P035 adjunct pharmacotherapy use for pouch-related symptoms in patients with ileal pouch-anal anastomosis
For patients with recalcitrant ulcerative colitis or indeterminate colitis, surgical intervention with restorative proctocolectomy and ileal pouch-anal anastomosis (IPAA) has become the standard of therapy. The most common complication after IPAA is pouchitis, which may manifest with pouch related symptoms (PRS) such as increased bowel frequency, abdominal pain, pelvic pain, urgency, or incontinence, necessitating use of adjunctive pharmacotherapies for symptom control. We evaluated the prevalence of opioid-, NSAID-, and probiotic-use among IPAA patients with and without PRS.
Atypical chest pain is of diverse origin. Typically, we initially consider cardiac etiology. When pain appears non-cardiac, there is a tendency to underestimate the illness, especially if the patient has neuropsychiatric illness. Our resident with dementia and anxiety disorder had chest pain; the diagnosis was unexpected.
Chronic pain is common among older adults, as is the use of medications to treat these symptoms. Aging physiology, in combination with a higher likelihood of medication use and declining renal function, makes older adults more susceptible to adverse drug effects. As such, monitoring for side effects and changes in renal function is important to avoid drug toxicity, especially during acute illness when medication errors and acute changes in renal function are more likely to occur among older adults.
Many patients are discharged to post-acute care facilities (PACFs) following surgery. These patients have either had major surgery and require close monitoring and intensive rehabilitation, or have significant medical co-morbidities. Currently they are transported, sometimes at considerable cost, to the surgeon ’s office for post-surgery visits (PSVs). These trips can be painful and uncomfortable. A staff member from the PACF may need to accompany the patient. During PSVs surgeons observe the patient's incision(s), and assess potential complications following surgery, pain, and functional recovery.
ConclusionFissurectomy with posterior midline internal sphincterotomy and mucosal anoplasty is safe with minimal complications. It is still a dependable alternative treatment for chronic posterior anal fissures. The fear of keyhole deformity can be well addressed with the added anoplasty.
ConclusionFissurectomy with posterior mid line internal sphincterotomy and mucosal anoplasty is safe with minimal complications. It is still a dependable alternative treatment for chronic posterior anal fissures. The fear of keyhole deformity can be well addressed with the added anoplasty.
Abstract Inflammatory bowel diseases (IBD), Crohn`s disease and ulcerative colitis, are chronic conditions associated with high morbidity and healthcare costs. The natural history of IBD is variable and marked by alternating periods of flare and remission. Even though the use of newer therapeutic targets has been associated with higher rates of mucosal healing, a great proportion of IBD patients remain symptomatic despite effective control of inflammation. These symptoms may include but not limited to abdominal pain, dyspepsia, diarrhea, urgency, fecal incontinence, constipation or bloating. In this setting, commo...
CONCLUSION: Ulcerative colitis presented a high frequency of intestinal symptoms, and Crohn ’ s disease showed a high frequency of systemic manifestations at the onset of manifestation. There was a long delay in diagnosis, but individuals with more extensive disease and more obvious symptoms showed a shorter delay.RESUMO CONTEXTO: O diagn óstico da doença inflamatória intestinal é frequentemente retardado pela falta de capacidade para reconhecer as suas principais manifestações clínicas. OBJETIVO: Nosso estudo teve como objetivo descrever as manifestações...
Summary BackgroundPatient reported outcomes regarding perianal disease and faecal incontinence in the community‐based inflammatory bowel disease population are poorly described. AimsTo determine the impacts of perianal disease and faecal incontinence on quality of life and employment in inflammatory bowel disease patients. MethodsFor this cross‐sectional study, a comprehensive survey was sent out to members of the Dutch National Crohn's and Colitis patient organisation. Validated questionnaires regarding faecal incontinence and active perianal disease were used to estimate its prevalence's. The effect on the quality of...
Conclusions:These cases highlight the varied presentations of Coccidioidomycosis related mass lesions in the CNS, as well as the importance of remaining vigilant of these complications in patients already on azole therapy for Coccidioides meningitis.Disclosure: Dr. Chiang has nothing to disclose. Dr. Okazaki has nothing to disclose. Dr. Asbury has nothing to disclose. Dr. Blair has nothing to disclose. Dr. Vikram has nothing to disclose. Dr. Grill has nothing to disclose.
ConclusionDefaecating pouchography may be useful to identify anismus and pelvic floor disorders in pouch patients who have symptoms of straining, anal pain or incontinence. In patients with a high frequency of defaecation and abdominal pain it does not provide clinically meaningful information. Patients who complain of straining, incontinence, anal pain or urgency and have anismus or pelvic floor disorders may benefit from behavioural therapy.This article is protected by copyright. All rights reserved.