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. More here...

Instant Natural Colic Relief Overview


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Author: Dr. Carolyn Goh
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My Instant Natural Colic Relief Review

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It is pricier than all the other ebooks out there, but it is produced by a true expert and includes a bundle of useful tools.

Overall my first impression of this book is good. I think it was sincerely written and looks to be very helpful.

Curing Colic

Curing Colic is a clinically researched system for eliminating your babys colic for good. This is a very rare, highly unique and powerful colic curing system. You will learn how to prevent colic from reappearing and to how to focus on the root cause of colic rather than the symptom. Using these techniques will cure your babys colic for good. No more treating the symptoms without treating the cause at the same time. These techniques have worked over and over again. They have helped 1000s of parents world wide.

Curing Colic Overview

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Author: Mary Evans
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Gastrocolic Trunk Of Henle

Suprapubic Area Anatomy

First, the mesocolon near the ileocecal junction is lifted to confirm the ileocolic pedicle (Figure 8.3.4). The root of ileocolic pedicle is usually located at the lower border of duodenum. The independent right colic vessels, if present, are located at the upper border at duodenum. However, the majority of patients do not have the independent right colic vessels (vessels originating directly from the superior mesenteric artery and vein). The surgeon, first, should stand on the patient's left side to confidently know the ileocolic pedicle from the superior mesenteric vessels, and to mark the lower border of ileocolic pedicle (Figure 8.3.6). vascular anatomy of this area into two types (type A and type B Figure 8.3.9A and B). Because a complete lymphadenectomy around the origin of ileocolic vessels is necessary for advanced right colon cancer, this classification is very useful to safely and effectively achieve it. In type A, the ileocolic artery is running in front of the superior...

Lienocolic Ligament

Mobilisation Rectum

Vessels should now be clearly exposed and retracted away from the retroperitoneal structures, making them ready for ligation (Figure 9.1.5). The artery and vein are then divided either proximal to or just distal to the left colic artery, depending on the preference of the surgeon. We prefer to ligate the vessels with an endoscopic coagulation device instead of with an endoscopic stapler or surgical clips (Figure 9.1.6). Blunt dissection continues posterior to the left colon mesentery, with the first assistant elevating the mesentery, and the surgeon's fingers sweeping, dorsally, the retroperitoneal fat and the anterior aspect of Gerota's fascia (Figure 9.1.7). Dissection should continue until the lateral attachments of the left colon are encountered at the splenic flexure. The correct dissection plane is avascular. The next step in flexure takedown is separation of the greater omentum from the transverse colon. The surgeon initially grasps the transverse colon and retracts it caudally...

Ilocolic Pedical

White Line Toldt

The procedure then shifts to the division of the transverse mesocolon and middle colic vessels. The assistant has an important role in maintaining proper tension and angulation of the transverse mesocolon, to allow the surgeon to correctly identify and ligate the middle colic vessels (Figure 8.8.5). The assistant will elevate the transverse mesocolon in a vertical plane at a 90' angle to the small bowel mesentery and superior mesenteric artery. This maneuver (called the Ole maneuver, like the bullfighter's cape) is accomplished by passing a grasper from the right upper quadrant to hold the left side of the transverse mesocolon and another from the right lower quadrant cannula to the right side of the mesocolon. The camera person will often shift to a position between the legs at this time. The surgeon, still on the left side, may then work without the assistant's instruments crossing into the field. The surgeon incises transversely the transverse mesocolon to the left of the middle...

Action Astringent anti

Inflammatory, hepatic, cholagogue, diuretic, mild haemostatic, antibacterial. Used for irritations and infections of the intestinal tract, gallbladder diseases, hyperacidity, colic, urinary disorders (bed-wetting, incontinence), sluggish liver, mucus membrane inflammations externally for ulcerated

Special Considerations

In laparoscopic surgery, hemostasis is sometimes much more difficult and much more time-consuming than in open surgery. Therefore, very careful attention should be given, especially during the dissection of major vessels. In addition to skillful dissection and understanding of vascular anatomy, integrated three-dimensional computed tomography imaging is very helpful to simulate and navigate the individual patient's vascular anatomy, and to expeditiously accomplish laparo-scopic dissection without blood loss.8,9 Also, bipolar scissors and forceps are very safe and effective tools compared with monopolar electrocautery, so we prefer this to minimize the risk of inadvertent injury of vessels and or bowels. As previously mentioned, a particular concern for bleeding in extracting right colon from the small incision is the injury of accessory right colic vein. Therefore, it should be divided before extracting right colon to avoid its injury at Henle's trunk.

Superior Mesenteric Artery

The SMA arises from the ventral aspect of the aorta approximately 1 cm below the origin of the CA (Fig. 1b). Rarely, a single celio-mesenteric trunk arises directly from the aorta. The inferior pancre-aticoduodenal artery typically is the first branch of the SMA. The jejunal and ileal artery branches usually originate from the left side of the superior mesenteric artery. A distinguishing feature of the jejunal and ileal branches is the presence of arcades, which anastomose with adjacent branches. The most distal arcades run along the mesenteric border of the bowel and give off the straight vasa rectae, which reach the antimesenteric border 57 . The middle colic artery, the right colic artery, and the ileocolic artery are not visualized routinely with MRA.

Clinical Focus Box 262

Intestinal pseudoobstruction is characterized by symptoms of intestinal obstruction in the absence of a mechanical obstruction. The mechanisms for controlling orderly propulsive motility fail while the intestinal lumen is free from obstruction. This syndrome may result from abnormalities of the muscles or ENS. Its general symptoms of colicky abdominal pain, nausea and vomiting, and abdominal distension simulate mechanical obstruction.

Videolaparoscopic Hand Assisted Technique

This approach, which utilizes the hand-port, is called hand-assisted laparoscopy (HAL). With a sufficiently large protected access, it is possible to comfortably remove the specimen but most of all to insert a hand in the abdomen with the possibility of restoring tactile sense, of dislocating the intestine with a less traumatic traction than that of any laparoscopic instrument, thus obtaining better colon exposure. Even haemostasis in the case of a bleeding colic vessel can be easily conducted, reducing the blood loss and or the need for conversion. In comparing the conventional laparoscopic technique (VDLA) 32, 36 with HAL, results seem markedly superior in the latter case above all in terms of reduced operating time and consequently total costs, without reducing the known advantages of the laparoscopic approach compared to the traditional open approach 37 . Moreover, the learning curve for HAL appears to be shorter because technical gestures are more similar to the traditional ones....

Surgery for IBD and FAP

Among the existing colic surgery protocols, one that certainly deserves to be mentioned is the protocol developed by Kehlet and his Danish team 2 with their concept of accelerated rehabilitation, they developed a series of perioperative treatments that allow speedy recovery and an early dismissal. This treatment concept preserves bodily organ functions and avoids the usual postoperative deterioration in pulmonary function, body composition and cardiovascular response to exercise 3 . (See Table 1 for a comparison of this protocol with the Conventional Care and Multimodal Rehabilitation programmes.) The multimodal rehabilitation programme, with epidural analgesia, early oral nutrition and mobilisation, besides application after open colonic surgery for noninflammatory bowel disease, is also used after ileocolic resections for Crohn's disease 4 . Andersen and Kehlet, at the end of this prospective, nonrandomized study, observed that open ileocolic resections for Crohn's disease combined...

Operative Technique

Ileal Pouch Construction

Denuded of blood supply in preparation of ileostomy, and the mesentery is divided up to the region of the right and middle colic vessels. Individual sigmoid branches, rather than the inferior mesenteric trunk, are isolated in order for the distal sigmoid colon to reach the anterior abdominal wall without tension (Fig. 5). Terminal branches of the inferior mesenteric artery and the superior rectal artery are preserved in order to ensure a good supply to the rectal stump. When rectum-preserving total colectomy is performed, the whole colon is excised to the point of confluence of the colonic taenia at level of the sacral promontory with a stapler loaded with 4.8-mm staples. The sutured link may be oversewn with continuous or interrupted Lembert sutures. In most cases, disease activity settles down, and the rectum heals without problems. It is mandatory to leave intact the

Dissection and Detachment of the Rectosigmoid Colon

White Line Toldt

Is required using the dissecting forceps and scissors. Exposing the root of the IMA carefully, it is possible to preserve the nerves using either electrosurgery or the Laparoscopic Coagulating Shears (LCS) (Harmonic Scalpel Ethicon Endosurgery, Cincinnati, OH). Once the adventitious tunica of IMA is exposed, we separate it sufficiently around the vessels to perform clipping, then transection (Figure 8.5.6). We take care to only divide the nerves that branch toward the sigmoid colon by LCS, so as not to injure the aortic nerve plexus itself, especially on the left side, and furthermore, we take care to also protect the nerve bundle around the IMA on the cephalic side. After sweeping the pedicle free from the retroperitoneal structures, we then resect en masse the inferior mesenteric vein (IMV) and the left colic artery by stapling devices or LCS from the right-sided cannulae. If the instrument is introduced from the suprapubic port, the angle becomes too tangential to the vessels,...

Cannula Positioning

Splenic Flexure

Once the origin of the IMA is identified, the peritoneum is incised anteriorly over this pedicle and then left toward the inferior mesenteric vein. Using a combination of blunt and sharp dissecting techniques, a peritoneal window is made just lateral to the inferior mesenteric vein. The pedicle of the inferior mesenteric artery and eventually vein (if anatomically close) is ligated above or below the left colic artery (according to the surgeon's judgment) with a 30-mm endoscopic vascular stapler, but only after the left ureter has been clearly identified and retracted so it is not injured (Figure 8.7.5). We prefer to leave the IMA 1.0-1.5 cm long so if any bleeding occurs, an additional ligature can be applied to the vessel. After the stapler has been placed across the IMA (and concurrently placed across the inferior mesenteric vein if this is feasible and safe), the stapler is closed and again the ureter is checked. The tip of the stapler should be free and clearly visible, and then...

Stricturoplasties Notes on Surgical Technique

Michelassi Stricturoplasty

Recently, the indication for conservative treatment extended to the treatment of terminal ileitis. Poggioli proposed a side-to-side entero-colic anastomosis 32 , contemplating the section of the terminal loop, of the ileocecal valve and the colon along the tenia and a Finney-fashion suture. Taschieri 43 described an analogous technique to be applied in the case of important narrowing of the ileocecal valve requiring resection of the cecum and the ileocolic junction. The anastomosis is between the ileum and the right colon.

Isolated angiitis of the central nervous systen is a recently recognized vasculitic disorder primarily involving the

The classic triad is palpable purpura with a normal platelet count, colicky abdominal pain, and arthritis. Palpable purpura occurs in 100 of patients but is the presenting symptom in only half. Dependent areas are usually involved, and involvement of the buttocks is common. Arthritis is transient and usually involves the knees and ankles there are no permanent sequelae. Up to one-third of patients may experience hemoptysis and half have occult gastrointestinal bleeding, but serious hemorrhage is rare. Ten percent to fifty percent have renal involvement, ranging from transient isolated microscopic hematuria to rapidly progressive glomerulonephritis. HSP and immunoglobulin A (IgA) nephropathy are similar, but the latter is confined to the kidney, whereas the former is a systemic disease.

Flogistic and Fistulous Disease

CCC, concurrent cohort comparison (matched, non randomised) CS, case series HNCC, historic non concurrent cohort case study NRCR, non randomised comparative retrospective PR, prospective randomised Lap, laparoscopic Op, open surgery ICR, ileo-colic resection TI, terminal ileum

Bowel Obstruction In The Elderly

Sigmoid volvulus is 20 times more likely in the patient age 60 yr and greater (19). This age association may be due to acquired redundancy of the sigmoid colon. High-residue diets are believed to be the causative factor in developing a redundant sigmoid (20). Other factors associated with volvulus are Parkinson's disease, dementia including Alzheimer's disease, bedridden state, and prior abdominal operations, all of which increase in frequency in the elderly patient. Sigmoid volvulus usually presents as acute onset of colicky abdominal pain, distention, and obstipation. When strangulation has

Dissection of the Inferior Mesenteric Artery

Retroperitoneum Sigmoid Colon

With the IMA identified and ligated, the peritoneum is incised anteriorly over the pedicle, dissecting leftward toward the inferior mesenteric vein (IMV). Careful dissection with a right-angled dissector is used to create a peritoneal window just lateral to the IMA and IMV. This pedicle is ligated above or below the left colic artery (according to the surgeon's judgment) using a LigaSure device, but only if the left ureter can be clearly identified and retracted to avoid injury (Figure 8.6.7). We prefer to leave the IMA and IMV 1.0-1.5 cm long so that if any bleeding occurs, an additional grasping of the vessel is possible with application of another seal of the LigaSure device (or alternatively looping by an endoscopic loop can be done).

Inferior Mesenteric Artery

Branches The Middle Colic Artery

The inferior mesenteric artery (IMA) (Fig. 1c) arises from the ventral aspect of the aorta approximately at the level of the L3 vertebral body and measures between 1.2 and 5.5 mm in diameter at its origin. This makes it difficult to image consistently with MRA 6 .The first branch of the IMA is typically an ascending branch, which represents the left colic artery. The inferior mesenteric artery then gives off the sigmoid branches. More distally, the IMA becomes the superior rectal artery. 2 Medial colic artery 3 Right colic artery 1 Left colic artery

Superior Mesenteric Vein Anatomy

Inferior Mesenteric Vein Anatomy

Splenic vein branches drain into the main splenic vein. The inferior mesenteric vein receives its supply from the left colic, sigmoid and superior hem-orrhoidal veins. It usually joins the splenic vein prior to the junction of the splenic vein with the superior mesenteric vein. The superior mesenteric vein receives its contribution from jejunal, ileal right colic, and middle colic veins. The coronary veins (right and left gastric veins) usually drain directly into the portal vein. The portal vein then divides into the right and left portal branches at the porta hepatic. Approximately one half of patients have the portal vein bifurcation outside the liver capsule. A common normal variant of the portal venous system is trifurcation of the main portal vein, which is present in about 8 of patients. In these patients, the main portal vein divides into the right posterior segmental branch, the right anterior segmental branch, and the left portal vein.

The Left Upper Quadrant

Pancreas Mesocolon

The splenic flexure may be seen by lifting the omentum cephalad. In this thin patient, many of the left colonic vessels and retroperitoneal structures are seen. SF, splenic flexure Pb, pancreatic body LbMCA, left branch of the middle colic artery RV, renal vein RA, renal artery K, kidney LCA, left colic artery. (See color plate.) Figure 7.7. The splenic flexure may be seen by lifting the omentum cephalad. In this thin patient, many of the left colonic vessels and retroperitoneal structures are seen. SF, splenic flexure Pb, pancreatic body LbMCA, left branch of the middle colic artery RV, renal vein RA, renal artery K, kidney LCA, left colic artery. (See color plate.)

Abdominal distension bloating

Taking drugs with anticholinergic effects, such as tricyclic antidepressants. Painless abdominal distension and constipation from early childhood in the absence of faecal soiling suggests the possibility of Hirschsprung's disease. Fluctuating abdominal swelling which develops during the day hut resolves overnight is particularly common in women and is rarely if ever due to organic disease. It usually occurs with other symptoms of the irritable bowel syndrome, namely abdominal pain relieved by defecation and altered bowel habit. Painful abdominal distension suggests intestinal obstruction associated with intestinal colic. Chronic simple constipation rarely produces painful distension unless associated with the irritable bowel syndrome.

The Right Lower Quadrant

Ileocolic Artery And Duodenum

By placing the patient in the Trendelenburg position with the right side up, the terminal ileum, its retroperitoneal attachments, the cecum, and the ligament of Treitz can be visualized (Figure 7.12, see color plate). The vascular structures of the ileum and right colon may also be identified (Figure 7.13, see color plate), and their relationship to the duodenum may be appreciated. With dissection of the ileum and right colon away from their retroperitoneal attachments, then the psoas major muscle, the psoas minor tendon, and the right gonadal vessels and ureter are easily seen. The hepatic flexure is well visualized as the ascending colon is mobilized from the retroperitoneum (Figure 7.14). In thinner patients, the vascular structures in the transverse mesocolon (i.e., right and left branches of middle colic vessels) can be clearly demonstrated even before mesenteric dissection (Figure 7.15, see color plate). Figure 7.15. In thin patients, the vessels of the transverse colon and...

Pfannenstiel Incision Using 28 Mm Device To Transect Bowel

Gerota Fascia

A monopolar scissors is used to incise the mesentery just inferior and superior to the ileocolic vessels, isolating them (Figure 9.2.3). These vessels are then divided at their appropriate level in the case of benign disease, they are divided comfortably away from the origin. The vessels can be divided using a vessel-sealing device such as the LigaSureTM device, or the artery and vein can be isolated separately using an endo-scopic dissector and clipped (Figure 9.2.4). In nearly 87 of cases, the right colic artery arises as a tributary of the ileocolic artery and not from the superior mesenteric artery,2 and the ileocolic artery is usually divided proximal to the take-off of the right colic artery. on it, as the transverse colon is held by the left hand of the surgeon. Initially starting this dissection in the midtransverse colon and working back toward the hepatic flexure seems to allow for the easiest dissection. Larger omental vessels are divided using the LigaSure , and care...

Hand Assisted Technique with Personal Adjustments

Cuffitis Ipaa

We separate the ileum and cecum with a linear stapler (GIA60), taking care to spare as much ileum as possible. We identify the right ureter and gonadic vessels and complete the mobilisation of the cecum with the section of the terminal branches directed towards it, sparing the ileo-colic artery arch. We uncover the sigmoid-rectal junction and prepare the rectum and separate it from the sigma again with the linear stapler GIA60 already used. We proceed by further mobilising the sigma by tying and sectioning the sigmoidal vessels reached through the Pfannenstiel incision. Tractioning the sigmoid colon with the left hand and using a Babcock forceps through the upper trocar, we expose the colon mesentery starting the synthesis and section of the colic vessels with the instrument inserted in the left trocar. We generally use a radiofrequency instrument (Ligasure-Atlas , Valleylab, CA, USA), particularly indicated for colic vessels but also the last generation of ultrasound instruments...

Crohn S Disease Indication To Total Abdominal Colectomy

Except for cancer, the indications for laparoscopic total abdominal colectomy are basically the same as in open surgery. For less experienced laparoscopic surgeons, however, further restrictions may apply such as previous operations with formation of intraabdominal adhesions, obesity, or fistula formation, because these conditions may make laparoscopic orientation and accessibility difficult.1,2 This is especially true for the anatomic regions of the omentum, transverse colon, and meso-colon including its vessels. If the laparoscopic approach proves to be difficult, early conversion is recommended. In Crohn's disease, extensive colonic involvement or pancolitis with rectal sparing is an indication for total abdominal colectomy.3-5 It may also be indicated in rare cases of ulcerative colitis with minimal rectal involvement but still carries the risk of leaving behind the principally diseased rectum with all its consequences.6-10 In familial adenomatous polyposis, the situation is...

Clinical Aspects of the Urinary System Infections

Foley Cath Removal Female

Urinary lithiasis (condition of having stones) may be related to infection, irritation, diet, or hormone imbalances that lead to an increased level of calcium in the blood. Most urinary stones, or calculi, are formed of calcium salts, but they may be composed of other materials as well. Causes of stone formation include dehydration, infection, abnormal pH of urine, urinary stasis, and metabolic imbalances. The stones generally form in the kidney and may move to the bladder (Fig. 13-8). This results in great pain, termed renal colic, and obstruction that can promote infection and cause hydronephrosis (collection of urine in the renal pelvis). Because they are radiopaque, stones can usually be seen on simple radiographs of the abdomen. Stones may dissolve and pass out of the body on their own. If not, they may be removed surgically, in a lithotomy, or by

Laparoscopic Gastric Bypass for Recurrent Reflux

Revision Ethicon

Accomplished, a 15- to 30-cc pouch is created based on the lesser gastric curve. This can be performed with an EEA anvil, by visualization, or by using a 36-French orogastric tube. Next, the jejunum is divided approximately 20-30cm from the ligament of Trietz. A 75- to 150-cm Roux limb is measured and a jejunojejunostomy is created with the EndoGIA stapler. Some surgeons base the Roux limb lengths on preopera-tive BMI with BMI > 50 necessitating a 150-cm Roux limb and a BMI < 50 receiving a 100-cm Roux limb. Other surgeons use the same Roux limb length in every case. The Roux limb is passed antecolic or retrocolic. If an antecolic route is used, the omentum must be divided to ensure a tension-free anastomosis. If the limb is positioned retrocolic, the mesenteric defect is closed with running, nonabsorbable suture to prevent internal herniation through the meso-colic window.

Patterns of presentation

Biliary colic Renal colic A change in (he pattern of symptoms should alert the clinician to the possibility that cither the initial diagnosis was wrong, or that complications have developed. In a patient with acute small bowel obstruction, a change in the pain from typical intestinal colic to persistent pain with Intestinal obstruction is suggested by the presence of typical central, colicky pain.

Large Intestine

Lymphatic vessels of the ascending and transverse colon drain into lymph nodes along the right and middle colic arteries and their branches and end in the superior mesenteric nodes. Those of the descending and sigmoid colon drain into small nodes along the left colic arteries and end in the pre-aortic nodes near the origin of the inferior mesenteric artery.

Infant Botulism

In many societies, herbal teas or infusions are given to infants for colic and other common ailments. No spores were detected in herbal teas given to some of the first cases of infant botulism recognized in California (91). Satorres et al. recently prepared infusions from 100 samples of medicinal herbs used in western Argentina (92). They isolated type A C. botulinum from one sample of Lippia turbinata (commonly poleo) and detected toxicity in mice suggestive of botulinum toxin from one sample each of three additional herbs. When attempting to link an item from the baby's diet with the subsequent diagnosis of infant botulism, one must carefully compare the timing of feedings with the onset of symptoms. For instance, both corn syrup and honey have been given to treat constipation caused by infant botulism. Herbal teas have been given to infants believed to have colic, who instead were distraught from hunger caused by the feeding paralysis of early infant botulism.

Verum Hook

It is often chewed in small quantities after each meal to promote digestion and to sweeten the breath (Grieve, 1998), and it has carminative properties (Simonetti, 1991) and helps to relieve flatulence (Lust, 1986). The fruit is used in Asia as a remedy for colic and rheumatism (Grieve, 1998).

Urogenital pain

Severe pain, known as renal colic, can be caused by acute distension of the renal pelvis and ureter, resulting from obstruction by calculus or blood clot. Renal colic is not a true colic the pain is severe, sustained and The pain ol ureteric colic is usually sustained and associated with vomiting. unremitting and the patient is restless, nauseated and often vomits. The pain may radiate from the renal angle and loin to the iliac fossa, the groin and into the genitalia. Once the stone reaches the bladder, it is often asymptomatic until it enters the urethra and causes dysuria. In patients with renal colic, specific questions should he asked to try to determine any underlying cause for stone formation (see Fig. 5.3). Fig. 5.3 Checklist in patients with renal colic. Fig. 5.3 Checklist in patients with renal colic.

Herbal Alert Garlic

Garlic has been used for many years throughout the world. The benefits of garlic on cardiovascular health are the best known and most extensively researched benefits of the herb. Its benefits include lowering serum cholesterol and triglyceride levels, improving the ratio of HDL to LDL cholesterol, lowering blood pressure, and helping to prevent the development of atherosclerosis. The recommended dosages of garlic are 600 to 900 mg day of the garlic powder tablets, 10 mg of garlic oil perles, or one moderate-sized fresh clove of garlic a day Adverse reactions include mild stomach upset or irritation that can usually be alleviated by taking the supplements with food. Although no serious reactions have occurred in pregnant women taking garlic, its use is not recommended. Garlic is excreted in breast milk and may cause colic in some infants.


If esophageal resection is likely to be necessary then the method of reconstruction needs to be determined, and when considering a colon interposition then evaluation with colonoscopy and potentially a visceral arteriogram is recommended. Colonoscopy or an air-contrast barium radiographic study should be performed before use of the colon as an esophageal substitute to rule out polyps, malignancy, or evidence of either inflammatory disease or significant diver-ticulosis in the area of the colon to be used. Careful consideration should be given before using a colon graft in the presence of any of these abnormalities with the exception of a polyp that has been completely excised. Routine angiography, although not essential, does provide information about anatomic variations that may be present, but most importantly confirms patency of the colonic vessels and the marginal arcade.3 Most surgeons prefer to use the transverse colon based on the ascending branch of the left colic artery. A...

Surgical Approach

At this point, the gastroesophageal junction has been completely exposed and the lesser curve above the crow's foot skeletonized. If the stomach is to be used for esophageal replacement, then the greater curve is mobilized in the same manner as for a standard gastric pull-up. However, if the colon is to be used, then there is no need to mobilize the greater curve completely. Instead, the omentum is detached from the transverse colon and a window created into the lesser sac along the mid-greater curve of the stomach. It is also useful to expose the left crus and divide the most proximal one or two short gastric and posterior pancreatico-gastric vessels to create a passage from the lesser sac to the hiatus for the colon graft. The colon is mobilized in standard manner based on the ascending branch of the left colic artery whenever possible.4 The necessary length of colon is marked out by measuring the distance from the bottom of the left ear to the xiphoid anteriorly with an umbilical...

Nausea and vomiting

The combination of nausea and vomiting usually suggests an upper gastrointestinal disorder but may also be a prominent feature of non-alimentary disorders (see Disorders box). In most instances, vomiting is preceded by nausea, but in some cases, e.g. intracranial tumour, the vomiting can occur without warning. Vomiting may also result from severe pain, as in renal or biliary colic or myocardial infarction, from systemic disease, metabolic disorders and drug therapy. Vomiting may be self-induced in paiients with peptic ulceration (for pain relief) or with bulimia nervosa. Gastric outlet obstruction is associated with the projectile vomiting of large volumes of gastric content, the vomitus also being noteworthy for the absence of bile-staining. Obstruction distal to the pylorus produces bilc-stained vomiting the lower the level of intestinal obstruction, the more marked are the accompanying symptoms of abdominal distension and intestinal colic. Vomiting also occurs in other...


Enterohepatic System And Urobilinogen

Typical symptoms include itching (pruritus), dark urine and pale stools. Obstruction of the biliary tract is usually extrahepatic in origin and caused by either gallstones or pancreatic carcinoma. The former is suggested by a history of fever, rigors, biliary colic or previous biliary surgery in the latter, chronic persistent back pain, aggravated by recumbency, and palpable enlargement of the gall bladder may occur. Intrahepatic obstruction is most often due to alcohol abuse, drug therapy and primary biliary cirrhosis (a disorder of middle-aged women often preceded by marked pruritus).

Toxic Colitis

Toxic colitis, with or without megacolon, is an emergent life-threatening complication of inflammatory bowel disease. Its overall incidence in patients with ulcerative colitis is about 10 27 . Although in the past, toxic colitis was thought to be a rare complication of Crohn's disease compared with ulcerative colitis, recent studies have shown that Crohn's colitis is the etiology in approximately 50 of the cases 28 . The overall incidence of complicated Crohn's disease is about 6 , with an increasing number occurring in Crohn's colitis 29 . The presentation of toxic fulminant colitis includes fever, an abrupt onset of bloody diarrhoea, abdominal tenderness, colicky pain, and anorexia 30 . Toxic megacolon is present if, in addition to toxic colitis, either total or segmental dilatation of the colon occurs 31, 32 . Once the diagnosis of toxic colitis is suspected, aggressive medical therapy is initiated. A team approach is required involving both gastroenterologists and surgeons. Prompt...


Colon Arteries

Alternatively, a short segment of colon based on the middle colic artery or on the ascending branch of the left colic artery is prepared (Figure 14.4). The conduit is brought posterior to the stomach and through the esophageal hiatus in an isoperistaltic orientation. An end-to-side proximal anastomosis is usually performed when jejunum is used, whereas an end-to-end anastomosis is performed when the colon is selected. The interposition graft is then drawn into the abdomen to eliminate any redundancy and is anastomosed to the back wall of the body of the stomach. The graft is sutured to the crura with several interrupted stitches to prevent herniation of intraabdominal contents. The stomach is tacked to the diaphragm in a horseshoe shape around the interposition to create a low-pressure antireflux barrier. Intestinal continuity is restored. Figure 14.4. The blood supply to the colon includes the ilecolic (IC), right colic (RC), and middle colic (MC) arteries that arise from the...

Surgical procedures

Steps Studer Pouch Procedure

Conduit stenosis is a condition affecting ileal conduits. It has never been described in colonic conduits, indicating fundamental but unknown differences between ileum and colon in resistance to urine exposure. The whole, or part of the conduit, is transformed into a thick-walled tube without peristaltic activity (Figure 7). The pathogenesis of this disorder, which manifests late after diversion, is obscure. The clinical picture is colicky flank pain and or fever and is produced by upper tract obstruction. Treatment is by removal of the conduit or partial resection with or without ureteric re-implantation.62

Cowden Disease

Cowden disease is an uncommon autosomal dominant disorder and is the family name of the original report patient, Rachel Cowden. This syndrome is a rare disorder that is inherited in autosomal dominant manner with intrafamilial and interfamilial differences in symptom expression. In Cowden disease, one sees facial trichilemmomas, acral keratosis and oral mucosal papillomas. This disorder is also associated with breast and thyroid cancer. There are numerous colic and small-intestinal polyps. They have been described as hamartomatous lesions 13 consisting of mildly fibrotic, mildly disordered mucosa overlying a submucosa that display disorganisation and splaying of smooth-muscle fibres. These lesions show some similarities to the pathology seen in solitary rectal ulcer syndrome. Other authors reported polyps that they described as inflammatory lesions, lipomas and ganglioneuromas. There is no increased risk for GI cancers in this disorder 14 .

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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