once the blood is processed in the liver it enters the systemic circulation by the hepatic veins. f. Hemiazygos v., g. Gonadal v., h. Hepatic portal v., i. Superior mesenteric v., j. Right colic v., k. Gastric v., I. Splenic v.,

Arteries Of Digestive System

Ileocolic Artery

Small intestine and to several of the colic arteries that supply blood to the proximal portion of the large intestine. These are the middle colic artery, the intestinal branches, the right colic artery and the ileocolic artery. The inferior mesenteric artery takes blood to the distal portion of the large intestine via the left colic artery, sigmoid artery and the rectal artery. Answer Key a. Celiac trunk, b. Common hepatic a., c. Left gastric a., d. Splenic a, e. Right gastroepiploic a., f. Left gastroepiploic a., g. Superior mesenteric a., h. Middle colic a., i. Intestinal branches, j. Right colic a., k. Ileocolic a., I. Inferior mesenteric a., m. Left colic a., n. Sigmoid a., o. Superior rectal a.

STEP 11Anisoperistaltic reconstruction not standard

Arcada Riolan

Preparation of an anisoperistaltic (not standard) colonic segment begins with incision of the peritoneum far from the colon and stepwise preparation of the mesocolon maintaining the paracolic arcades and the middle and left colic vessels. A vascular clamp is provisionally applied across the left colic artery and the sigmoid artery across the provisional colonic transection plane to prove a sufficient arcade of Riolan. If no ischemia occurs after 3min, the colon interposition can be performed.

STEP 1Exposure of central part of pancreas

The pancreas is exposed by detaching the greater omentum from the transverse colon and freeing the superior aspect of the middle colic vessels until the anterior aspect of the pancreas is exposed completely stomach is retracted rostrally. The superior mesenteric vein is identified, and its anterior surface cleared below the neck of the pancreas care must be taken not to injure venous tributaries occasionally a middle colic branch of the superior mesenteric vein requires division, especially if it joins in a V-shaped way with the right gastroepiploic vein. Gastroepiploic vessels are preserved, unless the lesion reaches the right border of the superior mesenteric-portal vein (A-1).

Where Are Ovaries Compared To Iliac Crest

Low Anterior Rectosigmoid Resection

The inferior mesenteric artery (IMA) arises from the dorsal side of the aorta often to the left at the level of L3, about 3-4 cm proximal to the bifurcation of aorta. After veering to the left it gives off the left colic artery which divides into ascending and descending branches. The sigmoid colon is supplied by two to four arteries. The first one, which is the largest, comes from the left colic artery (30 of cases) or the IMA. From this first sigmoid vessel, second or third vessels may originate, or may arise directly from the IMA. As the IMA enters the pelvis, it becomes the superior rectal (hemorrhoidal) artery.

STEP 10Standard procedure isoperistaltic reconstruction

Arcade Riolan

This approach ensures an isoperistaltic reconstruction (standard procedure). Care has to be taken not to injure the left colic vessels. Therefore preparation has to be done carefully and closely to the wall of the colon, and transection of the descending colon is always done without extensive dissection of the colon using a linear stapler device. The right and middle colonic vessels are dissected close to their origin. A prophylactic appendectomy after total mobilization of the colon is recommended.

Periampullary Lesions

Reconstruction, some groups favor a separate Roux-en-Y reconstruction for pancreas or even a double Roux-en-Y reconstruction for the pancreas and bile duct. Controversy continues regarding the best type of pancreaticojejunos-tomy, the importance of duct-to-mucosa sutures, and the use of pancreatic duct stents. At the Johns Hopkins Hospital, the pancreatic reconstruction is typically performed with an end-to-end or end-to side pancreaticoje-junostomy to the proximal jejunum brought through a defect in the mesocolon to the right of the middle colic artery. The biliary anastomosis is typically performed with an-end-to-side hepaticojejunostomy approximately 10 to 15 cm distal from the pancreaticojejunostomy. If the patient has a percutaneous biliary stent, then this is left in place, traversing the anastomosis. The third anastomosis performed is the duodenojejunostomy in cases of pylorus preservation, or the gastrojejunostomy in patients who have undergone classic pancreaticoduodenectomy....

Ruptured Abdominal Aortic Aneurysm

Several other conditions occasionally masquerade as ruptured AAA. Acute myo-cardial infarction is one such condition. In addition, perforated peptic ulcer or other such intraabdominal condition, ureteral colic, or herniated disk may mimic ruptured AAA but these are rarely associated with sustained cardiovascular collapse.

Extracorporeal Shock Wave Lithotripsy

Pain during the procedure is not uncommon, and occurs more frequently with spark gap lithotriptors. In some patients, this may require intravenous analgesia. There can also be some local discomfort or bruising associated with the therapy. Microscopic hematuria has been found in 1 to 2 of patients. Biliary colic will develop in 30 to 40 of patients as stones fragment and pass from the gallbladder, usually within the first few weeks after therapy. However, few patients develop more severe complications such as pancreatitis. Up to 3 of patients may require cholecystectomy for persistent stones or symptoms. As with bile acid dissolution therapy, stone recurrence is frequent. Up to 12 of patients will have recurrent stones within 1 year, and up to 44 at 5 years of follow-up (Sackmann et al, 1994). Patients who are obese and those with poor gallbladder function are at higher risk of recurrence. Patients with recurrent stones can again develop biliary symptoms, such as biliary colic or...

Gastrointestinal obstruction

Pictures Nurse Ray Showing Limbs

Malignant obstruction of the gastrointestinal tract may be due to occlusion of the lumen by tumour or distortion of gut and mesentery by tumour, or may be functional due to a failure of normal peristalsis. Obstruction may be partial or complete and may develop gradually with self resolving episodes of partial obstruction preceding a complete obstruction. The treatment of choice for a single level of occlusion is surgery, but when the patient is unfit for surgery, or when there are multiple levels of obstruction, an alternative treatment regimen is necessary to palliate symptoms of nausea, vomiting, colic, abdominal distension, and peritoneal pain. The amount of vomiting depends on the level of obstruction, with more proximal upper gastrointestinal obstruction causing larger volume vomiting. If the level of obstruction is beyond the mid-jejunum, the mucosa of the upper gastrointestinal tract can continue to absorb fluids from the lumen. This reduces the volume of intestinal contents...

Pancreatic Islet Cell Transplantation

The surgical approach consists of the cannulation of a tributary of the portal vein (omental vein, branch of the middle colic vein, or inferior mesenteric vein) that requires laparotomy. This approach is preferred during a simultaneous islet and kidney (SIK) transplantation, when access to the portal system can be obtained during an open surgical procedure (Alejandro et al, 1997) or in selected cases (IAK and ITA) in which the percutaneous procedure may be contraindicated, including patients at high risk of bleedings, patients with hepatic hemangiomas, lack of an experienced interventional radiologist, or patient preference after inform consent. Alternative less invasive surgical procedures under evaluation include the use of laparoscopic access to infuse islets in the umbilical vein or islets implantation within the omental layers.

Parviz NikoomaneshMD and Salim A JafferMD

Patients with acute pseudo-obstruction have a soft, but distended, and tympanic abdomen. Bowel sounds are high pitched to absent. Patients usually do not have peritoneal signs or colicky pain, but may precipitate vague abdominal pain as the cecum distends. Nausea and vomiting may be present. Patients may pass flatus and liquid stools or they may be obstipated. White blood cell (WBC) count is usually normal.

Medical Therapy Oral Bile Acid Dissolution Therapy

Either as single bedtime dose, or divided in 2 daily doses. Patients should be treated until stones are sonographically documented to resolve. Rarely, dissolution therapy can be accompanied by attacks of biliary colic as stones fragment and pass through to the duodenum. In addition, the risk of recurrent stones after UDCA is discontinued is not insubstantial (up to 50 at 5 years) (Villanova et al, 1989). Thus, bile acid dissolution is not curative for gallstones. This therapy should only be applied in patients who are unwilling or unable to undergo a definitive cholecystectomy. In some patients, symptoms of biliary colic often improve before gallstones are documented to disappear. However, in some patients, biliary colic continues as stones dissolve and the fragments pass from the gallbladder. Long term therapy with bile acids may result in a lower risk of biliary colic and acute cholecystitis, whether or not stones completely resolve. Therefore, in patients with severe comorbidities...

Ureteric stones

Most ureteric calculi arise for unknown reasons, although inadequate urinary drainage, the presence of infected urine, and hypercalcaemia are definite predisposing factors. The presence of an impacted ureteric stone is characterized by haematuria and agonizing colicky pain (ureteric colic), which classically radiates from loin to groin. Large impacted stones can lead to hydronephrosis and or infection of the affected kidney and consequently need to be broken up or removed by interventional or open procedures.

Figure 636

The passage of sloughed papillae is associated with lumbar pain, which is indistinguishable from ureteral colic of any cause and is present in about half of patients. Oliguria occurs in less than 10 of patients. A definitive diagnosis of RPN can be made by finding portions of necrotic papillae in the urine. A deliberate search should be made for papillary fragments in urine collected during or after attacks of colicky pain of all suspected cases, by straining the urine through filter paper or a piece of gauze. The separation and passage of papillary tissue may be associated with hematuria, which is microscopic in some 40 to 45 of patients and gross in 20 . The hematuria can be massive, and occasionally, instances of exsanguinating hemorrhage requiring nephrectomy have been reported. (From Eknoyan and coworkers 8 with permission.)

Figure 125

Excessive urinary excretion of cystine (250 to 1000 mg d of cystine g of creatinine) coupled with its poor solubility in urine causes cystine precipitation with the formation of characteristic urinary crystals and urinary tract calculi. Stone formation often causes urinary tract obstruction and the associated problems of renal colic, infection, and even renal failure. The treatment objective is to reduce urinary cystine concentration or to increase its solubility. High fluid intake (to keep the urinary cystine concentration below the solubility threshold of 250 mg L) and urinary alkalization are the mainstays of therapy. For those patients refractory to conservative management, treatment with sulfhydryl-containing drugs, such as D-penicillamine, mercaptopropionylglycine, and even captopril can be efficacious 14,15 .

Colon Resection

Tumors of the cecum and ascending colon are typically managed with a right hemicolectomy (Figure 96-1A). This involves resection of the terminal ileum, cecum, and ascending colon including the hepatic flexure. High liga-tion of the ileocolic and right colic vessels provides for an adequate lymphadenectomy. Tumors of the transverse colon are often managed with a transverse colectomy, including the middle colic and lymphatics. Left hemicolec-tomy (Figure 96-1B) is performed for tumors arising in and descending colon and includes ligation of the left colic artery. The splenic flexure is mobilized and the transverse colon is anastomosed to the proximal rectum. For sigmoid cancers, either a left hemicolectomy or a sigmoid colectomy (Figure 96-1C) can be performed. When performing the bowel anastomosis, various methods can be used, including hand-sewn or stapling techniques.


Anticholinergic drugs must be discontinued if at all possible. Prokinetic drugs may restore gastric emptying if the lumen is patent and the autonomic nerves are intact, but they may cause colic if there is an upper gastrointestinal obstruction. In normal circumstances, using a proton pump inhibitor or H blocker can reduce the volume of gastric secretions, and parenteral administration can help some patients with obstruction. Ingested air can be de-foamed with dimethicone (tablets or compounded with an antacid).

Creation of a tube

For creation of a permanent reverse gastrostomy, usually the greater curvature is used. The left gastroepiploic vessels represent the vascular pedicle of the tube. After interruption of the right gastroepiploic vessels at the site of the beginning of the tube, the gastro-colic and, if necessary, gastrosplenic ligaments are transected at a safe distance from the left vascular pedicle without compromising the integrity of the gastroepiploic arcade (A).

Figure 88

Tomatic , and the disease may go undetected. Polyuria and a reduced capacity to concentrate the urine are its main manifestations. Either of these two features may be the result of tubulointerstitial nephritis caused by sar-coidosis, and can be present in the absence of any altered calcium metabolism. Nephrocalcinosis also may be asymptomatic. In contrast, nephrolithiasis presents as renal colic or hematuria. Hypercalcemia develops only when the load of calcium to be excreted exceeds the ability of the kidneys to excrete the calcium load, either because of reduced renal function or, less commonly, when the amount of calcium absorbed is excessive. The magnitude of hypercalcemia determines its symptomatology. The circulating level of parathyroid hormone should be determined in patients with hypercalcemia. An increase in the prevalence of parathyroid adenomas seems to occur in sarcoidosis. In hypercal-cemia caused by elevated levels of calcitriol and by reduced renal excretion of...

See Also Plate 160

Left Gastric Artery Branches

Vagal branches (parasympathetic motor, secretomotor and afferent fibers) accompany superior mesenteric artery and its branches usually as far as left colic (splenic) flexure Vagal branches (parasympathetic motor, secretomotor and afferent fibers) accompany superior mesenteric artery and its branches usually as far as left colic (splenic) flexure


Psoas Hitch Boari Flap

The ileum receives its vascular supply from the ileocolic artery, which is a branch of the superior mesenteric artery (SMA). Collateral circulation is from the right colic artery, which is also a branch of the SMA. The terminal ileum is at particular risk of vascular insufficiency owing to the fact that it is supplied by the terminal branches of the ileocolic artery and collateral circulation is poor. The colon is supplied by branches of the superior and inferior mesenteric arteries (IMA). The right and middle colic arteries arise from the SMA and supply the right and transverse colons respectively up to the splenic flexure. The left colic and sigmoid arteries are branches of the IMA and supply the left and sigmoid colon respectively. Collateral circulation to the sigmoid is via the superior rectal artery, a branch of the IMA, which anastomoses with the middle and inferior rectal arteries, both branches of the hypogastric artery.


The syndrome, as it was originally described, consisted ofWatery Diarrhoea, Hypokalaemia and Achlorhydria or hypochlorhydria (WDHA syndrome).The diarrhoea is secretory and continues even when fasting (Perry & Vinik 1995). It is accompanied by weight loss and dehydration, and a history of abdominal colic and cutaneous flushing.

Stimulant Laxatives

The anthraquinone-containing laxatives (ie, senna, cascara sagrada) are widely used. Senna is best administered at bedtime with fluids 2 to 3 times weekly if no defecation occurs spontaneously. Cascara also produces a soft or formed stool with little or no colic. Most anthraquinone-containing laxatives discolor the colonic mucosa ( melanosis coli) if used chronically. The pale-brown to jet-black discoloration of melanosis coli occurs throughout the colon and is more prominent in the proximal colon. Withdrawal of laxatives is normally accompanied by resolution of pigmentation after many months.

Baby Sleeping

Baby Sleeping

Everything You Need To Know About Baby Sleeping. Your baby is going to be sleeping a lot. During the first few months, your baby will sleep for most of theday. You may not get any real interaction, or reactions other than sleep and crying.

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