FBO and fructose malabsorption
Posted 13 November 2009 - 06:37 AM
Posted 13 November 2009 - 06:48 AM
Ph.D in Biology
Posted 13 November 2009 - 12:30 PM
Posted 14 November 2009 - 11:12 AM
Fecal incontinencePathophysiology and etiologyPartial incontinence ‚€“ loss of control to flatus and minor soiling Major incontinence ‚€“ frequent and regular deficiency in the ability to control stool of normal consistencyFour basic physiologic factors:1.stool consistency, 2.rectal compliance,3.rectal and anal sensation4.pelvic floor function can lead to a defective continencemechanismIncontinence with normal pelvic floorfunction:-1-Altered stool consistency‚€ĘInflammatory bowel disease‚€ĘInfectious diarrhea‚€ĘLaxative abuse‚€ĘRadiation enteritis‚€ĘShort bowel syndrome‚€ĘMalabsorption syndrome2-Inadequate rectal compliance ‚€ĘInflammatory boweldisease‚€ĘAbsent rectal reservoir (ileoanal, low ant. resection)‚€ĘRectal ischemia‚€ĘCollagen vascular disease (scleroderma, amyloidosis, dermatomyositis)‚€ĘRectal neoplasms3-Inadequate rectal sensation‚€ĘDementia, CVA, MS, brain or spinal cord injury/neoplasm, sensoryneuropathy, tabes dorsalis ‚€ĘOverflow incontinence:-Fecal impaction ‚€“ leading cause of incontinence in institutionalizedelderly patients‚€ĘDiabetes ‚€“ multifactorial, impaired rectal sensation is importantIncontinence with abnormal pelvic floorfunctionAnatomic sphincter defect ‚€“ internal or externalTraumaticObstetric injury ‚€“ prolonged difficult labor with forceps application,episiotomy complications, third or fourth-degree lacerationsAnorectal surgery ‚€“ anal fistula surgery - most common operativeprocedure that results in fecal incontinence; hemorrhoidectomyPelvic floor denervation ‚€“ degenerative neurogenicfactors are a common cause of non-surgically relatedincontinence1-Primary (idiopathic neurogenic incontinence)a-Pudendal neuropathy ‚€“ 80%. Denervation of the puborectalis muscle andexternal anal sphincter muscles ‚€“ results in an impaired ability tomaintain the anorectal angle and prevent gross incontinenceb-‚€œDescending perineal syndrome‚€Ě‚€“ results from constant strainingduring defecation that causes a traction neuropathy of the nervesrunning along the pelvic floor muscles. Both the puborectalis andexternal anal sphincter muscles become denervatedc-Vaginal deliveries2-Secondary:-1.Injuries to spinal cord, cauda equina2.Diabetic neuropathyCongenital abnornmalities:-‚€ĘSpina bifida‚€ĘMyelomeningoceleMiscellaneous
TreatmentImproving stool consistency:-Increase intake of bulking agents ‚€“ bran, psylliumAntidiarrheal agents ‚€“ loperamide, lomotil, cholestyramineBowel management:-‚€ĘFecal disimpaction‚€ĘScheduled toileting‚€ĘGlycerin suppositories daily, 30 min postprandial‚€ĘAttempt to defecate at the same time daily‚€ĘDaily tap water enemaBiofeedback therapyPatients looks at a polygraph tracing while attempting to contract theexternal anal sphincterThrough visual ‚€œfeedback‚€Ě of looking at anal canal pressures duringcontraction and verbal guidance, patients can learn to appropriatelycontract the external sphincter in response to the sensation of rectaldistension70% restoring continence 90% reduction in incontinent episodesSurgery....................
- Rectal prolapse ‚€“ 60-70% incontinence.
- Aging ‚€“ anal canalpressure and rectal compliance are decreased
- Diagnostic evaluation