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| Ulcerative Colitis Complications |
| Ulcerative Colitis Complications in the Intestine may occur in the form of Toxic Megacolon, Malabsorption and Malnutrition, Bleeding & Intestinal Infections |
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(source: Southern Medical Journal).
More Information (source: Southern Medical Journal).
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12/31/1969 03:59 PM
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Surgical Management of Anorectal Complications of Chronic Ulcerative Colitis
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Several complications of ulcerative colitis may show themselves during the course of disease. They must be recognized and be thoroughly considered from the standpoint of surgical management.
(C) 1961 Southern Medical Association
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12/31/1969 03:59 PM
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Ulcerative Proctitis
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Ulcerative proctitis, a nonspecific inflammatory process involving the rectal mucosa but not the mucosa of the sigmoid or more proximal colon, is often diagnosed mistakenly as ulcerative colitis because of similarity in gross and microscopic appearances. Ulcerative proctitis, however, is more benign, symptoms are limited to the rectum (bleeding), extracolonic complications are rare, and there is little if any malignant potential, Prognosis is excellent. Review of 50 cases of ulcerative practitis showed a relationship to emotional tension in over one third of the cases. Effective treatment includes hydrocortisone enemas, salicylazosulfapyridine, and especially reassurance of the limited and benign nature of the disease.
(C) 1974 Southern Medical Association
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12/31/1969 03:59 PM
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Technical Complications of Ileostomy
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A review of 45 patients with ileostomy revealed a complication rate of 24%. A higher incidence of complications was seen in those patients who were obese (80%), who had chronic ulcerative colitis (45%), or who had an emergency ileostomy because of a surgical complication (50%). Strict attention to technic should prevent the majority of these complications.
(C) 1980 Southern Medical Association
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12/31/1969 03:59 PM
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Inflammatory Bowel Disease-Related Thoracic Aortic Thrombosis
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Arterial and venous thromboembolisms have long been associated with inflammatory bowel disease (IBD) and can cause significant morbidity and mortality. We present a patient with aortic arch thrombosis embolizing to the left lower extremity during hospitalization for active ulcerative colitis (UC). The limb was preserved following emergent embolectomy. Thrombophilia was attributed to UC, as hypercoagulable testing was negative. IBD is certainly a hypercoagulable state, and aggressive thromboembolism prevention should be considered for hospitalized patients with active disease.
(C) 2010 Southern Medical Association
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12/31/1969 03:59 PM
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Current Surgical Management of Inflammatory Bowel Disease
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colon; When surgery is required for complications of inflammatory bowel disease (IBD) or for failure of medical management, numerous options exist. This review focuses on surgical alternatives, technical considerations, and complications for both routine and unusual problems associated with IBD. Restorative proctocolectomy for chronic ulcerative colitis, intestine-sparing procedures for Crohn's disease, and the management of Crohn's disease in difficult anatomic sites or with unusual complications are discussed.
(C) 1994 Southern Medical Association
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12/31/1969 03:59 PM
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Restorative Proctocolectomy: Ochsner Clinic Experience
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Background. Restorative proctocolectomy, a standard operation for ulcerative colitis and familial adenomatous polyposis has significant complications, even in experienced hands.
Methods. We studied surgical outcome by retrospectively reviewing cases of restorative proctocolectomy done at Ochsner Foundation Hospital from 1982 to 1995. Demographic and clinical data from two periods (1982 to 1989 and 1989 to 1995) were compared to determine factors associated with improved outcome.
Results. We performed 145 ileal pouch-anal procedures. In 56 patients, 104 complications occurred. The more recent group had a greater incidence of inflammatory bowel disease, steroid use, and staged operations; reduced operative times and hospital stays; more general but fewer pouch-related complications. Pouch failures were similar for both groups.
Conclusions. Perioperative outcome appeared to be associated with technical experience, improved perioperative care, exclusion of patients with Crohn's disease, judicious surgical reoperation for pouch complications, and use of a 3-stage procedure in malnourished patients or those with acute or toxic colitis.
(C) 2001 Southern Medical Association
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12/31/1969 03:59 PM
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Current Controversies in Pouch Surgery
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Restorative proctocolectomy with ileal pouch anal anastomosis has become the most commonly used procedure for elective treatment of patients with mucosal ulcerative colitis and familial adenomatous polyposis. Since its original description, the procedure has been modified in an attempt to obtain optimal functional results with low morbidity and mortality, and yet provide a cure for the disease. These modifications of the technique are discussed in this review, limited to the current points of controversy. We reviewed the current literature describing restorative proctocolectomy with ileal pouch anal anastomosis. The current "hot topics" for debate are transanal mucosectomy with hand-sewn anastomosis versus the double-stapled technique, the use of diverting ileostomy, indeterminate colitis, the role of laparoscopy, and indications for pouch surgery in the elderly. Longer follow-up of patients and increased knowledge and experience with pouch surgery, coupled with active prospective evaluation of the procedure are required to settle these issues. Patients must be fully informed to understand inherent risks of each choice.
(C) 2003 Southern Medical Association
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12/31/1969 03:59 PM
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Loop IleoStomy: A Reliable Method of Diversion
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colon; Between September 1983 and March 1989, 36 loop ileostomies were performed on 34 patients (16 male and 18 female, mean age 36 years, range 11 to 68). Thirty-two patients had ileoanal pouch procedures (30 for ulcerative colitis and two for familial polyposis). One patient had a low anterior resection and another had a coloanal procedure. By the time of this review, 31 of the loop ileostomies were closed. The average time before closure was 5 months and the average length of follow-up was 37 months. All stomas were brought out through the rectus muscle in the right side of the abdomen, without ileal rotation, mesenteric fixation, or parastomal fascial sutures. A support rod was left in place for 3 to 4 weeks postoperatively. There were no major difficulties with skin irritation or appliance management and no instance of parastomal abscess and stoma retraction. Although no complications related to the ostomy or its closure were encountered in these patients, small bowel obstruction before closure (8 patients) or after takedown (5 patients) of the loop ileostomy required operative correction in one patient in each group.
(C) 1994 Southern Medical Association
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12/31/1969 03:59 PM
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Colonic Pseudo-obstruction in Sickle Cell Disease
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A young Arab woman with sickle cell-[beta]0-thalassemia disease developed acute colonic pseudo-obstruction that became chronic but showed some response to hydroxyurea. There was no evidence of microvascular or macrovascular occlusion. We also report the case of an Arab man with sickle cell anemia who presented with acute colonic pseudo-obstruction from which he recovered completely within a few days. Although the development of pseudo-obstruction in these two cases seems to have been a complication of sickle cell anemia, its pathogenesis remains unclear. There are several reports of ischemic and inflammatory disorders of the colon complicating sickle cell disease; however, these two cases represent the first descriptions of large-bowel pseudo-obstruction in this hemoglobinopathy.
(C) 2003 Southern Medical Association
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12/31/1969 03:59 PM
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Intestinal Necrosis due to Sodium Polystyrene Sulfonate (Kayexalate) in Sorbitol
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Background: Sodium polystyrene sulfonate (SPS, Kayexalate) has been implicated in the development of intestinal necrosis. Sorbitol, added as a cathartic agent, may be primarily responsible. Previous studies have documented bowel necrosis primarily in postoperative, dialysis, and transplant patients. We sought to identify additional clinical characteristics among patients with probable SPS-induced intestinal necrosis.
Methods: Rhode Island Hospital surgical pathology records were reviewed to identify all gastrointestinal specimens reported as containing SPS crystals from December 1998 to June 2007. Patient demographics, medical comorbidities, and hospital courses of histologically verified cases of intestinal necrosis were extracted from the medical records.
Results: Twenty-nine patients with reports of SPS crystals were identified. Nine cases were excluded as incidental findings with normal mucosa. Nine patients were excluded as their symptoms began before SPS administration or because an alternate etiology for bowel ischemia was identified. Eleven patients had confirmed intestinal necrosis and a temporal relationship with SPS administration suggestive of SPS-induced necrosis. Only 2 patients were postoperative, and only 4 had end-stage renal disease (ESRD). All patients had documented hyperkalemia, received oral SPS, and developed symptoms of intestinal injury between 3 hours and 11 days after SPS administration. Four patients died.
Conclusion: Intestinal ischemia is a recognized risk of SPS in sorbitol. Our series highlights that patients may be susceptible even in the absence of ESRD, surgical intervention, or significant comorbidity.
(C) 2009 Southern Medical Association
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12/31/1969 03:59 PM
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Physical Activity Benefits and Risks on the Gastrointestinal System
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Abstract: This review evaluates the current understanding of the benefits and risks of physical activity and exercise on the gastrointestinal system. A significant portion of endurance athletes are affected by gastrointestinal symptoms, but most symptoms are transient and do not have long-term consequences. Conversely, physical activity may have a protective effect on the gastrointestinal system. There is convincing evidence that physical activity reduces the risk of colon cancer. The evidence is less convincing for gastric and pancreatic cancers, gastroesophageal reflux disease, peptic ulcer disease, nonalcoholic fatty liver disease, cholelithiasis, diverticular disease, irritable bowel syndrome, and constipation. Physical activity may reduce the risk of gastrointestinal bleeding and inflammatory bowel disease, although this has not been proven unequivocally. This article provides a critical review of the evidence-based literature concerning exercise and physical activity effects on the gastrointestinal system and provides physicians with a better understanding of the evidence behind exercise prescriptions for patients with gastrointestinal disorders. Well-designed prospective randomized trials evaluating the risks and benefits of exercise and physical activity on gastrointestinal disorders are recommended for future research.
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12/31/1969 03:59 PM
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Pneumocystis carinii jiroveci Pneumonia Following Infliximab Infusion for Crohn Disease: Emphasis on Prophylaxis
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Pneumocystis carinii jiroveci Pneumonia Following Infliximab Infusion for Crohn Disease: Emphasis on Prophylaxis. Wright State University School of Medicine, Miami Valley Hospital, Medical Surgical
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12/31/1969 03:59 PM
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Microscopic Polyangiitis Presenting with Liver Dysfunction Preceding Rapidly Progressive Necrotizing Glomerulonephritis
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The authors describe a 52-year-old woman diagnosed with microscopic polyangiitis. She presented with abnormal liver function tests accompanied by fever, headache, and fatigue. Two months later, rapidly progressive necrotizing glomerulonephritis developed together with seropositivity for perinuclear antineutrophil cytoplasmic antibody. Although liver dysfunction from microscopic polyangiitis is very rare, especially at presentation, this diagnostic possibility should be kept in mind to permit prompt consideration of steroid therapy.
(C) 2004 Southern Medical Association
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12/31/1969 03:59 PM
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Cytomegalovirus Enteritis in Common Variable Immunodeficiency
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A woman with previously undiagnosed common variable immunodeficiency presented with diarrhea and volume depletion. Biopsies from upper and lower endoscopy revealed atrophic gastritis, villous atrophy, and an inflammatory bowel disease-like chronic colitis, with absence of plasma cells in all sites. Cytomegalovirus inclusions were demonstrated in the colon and small bowel mucosa. Despite therapy with intravenous immunoglobulin and ganciclovir, the patient deteriorated rapidly and subsequently died. This case report highlights the potential for cytomegalovirus to cause extensive disease in patients with common variable immunodeficiency and, thus, the importance of considering it in the initial differential diagnosis so that further morbidity and mortality might be prevented.
(C) 2004 Southern Medical Association
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12/31/1969 03:59 PM
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Diagnosing Irritable Bowel Syndrome: A Changing Clinical Paradigm
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Rather than being a diagnosis of exclusion, irritable bowel syndrome (IBS) is a diagnosis that can be identified by symptom-based criteria. The collection of these criteria by a meticulous history can be enhanced by using various tools. Once a positive diagnosis is made, using clinical criteria for diagnosis, one should look for alarm or warning symptoms or signs, and should characterize the type of bowel habit. Determining whether the condition is a diarrhea-predominant or a constipation-predominant IBS will direct further diagnostic evaluation and management.
Key Points
* IBS is diagnosed by symptom-based clinical criteria.
* A positive diagnosis using clinical criteria can avoid exhaustive diagnostic testing.
* Characterizing the bowel habit as diarrhea- or constipation-predominant will direct further diagnostic evaluation and management.
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12/31/1969 03:59 PM
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Colorectal Cancer Screening: Today and Tomorrow
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Colorectal cancer remains a disease with significant morbidity and mortality. However, the prognosis can be greatly improved with early detection. Here, we review the current screening modalities and guidelines for patients at average, moderate, and high risk for colorectal cancer. New experimental modalities are also introduced.
(C) 2006 Southern Medical Association
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12/31/1969 03:59 PM
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Emphysematous Cystitis in the Absence of Known Risk Factors: An Unusual Clinical Entity
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Emphysematous cystitis is a rare disorder that is usually associated with immunosuppression, poorly controlled diabetes mellitus, and other risk factors such as previous urinary tract infection and/or recent instrumentation of the urinary tract. The case of an 89-year-old woman with emphysematous cystitis who had no evidence of immunodeficiency or other risk factors except for advanced age is reported. A review of the literature on emphysematous cystitis in immunocompetent, nondiabetic individuals is presented.
(C) 2009 Southern Medical Association
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12/31/1969 03:59 PM
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Kounis Syndrome
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The association between acute coronary events and acute allergic reactions has been recognized for several years. The first reported case occurred in 1950, during an allergic reaction to penicillin. In 1991, Kounis and Zavras described the syndrome of allergic angina and allergic myocardial infarction, currently known as Kounis syndrome. Two subtypes have been described: type I, which occurs in patients without predisposing factors for coronary artery disease and is caused by coronary artery spasm, and type II, which occurs in patients with angiographic evidence of coronary disease when the allergic events induce plaque erosion or rupture. This syndrome has been reported in association with a variety of medical conditions, environmental exposures, and medication exposures. Entities such as Takotsubo cardiomyopathy, drug-eluted stent thrombosis, and coronary allograft vasculopathy appear to be associated with this syndrome. In this review, we discuss the pathobiology, clinical features, associated entities, and management of Kounis syndrome.
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12/31/1969 03:59 PM
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Wegener Granulomatosis: A Case Report and Update
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Wegener granulomatosis (WG) is a systemic disease of unknown etiology characterized by necrotizing granulomatous inflammation, tissue necrosis, and variable degrees of vasculitis in small and medium-sized blood vessels. The classic clinical pattern is a triad involving the upper airways, lungs and kidneys. Ninety percent of patients present with symptoms involving the upper and/or lower airways, and 80% will eventually develop renal disease. WG should be suspected in any patient with progressive or unresponsive sinus disease, glomerulonephritis, pulmonary hemorrhage, mononeuritis multiplex or unexplained multisystem disease. Before the routine use of glucocorticoids and cyclophosphamide, the one year mortality was 82%. However in 1973, Fauci and Wolf discovered that daily prednisone and cyclophosphamide induced complete remission in 75% of patients. The continued use of prednisone and cyclophosphamide for 1 year past remission leads to marked improvement in more than 90% of patients; however, is also associated with serious toxicities. Depending on the disease severity, current treatments employ induction with short-term cyclophosphamide followed by less toxic agents such as methotrexate to maintain disease remission. Although it is a rare disorder, it is pertinent to internists because it is a multisystem disease that presents in a variety of ways. We describe a 63-year-old white male with WG who presented with progressively worsening headaches, bilateral eye redness, epistaxis, hemoptysis and an unintentional 20 pound weight loss, and review the current treatment recommendations.
(C) 2006 Southern Medical Association
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12/31/1969 03:59 PM
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Small Bowel Capsule Endoscopy: A Systematic Review
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Wireless capsule endoscopy offers a revolutionary diagnostic tool for small bowel diseases. Since its formal introduction, it has become an integral part of the diagnostic evaluation for obscure gastrointestinal bleeding. This relatively noninvasive imaging modality offered by small bowel capsule endoscopy is appealing to both patients and providers and consequently, the desire to expand its diagnostic role continues to grow. The use of CE in the diagnosis of Crohn disease and chronic diarrhea is being further investigated, as is the potential of employing this technique as a cancer surveillance mechanism in patients with hereditary polyposis syndromes which may involve the small bowel. This review article discusses the current indications for small bowel capsule endoscopy, the results of capsule endoscopy in patients with obscure gastrointestinal bleeding and small bowel diseases, and patient outcomes following capsule endoscopy. Capsule endoscopy is compared with traditional diagnostic modalities, including small bowel series, enteroclysis, CT, and push enteroscopy. Small bowel capsule endoscopy is the procedure of choice to evaluate obscure gastrointestinal bleeding, and is superior to radiographic procedures in detecting Crohn disease of the small bowel.
(C) 2007 Southern Medical Association
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