Rejection

Acute rejection of the intestinal allograft is not an uncommon event. The most frequent presentation is with fever. Other presenting symptoms include abnormal liver function tests, changes in ostomy output, bloody intestinal discharge, altered intestinal motility, increased reducing substances in the stool associated with carbohydrate malabsorption, and sepsis from bacterial translocation across the bowel wall. In cases of severe rejection, it is recom mended to administer an enteric decontaminant solution containing antibiotic and antifungal agents.

The classic classification of rejection is based on a histopathologic grading that encompasses mild, moderate, and severe categories. Rejection can demonstrate a geographical distribution. As such, to obtain an adequate diagnosis it is necessary to obtain multiple biopsies. Biopsy specimens at the ostomy site may show local trauma and inflammatory processes that may not reflect the status of the remaining portions of the intestine.

A more recent approach to the evaluation of rejection is by means of an endoscopic examination with visual magnification. Mucosal changes suggest the degree of damage, and, as such, the severity of rejection. It is recommended however, to perform multiple biopsies that include even normal looking mucosa to detect early changes.

Serum citrulline has also been found to be a marker of intestinal allograft rejection Treatment of rejection in with use of steroids, increases in immunosuppression levels, or administration of antibody preparations such as OKT3. According to the experience at the University of Miami, the presence of at least one episode of severe rejection is associated with diminished graft survival.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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