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Bowel Obstruction in Terminally Ill Patient

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1. Bowel Obstruction in Terminally Ill Patient

Bowel Obstruction in Terminally Ill Patient Bowel Obstruction in Terminally Ill Patient Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration (...) 4 Bowel Obstruction in Terminally Ill Patient Bowel Obstruction in Terminally Ill Patient Aka: Bowel Obstruction in Terminally Ill Patient , Cancer Related Bowel Obstruction II. Epidemiology in care: 3% Common end-stage cancer causes III. Symptoms Crampy from bowel fluid secretion IV. Differential Diagnosis See V. Management: Terminally ill, comfort care patients Surgical Intervention Usually not indicated for terminally ill High mortality High rate of recurrence (50%) Options to consider

2018 FP Notebook

2. Bowel Obstruction in Terminally Ill Patient

Bowel Obstruction in Terminally Ill Patient Bowel Obstruction in Terminally Ill Patient Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration (...) 4 Bowel Obstruction in Terminally Ill Patient Bowel Obstruction in Terminally Ill Patient Aka: Bowel Obstruction in Terminally Ill Patient , Cancer Related Bowel Obstruction II. Epidemiology in care: 3% Common end-stage cancer causes III. Symptoms Crampy from bowel fluid secretion IV. Differential Diagnosis See V. Management: Terminally ill, comfort care patients Surgical Intervention Usually not indicated for terminally ill High mortality High rate of recurrence (50%) Options to consider

2015 FP Notebook

3. Erythromycin: prophylaxis against recurrent small bowel obstruction. (PubMed)

Erythromycin: prophylaxis against recurrent small bowel obstruction. We describe three cases where erythromycin suspension has been used successfully in preventing recurrence of small bowel obstruction in patients with terminal illness and for whom it proved more effective than standard preparations such as metoclopramide and domperidone. These patients also experienced a longer term benefit over some months. With recent alerts over longer term use of metoclopramide and domperidone, we (...) demonstrate that erythromycin is a viable alternative prokinetic in patients with terminal illness at risk of small bowel obstruction instead of or alongside metoclopramide and domperidone. More research is required to establish the point at which erythromycin should be considered in the management of symptoms. In addition, research into the possibility of a viable alternative to erythromycin is needed.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under

2017 BMJ Supportive & Palliative Care

4. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient

to –0.34, p = 0.0007). Hospital LOS and mortality were not significantly different. These differences in outcome from the separate routes of feeding largely reflect findings from older studies and may diminish in the future with improvements in glycemic control, protocolized medical management and new lipid emulsions. Question: Is the clinical evidence of contractility (bowel sounds, flatus) required prior to initiating EN in critically ill adult patients? | B3. Based on expert consensus, we suggest (...) not necessarily relate to mucosal integrity, barrier function, or absorptive capacity. The argument for initiating EN regardless of the extent of audible bowel sounds is based on studies (most of which involve critically ill surgical patients) reporting the feasibility and safety of EN within the initial 36–48 hours of admission to the ICU. Nonetheless, reduced or absent bowel sounds may reflect greater disease severity and worsened prognosis. Patients with normal bowel sounds have been shown to have lower

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2016 Society of Critical Care Medicine

5. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient

ventilation. Bowel sounds are indicative only of contractility and do not necessarily relate to mucosal integrity, barrier function, or absorptive capacity. The argument for initiating EN regardless of the extent of audible bowel sounds is based on studies (most of which involve critically ill surgical patients) reporting the feasibility and safety of EN within the initial 36–48 hours of admission to the ICU. Nonetheless, reduced or absent bowel sounds may reflect greater disease severity and worsened (...) framework (ease and feasibility of placing small bowel enteral access devices, institutional policies, and protocols). In the largest multicenter RCT to compare gastric versus small bowel EN in critically ill patients, Davies et al found no difference in clinical outcomes between groups, including LOS, mortality, nutrient delivery, and incidence of pneumonia. Aggregating the data from the RCTs that met our inclusion criteria, 6 trials reported on improved nutrient delivery with small bowel feedings (WMD

2016 American Society for Parenteral and Enteral Nutrition

6. BSG consensus guidelines on the management of inflammatory bowel disease in adults

; PDAI: Pouchitis Disease Activity Score; PEG: polyethylene glycol; PEO, Population, Exposure, Outcome; PICO: Population, Intervention, Comparator, Outcome; PRO: Patient Reported Outcome; PROM: Patient Reported Outcome Measure; RCT: randomised controlled trial; RR: relative risk; SBUS: small bowel ultrasound; SES-CD: Simplified Endoscopic activity Score for Crohn's disease; s.c.: subcutaneous; TB: tuberculosis; TGN: thioguanine nucleotides; THC: delta 9 -tetrahydrocannabionol; TNF: tumour necrosis (...) and symptomatic burden between patients, and within individuals over time. Optimal management relies on understanding and tailoring evidence-based interventions by clinicians in partnership with patients. This guideline for management of inflammatory bowel disease in adults over 16 years of age was developed by Stakeholders representing UK physicians (British Society of Gastroenterology), surgeons (Association of Coloproctology of Great Britain and Ireland), specialist nurses (Royal College of Nursing

2019 British Society of Gastroenterology

7. The Association of Coloproctology of Great Britain and Ireland Consensus Guidelines in Surgery for Inflammatory Bowel Disease

‐designed clinical trials. IBD service provision should ensure support for patient recruitment to multidisciplinary trials and cohort studies. Level of evidence: IV Grade of recommendation: GP Consensus: 88.6% (SA 62.9%, A 25.7%) Small bowel surgery in Crohn's disease The small bowel, and especially the terminal ileum, is commonly affected in about 80% of Crohn's cases with one‐third of patients having isolated ileitis. Crohn's disease is a complex disorder with no surgical cure and the primary (...) or gastroenterology advice should be arranged for all patients after IBD surgery where required. Level of evidence: IV Grade of recommendation: GP Consensus: 94.3% (SA 51.4%, A 42.9%) Relationship between volume and outcomes in IBD surgery Inflammatory Bowel Disease is relatively uncommon in the general population and many clinicians may have relatively little experience of managing patients with IBD. It is therefore perhaps not surprising to find that there is a volume–outcome relationship in several aspects

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2018 Association of Coloproctology of Great Britain and Ireland

8. Clinical Practice Guidelines for Colon Volvulus and Acute Colonic Pseudo Obstruction

- sented by the individual patient. STATEMENT OF THE PROBLEM large-bowel obstruction in adults is most often caused by colon or rectal cancer, diverticular disease, or volvu- lus of the colon. 2,3 o bstruction from colonic volvulus results from twisting of a redundant segment of colon on its mesentery. 4–6 t he worldwide incidence of colonic volvulus is variable, with historical evidence indicating higher rates in parts of india, a frica, and middle eastern countries, and a relatively lower incidence (...) of the colon, creating a clinical picture consistent with large-bowel obstruction, although no mechanical block- age is present. 24–29 aCPo typically occurs in patients of advanced age who are hospitalized for medical conditions, traumatic injury, or a surgical procedure. 28,30–34 u ntreated a CPo may progress to ischemic perforation of the colon, and, thus, timely recognition and therapeutic intervention are essential. 30,35,36 t herapeutic interventions in aCPo are focused on decompression of the colon

2016 American Society of Colon and Rectal Surgeons

9. Small-Bowel Obstruction (Overview)

in childhood (see the images below). (See Etiology, Presentation, and Workup.) Small-bowel obstruction visible on plain radiograph caused by intussusception in a 5-month-old patient. Surgical photograph of a transition zone in an infant with small bowel obstruction. occurs in about 1 in 1,500 live births. Intestinal obstruction should be suspected in any child with persistent vomiting, distention, and abdominal pain, because delayed diagnosis and treatment can lead to devastating consequences. Infants (...) , the infant's stomach should be aspirated immediately after birth. Aspiration of 15-20 mL or more of gastric fluid, especially if it is bile stained, is suggestive of a high intestinal obstruction. [ ] (See Presentation and Workup.) Patient education For patient education information, see the , as well as , , , , and . Next: Pathophysiology The normal bowel contains gas and chyle, which is the sum of food and salivary, gastric, biliary, pancreatic, and intestinal secretions. Chyle continues to accumulate

2014 eMedicine Pediatrics

10. Small-Bowel Obstruction (Diagnosis)

in childhood (see the images below). (See Etiology, Presentation, and Workup.) Small-bowel obstruction visible on plain radiograph caused by intussusception in a 5-month-old patient. Surgical photograph of a transition zone in an infant with small bowel obstruction. occurs in about 1 in 1,500 live births. Intestinal obstruction should be suspected in any child with persistent vomiting, distention, and abdominal pain, because delayed diagnosis and treatment can lead to devastating consequences. Infants (...) , the infant's stomach should be aspirated immediately after birth. Aspiration of 15-20 mL or more of gastric fluid, especially if it is bile stained, is suggestive of a high intestinal obstruction. [ ] (See Presentation and Workup.) Patient education For patient education information, see the , as well as , , , , and . Next: Pathophysiology The normal bowel contains gas and chyle, which is the sum of food and salivary, gastric, biliary, pancreatic, and intestinal secretions. Chyle continues to accumulate

2014 eMedicine Pediatrics

11. Small-Bowel Obstruction

of small-bowel obstruction. The scan shows active uptake of the radionuclide in the terminal ileum and the cecum/ascending colon indicative of an active inflammatory process. The patient was treated for active Crohn disease. The diagnosis of small-bowel obstruction has been achieved by using magnetic resonance imaging (MRI) with T1-weighted sequences combined with antiperistaltic agents and retrograde insufflation. Similar results have been achieved by using subsecond rapid acquisition with relaxation (...) with intussusception, barium enema studies are not only diagnostic but possibly therapeutic as well. Postevacuation image from part of a double-contrast barium enema study in a 47-year-old man presenting with features of small-bowel obstruction. The image shows a coiled-spring appearance in the region of the cecum suggestive of an intussusception (same patient as in the previous 2 images). At laparotomy, an ileocecal intussusception was found in association with a carcinoid tumor of the terminal ileum. An erect

2014 eMedicine Radiology

12. Inflammatory Bowel Disease (IBD)

are biopsied. ? Identifying lymphocytic colitis or collagenous colitis in an otherwise endoscopically normal-appearing colon. These diagnoses may coexist with small- bowel Crohn’s disease, and should be sought in patients with diarrhea. 3.4 Imaging and endoscopy ? Plain abdominal radiography: — Can establish whether colitis is present and its extent in some cases. — Used when bowel obstruction or perforation is expected. — Excludes toxic megacolon. ? Barium double-contrast enema/barium small-bowel (...) radiography: — Not typically recommended in severe cases. — Can be useful for identifying fistulas that arise from or bridge to the colon. — Barium small-bowel radiography is still widely used to assess the gastrointestinal tract as far as the distal small bowel. — Can provide an anatomic “road-map” prior to surgery. ? Sigmoidoscopy, colonoscopy: — Examine for ulcers, inflammation, bleeding, stenoses. — Multiple biopsies from the colon and terminal ileum. — Colonoscopy in severe or fulminant cases may

2015 World Gastroenterology Organisation

13. TAK-954 in Critically Ill Participants With Enteral Feeding Intolerance (EFI)

. TAK-954 in Critically Ill Participants With Enteral Feeding Intolerance (EFI) The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our for details. ClinicalTrials.gov Identifier: NCT03477903 Recruitment Status : Terminated (Insufficient enrollment; No safety concerns) First Posted : March 27, 2018 Last Update Posted : December 17, 2018 Sponsor (...) . Study Design Go to Layout table for study information Study Type : Interventional (Clinical Trial) Actual Enrollment : 1 participants Allocation: Randomized Intervention Model: Parallel Assignment Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor) Primary Purpose: Treatment Official Title: A Phase 2b, Randomized, Multi-Center, Double-Blind, Dose-Ranging Study to Assess the Efficacy, Safety and Pharmacokinetics of Intravenous TAK-954 in Critically Ill Patients

2018 Clinical Trials

14. The SNMMI and EANM Practice Guideline for Small-Bowel and Colon Transit 1.0*

In into the bowel until they are dissolved in the pH environ- ment of the terminal ileum. The disadvantage is that these capsules are available only at imaging facilities capable of fabricating them. D. Protocol options For imaging gastrointestinal transit, 3 protocol options with various single or combination meals are available. These are summarized in Figure 1. The imaging parameters for the 3 protocol options are summarized in Figure 2. For each option, images may be acquired with the patient either (...) - passallactivityintheterminalileum(Fig.3).Ifactivityhas progressed into the cecum or colon, that activity is consid- ered to have transited through the small bowel and a larger ROI to include the terminal ileum and the cecum/colon is drawntomeasurealltheactivitythathaspassedthroughthe small bowel. Imaging is continued up to 360 min on the ?rst day to quantify the 111 In activity that transits into the terminal ileumreservoirorpassesintothececumorascendingcolon. The patient returns 24 h after the beginning of the study

2013 Society of Nuclear Medicine and Molecular Imaging

15. The SNMMI and EANM Practice Guideline for Small-Bowel and Colon Transit

pseudoobstruction,scleroderma,celiacdisease,andmalabsorption syndromes. In the evaluation of patients with constipation, transit measurements may demonstrate a motility disorder or slow colon transit or may provide evidence to support a diagnosis of defeca- tion disorder or functional rectosigmoid obstruction (3). V. QUALIFICATIONS AND RESPONSIBILITY OF PERSONNEL See the SNM Guideline for General Imaging. VI. PROCEDURE/SPECIFICATIONS OF THE EXAMINATION A. Study requisition The requisition for the bowel motility (...) - passallactivityintheterminalileum(Fig.3).Ifactivityhas progressed into the cecum or colon, that activity is consid- ered to have transited through the small bowel and a larger ROI to include the terminal ileum and the cecum/colon is drawntomeasurealltheactivitythathaspassedthroughthe small bowel. Imaging is continued up to 360 min on the ?rst day to quantify the 111 In activity that transits into the terminal ileumreservoirorpassesintothececumorascendingcolon. The patient returns 24 h after the beginning of the study

2014 European Association of Nuclear Medicine

16. A Phase IB Trial With OTX015, a Small Molecule Inhibitor of the Bromodomain and Extra-Terminal (BET) Proteins, in Patients With Selected Advanced Solid Tumors

cervical carcinoma) within 3 years of study entry; Other serious illness or medical conditions, such as active infection, unresolved bowel obstruction, or psychiatric disorders; Known human immunodeficiency virus (HIV) positivity; Participation in another clinical trial or treatment with any investigational drug within 30 days prior to study entry; Other concomitant anticancer treatment; Concomitant therapy with strong CYP3A4 interfering drugs; Current use of anticoagulants (e.g. warfarin, heparin (...) A Phase IB Trial With OTX015, a Small Molecule Inhibitor of the Bromodomain and Extra-Terminal (BET) Proteins, in Patients With Selected Advanced Solid Tumors A Dose-Finding Study of MK-8628, a Small Molecule Inhibitor of the Bromodomain and Extra-Terminal (BET) Proteins, in Adults With Selected Advanced Solid Tumors (MK-8628-003) - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x

2014 Clinical Trials

17. Intestinal metastasis from primary epidermoid anal carcinoma in a 34 year old male presented with acute bowel obstruction (PubMed)

. Examination under anaesthesia revealed a hard and fixed mass at the level of dentate line, which was biopsied. On histopathological examination, it was confirmed as primary moderately differentiated keratinising squamous cell carcinoma. Despite initial response to concomitant chemo-radiation, 4 months later, the patient presented with large bowel obstruction. On laparotomy, a large mass involving the terminal ileum and caecum was identified. Histopathological examination revealed metastatic spread from (...) Intestinal metastasis from primary epidermoid anal carcinoma in a 34 year old male presented with acute bowel obstruction Squamous cell carcinoma (SCC) of the anal canal is a rare condition comprising only 2-4% of all cancers of the colon, rectum and anus. The most common sites of metastases are liver and lung. We report a case of 34-year-old male, who presented with diarrhoeal illness and an acutely tender protruding anal lesion initially thought to be thrombosed external hemorrhoid

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2012 Journal of surgical case reports

18. The SNMMI and EANM Practice Guideline for Small-Bowel and Colon Transit

In into the bowel until they are dissolved in the pH environ- ment of the terminal ileum. The disadvantage is that these capsules are available only at imaging facilities capable of fabricating them. D. Protocol options For imaging gastrointestinal transit, 3 protocol options with various single or combination meals are available. These are summarized in Figure 1. The imaging parameters for the 3 protocol options are summarized in Figure 2. For each option, images may be acquired with the patient either (...) - passallactivityintheterminalileum(Fig.3).Ifactivityhas progressed into the cecum or colon, that activity is consid- ered to have transited through the small bowel and a larger ROI to include the terminal ileum and the cecum/colon is drawntomeasurealltheactivitythathaspassedthroughthe small bowel. Imaging is continued up to 360 min on the ?rst day to quantify the 111 In activity that transits into the terminal ileumreservoirorpassesintothececumorascendingcolon. The patient returns 24 h after the beginning of the study

2013 European Association of Nuclear Medicine

19. Global Vascular Guidelines for patients with chronic limb-threatening ischemia

Global Vascular Guidelines for patients with chronic limb-threatening ischemia Global vascular guidelines on the management of chronic limb-threatening ischemia - Journal of Vascular Surgery Email/Username: Password: Remember me Search JVS Journals Search Terms Search within Search Access provided by Volume 69, Issue 6, Supplement, Pages 3S–125S.e40 Global vascular guidelines on the management of chronic limb-threatening ischemia x Michael S. Conte Affiliations Division of Vascular (...) Surgery, University of California San Francisco, 400 Parnassus Ave, Ste A581, San Francisco, CA 94143-2202 , x Andrew W. Bradbury Affiliations Department of Vascular Surgery, University of Birmingham, Birmingham, United Kingdom , MD (Co-Editor) b , x Philippe Kolh Affiliations Department of Biomedical and Preclinical Sciences, University Hospital of Liège, Wallonia, Belgium , MD (Co-Editor) c , x John V. White Affiliations Department of Surgery, Advocate Lutheran General Hospital, Niles, Ill , MD

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2019 Society for Vascular Surgery

20. A cost-utility analysis of biosimilar infliximab compared to reference infliximab in adult switch patients with Crohn’s disease: A Canadian analysis

severe complication which affects approximately 30% of CD patients are fissures or fistulas. A fissure is a tear in the lining of the anus or rectum which can lead to fever or pain particularly during bowel movements (Crohn's and Colitis Foundation of Canada, 2012; Gastrointestinal Society - Canadian Society of Intestinal Research, 2017). A fistula is an abnormal tunnel which connects from one loop of intestine to another or even to the bladder, vagina or skin (Crohn's and Colitis Foundation (...) with these extensive treatment options surgical intervention will still be required in one in two patients either to manage complications or refractory symptoms (Fleshner, 2016). Biologic therapy Immunosuppressants Corticosteroids 5-Aminosalicylates & Antibiotics31 Figure 2 - Step Down Therapy 1.4.5.1 Operative Management Surgery is a necessary treatment for some variants of medically refractory disease, if complications such as fistulas, abscesses, scarring or narrowing of the bowel arise, or if dysplasia

2019 SickKids Reports

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