Ileum Health Dictionary

The operation by which an arti?cial opening is made into the ILEUM and brought through the abdominal wall to create an arti?cial opening or STOMA. It is most often performed as part of the operation for cancer of the RECTUM, in which the rectum has usually to be removed. An ileostomy is then performed which acts as an arti?cial anus, to which a bag is attached to collect the waste matter. Distressing though this may at ?rst be, the vast majority of people with an ileostomy learn to lead a fully active and normal life. Help and advice in adjusting to what can be described as an ‘ileostomy life’ can be obtained from the Ileostomy and Internal Pouch Support Group.... ileostomy

All the alimentary canal beyond below the stomach. In it, most DIGESTION is carried on, and through its walls all the food material is absorbed into the blood and lymph streams. The length of the intestine in humans is about 8·5–9 metres (28–30 feet), and it takes the form of one continuous tube suspended in loops in the abdominal cavity.

Divisions The intestine is divided into small intestine and large intestine. The former extends from the stomach onwards for 6·5 metres (22 feet) or thereabouts. The large intestine is the second part of the tube, and though shorter (about 1·8 metres [6 feet] long) is much wider than the small intestine. The latter is divided rather arbitrarily into three parts: the duodenum, consisting of the ?rst 25–30 cm (10–12 inches), into which the ducts of the liver and pancreas open; the jejunum, comprising the next 2·4–2·7 metres (8–9 feet); and ?nally the ileum, which at its lower end opens into the large intestine.

The large intestine begins in the lower part of the abdomen on the right side. The ?rst part is known as the caecum, and into this opens the appendix vermiformis. The appendix is a small tube, closed at one end and about the thickness of a pencil, anything from 2 to 20 cm (average 9 cm) in length, which has much the same structure as the rest of the intestine. (See APPENDICITIS.) The caecum continues into the colon. This is subdivided into: the ascending colon which ascends through the right ?ank to beneath the liver; the transverse colon which crosses the upper part of the abdomen to the left side; and the descending colon which bends downwards through the left ?ank into the pelvis where it becomes the sigmoid colon. The last part of the large intestine is known as the rectum, which passes straight down through the back part of the pelvis, to open to the exterior through the anus.

Structure The intestine, both small and large, consists of four coats, which vary slightly in structure and arrangement at di?erent points but are broadly the same throughout the entire length of the bowel. On the inner surface there is a mucous membrane; outside this is a loose submucous coat, in which blood vessels run; next comes a muscular coat in two layers; and ?nally a tough, thin peritoneal membrane. MUCOUS COAT The interior of the bowel is completely lined by a single layer of pillar-like cells placed side by side. The surface is increased by countless ridges with deep furrows thickly studded with short hair-like processes called villi. As blood and lymph vessels run up to the end of these villi, the digested food passing slowly down the intestine is brought into close relation with the blood circulation. Between the bases of the villi are little openings, each of which leads into a simple, tubular gland which produces a digestive ?uid. In the small and large intestines, many cells are devoted to the production of mucus for lubricating the passage of the food. A large number of minute masses, called lymph follicles, similar in structure to the tonsils are scattered over the inner surface of the intestine. The large intestine is bare both of ridges and of villi. SUBMUCOUS COAT Loose connective tissue which allows the mucous membrane to play freely over the muscular coat. The blood vessels and lymphatic vessels which absorb the food in the villi pour their contents into a network of large vessels lying in this coat. MUSCULAR COAT The muscle in the small intestine is arranged in two layers, in the outer of which all the ?bres run lengthwise with the bowel, whilst in the inner they pass circularly round it. PERITONEAL COAT This forms the outer covering for almost the whole intestine except parts of the duodenum and of the large intestine. It is a tough, ?brous membrane, covered upon its outer surface with a smooth layer of cells.... intestine

Chronic inflammation and ulceration of the gut, especially the terminal ileum from changes in the gut blood vessels. Commences with ulceration which deepens, becomes fibrotic and leads to stricture. Defective immune system. Resistance low. May be associated with eye conditions and Vitamin B12 deficiency.

Symptoms: malaise, bloody alternating diarrhoea and constipation; right side colicky abdominal pain worse after meals; flatulence, loss of weight and appetite. Intestinal obstruction can usually be palpated. Blood count. A blood count high in whites indicates an abscess – a serious condition which may require surgical repair during which segments of the gut may have to be removed. Malignant change rare. Differential diagnosis. Ulcerative colitis, appendicitis, appendix abscess, irritable bowel syndrome.

Cracks or ulcers at corners of the mouth may be a good marker of Crohn’s Disease.

Treatment. Select one of the following. Herbal treatment offers a safe alternative to steroids by inducing remission in acute exacerbation. Good responses have been observed from the anti-bacterials Wild Yam and Goldenseal. Fenugreek seeds are of special value. Comfrey (tissue regeneration). Irish Moss.

Teas: Chamomile, Comfrey leaves, Hops, Marshmallow leaves, Meadowsweet, Shepherd’s Purse (Dr A. Vogel), Lobelia. Silverweed and Cranesbill are excellent for internal bleeding; Poke root for intestinal ulceration.

Decoction. Fenugreek seeds: 2 teaspoons to large cup water simmered gently 10 minutes. 1 cup freely. The seeds also should be consumed.

Tablets/capsules. Wild Yam, Fenugreek, Ginger, Goldenseal, Lobelia, Slippery Elm.

Powders. Formula. Wild Yam 2; Meadowsweet 2; Goldenseal 1. Dose: 500mg (two 00 capsules or one- third teaspoon) thrice daily.

Liquid Extracts. (1) Formula. Wild Yam 1, Echinacea 2. 30-60 drops in water thrice daily. Or, (2) Formula: Turkey Rhubarb 2, Goldenseal 1, Caraway half. 20-30 drops in water thrice daily.

Tinctures. Formula. Bayberry 2, Goldenseal 1, Cardamoms 1. Dose: One to two 5ml teaspoons thrice daily.

Ispaghula seeds. 2-4 teaspoons thrice daily.

Tea Tree oil Suppositories. Insertion at night.

Diet. Bland, little fibre, Slippery Elm gruel. Irish Moss preparations. Increase fluid intake. Reject: broccoli, tomatoes, lima, Soya, Brussels sprouts, pinto beans, cocoa, chocolate, cow’s milk, peas, onions, turnips, radishes. Accept fish oils.

Addenbrookes Hospital, Cambridge. Reject foods containing wheat and all dairy produce.

Supplements. Vitamins A, B12, C, Calcium, Iron, Magnesium, Potassium, Zinc.

Study. In a study carried out by UK researchers (1993) food allergies were found to be the most common cause of the disease. Results suggested that dietary changes may be as effective as corticosteroids in easing symptoms. The most common allergens were corn, wheat, milk, yeast, egg, potato, rye, tea, coffee, apples, mushrooms, oats, chocolate. An elemental diet with a formula of nutrients (E028, produced by Hospital Supplies, Liverpool) was used in trials. (The Lancet, 6.11.1993)

Notes. Crohn’s Disease is associated with Erythema nodosum, more frequently recognised in childhood. A frequent cause is cow’s milk intolerance. Smoking adds to the risk of Crohn’s disease.

In susceptible people, the food additives titanium dioxide and aluminosilicates may evoke a latent inflammatory response resulting in Crohn’s disease, ulcerative colitis or bowel cancer. These chemicals may be found in the intestinal lymphoid aggregations in gut mucosa. (Jonathan Powell, Gastro-intestinal Laboratory, St Thomas’s Hospital, London) (Titanium dioxide rarely occurs naturally but is added to confectionery, drinking water and anti-caking agents.) ... crohn’s disease

Uptake by the body tissues of ?uids or other substances. For example, food is absorbed from the digestive tract into the blood and lymph systems. Food is absorbed mainly in the small INTESTINE (jejunum and ileum), which is lined by multiple villi that increase its surface area. (See also DIGESTION; ASSIMILATION.)... absorption

Also called regional enteritis or regional ileitis, this is a nonspecific inflammatory disease of the upper and lower intestine that forms granulated lesions. It is usually a chronic condition, with acute episodes of diarrhea, abdominal pain, loss of appetite, and loss of weight. It may affect the stomach or colon, but the most common sites are the duodenum and the lowest part of the small intestine, the lower ileum. The standard treatment is, initially, anti-inflammatory drugs, with surgical resectioning often necessary. The disease is autoimmune, and sufferers share the same tissue type (HLA-B27) as those who acquire ankylosing spondylitis.... crohn’s disease

In?ammation of the ileum – the lower part of the small INTESTINE. It may be caused by CROHN’S DISEASE, typhoid fever (see ENTERIC FEVER), TUBERCULOSIS or the bacterium Yersinia enterocolitica. Ileitis may also accompany ULCERATIVE COLITIS (see also INFLAMMATORY BOWEL DISEASE (IBD)).

Patients and their relatives can obtain help and guidance from the National Association for Colitis and Crohn’s Disease.... ileitis

The middle, coiled section of the small intestine, joining the duodenum to the ileum.

The jejunum’s function is the digestion of food and absorption of nutrients.

It may be affected by coeliac disease, Crohn’s disease, and lymphoma.... jejunum

Linn. var. himalaica (C. B. Clarke) Krishna and Badhwar

Family: Umbelliferae; Apiaceae.

Habitat: Native to Syria; now grown in Kashmir at 1,000-3,900 m.

Ayurvedic: Chandaa, Chandaam- shuka, Kathachoraa.

Action: Expectorant, carminative, digestant, cholagogue, antispas- modic, diaphoretic, diuretic, anti-inflammatory, smooth muscle relaxant, antifungal, antibacterial.

Key application: In flatulence and peptic discomforts. The root is a component in numerous gastrointestinal, cholagogue and biliary remedies in Germany. (Angelica root is an approved herb, whereas the seed and above-ground parts have been included among unapproved herbs by German Commission E.)

Chinese angelica root, Dong Quai, is equated with Angelica sinensis. It is prescribed internally for menstrual irregularity, lack of menstruation and painful menstruation.

The roots from Kashmir yield furo- coumarins, phenol compounds and flavonoids.

Xanthotoxol exhibited antihista- mintic and antinicotinic activities on guinea-pig ileum. The dry extract has been shown to have anti-inflammatory activity

The root is reported to inhibit bacterial and fungal growth.

Furocoumarins, especially psoralen and 8-methoxypsoralen, are used in the photochemotherapy of psoriasis and vitiligo. The biological activity is due to covalent linkage formed with DNA by irradiation with long- wavelength UV light.

Most of the coumarins have shown significant calcium antagonistic activity in vitro.

Angelicin, a resin, is stimulating to the lungs and skin. contraindicated in bleeding disorders, peptic ulcers and pregnancy. (Sharon M. Herr.)

Dosage: Root—1-3 g powder. (CCRAS.)... angelica archangelica

Linn.

Family: Palmae; Arecaceae.

Habitat: Native to Malaysia; now grown along the coasts of Karnataka, Kerala, Tamil Nadu, West Bengal, Assam and Maharashtra.

English: Arecanut, Betel Nut.

Ayurvedic: Puuga, Puugi, Kramuka, Ghontaa, Guwaak, Ghorant.

Unani: Fufal, Chhaalia, Supaari.

Siddha/Tamil: Kottai Paakku, Kamugu.

Action: Taeniacide (confined to veterinary medicine), astringent, stimulant.

Along with other therapeutic application, The Ayurvedic Pharmacopoeia of India indicates the use of dried ripe seed in leucorrhoea and vaginal laxity.

Arecanut contains several alkaloids belonging to pyridine group, the most important being arecoline (0.1-0.5%). Arecaidine, guvacine and isoguvacine are also present. Arecoline is an- thelmintic (in animals, not in humans). Arecaidine has no parasympa- thomimetic effects, but only stimulating properties; sedative in higher doses. Isoguvacine produces hypotension.

Contraindicated in asthma due to bronchoconstrictive effects of the alkaloid arecoline (human case reports). (Francis Brinker.)

Arecanut tannins (8.0-18.0%) are predominantly catechol tannins which closely resemble Mimosa bark tannins. Powdered nuts are prescribed in diarrhoea and urinary disorders. In combination with other astringent and styptic herbs, arecanut is used as a major constituent in confections of Indian medicine for gynaecological disorders.

Aqueous extract of the nut exhibits direct vasoconstriction and adrenaline potentiation in rats. Antimicrobial activity is due to polyphenolic fraction. Tannins potentiated the action of acetylcholine in ileum and uterus of rat and noradrenaline on seminal vesicle at low concentration.

Due to increased incidence of oral cancer associated with betel chewing, the use of arecanut as a masticatory is being discouraged.

Seeds are toxic at 8-10 g, fluid extract at 3.7 ml; and arecoline hydrobromide at 4.3-6.5 mg. (Francis Brinker.)

Dosage: Dried ripe fruit—1-2 g powder. (API Vol. I.)... areca catechu

Pertaining to both the last section of the small intestine (the ileum) and the beginning of the large intestines, the ascending colon or cecum. EXAMPLE: Ileocecal valve... ileocecal

Lam.

Synonym: A. bracteata Retz.

Family: Aristolochiaceae.

Habitat: Uttar Pradesh, Bengal, Madhya Pradesh and western peninsular India.

English: Bracteated Birthwort.

Ayurvedic: Kitamaari, Dhumrapa- traa, Naakuli.

Unani: Kiraamaar.

Siddha/Tamil: Aadutheendaappaalai, Kattusuragam.

Action: Oxytocic, abortifacient, emmenagogue.

Leaves and fruit contain ceryl alcohol, aristolochic acid and beta-sitos- terol. Aristolochic acid is insecticidal, poisonous, nephrotoxic. Leaf juice— vermifuge. Seeds—strong purgative. Products containing aristolochic acid are banned in the U.S., Canada, Great Britain, European countries and Japan.

The seed compounds, aristolochic acid and magnoflorine, induce contractions in the isolated uterus of pregnant rat and stimulate the isolated ileum of guinea pig. They also activate the muscarinic and serotoner- gic receptors in a variety of organs. Magnoflorine decreases arterial blood pressure in rabbits, and induces hypothermia in mice.

See also A. longa.... aristolochia bracteolata

Linn.

Family: Sapindaceae.

Habitat: Throughout the plains of India, as a wild climber.

English: Ballon Vine, Winter Cherry, Heartseed.

Ayurvedic: Kaakatiktaa, Kaakaadani, Karnsphotaa, Shatakratulataa.

Unani: Habb-e-Qilqil.

Siddha/Tamil: Mudukottan, Kottavan.

Folk: Kanphotaa, Kanphuti, Lataaphatakari. Used as Jyotishmati in Bengal.

Action: Used in rheumatism, lumbago, skeletal fractures, nervous diseases, amenorrhoea, haemorrhoids, erysipelas. The herb is used in hairoils for treating dandruff, alopecia and for darkening hair.

The plant extract showed significant analgesic and anti-inflammatory activity and sedative effect on CNS. The drug also showed (transient) vasode- pressant activity.

The leaves contain beta-sitosterol and its D-glucoside, an alkaloid, oxalic acid and amino acids. The presence of a saponin and quebrachitol is reported in the plant.

The leaves and stem are used in preparations used against common cold. Alcoholic extract of the plant exhibits antisickling and antiarthritic activity. Seeds have positive anabolic activity and increase body weight by inducing a positive nitrogen balance.

The alkaloid fraction from the seeds showed hypotensive activities and cardiac inhibition in anaesthetized dogs; blocked spasmogenic effects of acetyl- choline, histamine and 5-HT on guinea pig ileum, biphasic effort on frog rec- tus abdominis muscle. The seeds also showed antibacterial activity.

Dosage: Whole plant—50-100 ml decoction. (CCRAS.)... cardiospermum halicacabum

Linn.

Family: Caricaceae.

Habitat: Native to West Indies and Central America; now cultivated in Uttar Pradesh, Punjab, Rajasthan, Gujarat, Maharashtra and South India.

English: Papaya, Papaw.

Ayurvedic: Erand-karkati, Papitaa.

Unani: Papitaa Desi.

Siddha/Tamil: Pappaali, Pappayi.

Action: Ripe fruit—stomachic, digestive, carminative, diuretic, galactagogue. Useful in bleeding piles, haemoptysis, dysentery and chronic diarrhoea. Seeds— emmengagogue, abortifacient, vermifuge. Juice of seeds is administered in enlarged liver and spleen, and in bleeding piles.

Key application: Papain, the enzyme mixture extracted from raw papain (latex of Carica papaya), has been included among unapproved herbs by German Commission E. Experiment-based as well as clinical research indicate that papain may be effective (in the treatment of inflammations) in high doses (daily dose 1500 mg corresponding to 2520 FIP units).

Unripe fruit—emmengagogue and abortifacient. Latex—applied topically on eczema, ringworm, psoriasis, corns, warts, sloughing wounds, carbuncles and eschar of burns.

Green parts of the plant and seed contain an alkaloid carpaine. Seeds also contain carpasemine.

Latex contain enzymes—papain and chymopapain and alkaloids carpaine and pseudocarpaine. A proteinaceous material from latex showed anticoagulant activity; in higher doses it is heart depressant and as a spasmogen on smooth muscle of guinea pig ileum. An alkaloid solution showed depressant action on heart, blood pressure and intestine.

The anthelmintic action of seeds against Ascaris lumbricoides is due to carpasemine.

Papain, an enzyme mixture prepared from the fruit, seeds and leaf, hydrolyses polypeptides, amides and esters, particularly when used in an alkaline environment, and is used in digestive disorders.

Papain inhibits platelet aggregation, which may further increase the risk of bleeding in patients also taking anticoagulants. Concurrent administration of cyclophosphamide with papain caused sever damage to lung tissues in rats. (Sharon M. Herr.)

Chymopapin C is an immunosup- pressive enzyme from plant extract. Carpaine, extracted from the plant, exhibited anti-tubercular activity, also antitumour in vitro, and hypotensive.

Dosage: Leaf—40-80 ml infusion; latex—3-6 g (CCRAS.)... carica papaya

Improper utilization of needed and available nutrients, either from impaired digestive function (such as B12 being unabsorbed because of gastritis), impaired absorption (poor Vitamin E absorption because of an inflamed ileum) or impaired transport (the diminished blood proteins of the advanced alcoholic). There are other causes as well, but you get the idea.... malabsorption

Peyer’s patches are conglomerations of lymphoid nodules in the ileum, or lower part of the small INTESTINE. They play an important part in the defence of the body against bacterial invasion, as in typhoid fever (see ENTERIC FEVER).... peyer’s patches

(Linn.) Moon.

Family: Verbenaceae.

Habitat: A shrub distributed throughout the country, especially common in Assam and Bengal.

English: Blue-flowered Glory tree, Beetle Killer.

Ayurvedic: Bhaargi, Bhaaran- gi, Angaarvalli, Phanji, Braah- manyashtikaa, Kharshaak, Padma, Bhragubhavaa, Brahmayashtikaa.

Siddha/Tamil: Kandoorbarangi (root), cherutekku.

Action: Root—Antiasthmatic, antihistaminic, antispasmodic, antitussive carminative, febrifuge. Leaf—febrifuge.

The Ayurvedic Pharmacopoeia of India indicated the use of the dried roots in cough, bronchitis, dyspnoea, chest diseases and sinusitis.

The bark contains triterpenoids— serratagenic, oleanolic and queretaric acids; leaves contain alpha-spinasterol and flavonoids, including luteolin, api- genin, baicalein, scutellarein, phenolic acids—caffeic and ferulic acids.

EtOH (50%) extract of the plant exhibited hypotensive and spasmolytic activity. Polyhydric property on isolated guinea pig ileum. Antiasthmatic effect was also observed pharmacologically.

Dosage: Root—3-6 g powder; 1020 g for decoction. (API Vol. III.)... clerodendrum serratum

Lam.

Family: Tiliaceae.

Habitat: Throughout warmer parts of India.

Ayurvedic: Chanchuka, Chanchu.

Folk: Chanchu shaaka, Baaphali.

Action: Astringent, spasmolytic, restorative, mucilaginous.

The plant contains betulinic acid and beta-sitosterol. Seeds yield cardeno- lides including trilocularin. The glyco- sides of the plant were found to be devoid of any effect of its own on smooth muscle of guinea pig ileum, but produced spasmolytic effect against acetyl- choline, histamine and bradykinin. Direct action of the drug was observed on rabbit intestines. Slight cardiac depressant effect was found on isolated amphibian heart preparation.

Corchorus depressus (L.) Christensen, found in drier parts of North India, is known as Bhauphali (Delhi).

The Plant is used as a cooling medicine in fevers; its mucilage is prescribed in gonorrhoea, also for increasing the viscosity of seminal fluid. An extract of the plant is applied as a paste to wounds.

The plant contains alpha-amyrin derivatives, together with apigenin, luteolin, sitosterol and its glucoside. Presence of quercetin and kaempferol has been reported in leaves and flowers.

The plant exhibits antimicrobial and antipyretic activities.... corchorus fascicularis

(Koenig) Sm.

Family: Zingiberaceae.

Habitat: Assam, North Bengal, Khasi and Jaintia Hills, sub Himalayan tracts of Uttar Pradesh and Himachal Pradesh and Western Ghats.

English: Canereed, Wild Ginger.

Ayurvedic: Kebuka, Kembuka.

Siddha/Tamil: Krrauvam, Malai Vasambu, Ven Kottam.

Folk: Kebu.

Action: Astringent, purgative, depurative, anti-inflammatory (used in gout, rheumatism; bronchitis, asthma, catarrhal fevers, dysuria), anthelmintic, antivermin, maggoticide, antifungal.

The rhizomes contain saponins— dioscin, gracillin and beta-sitosterol- beta-D-glucoside. The alkaloids show papaverine-like smooth-muscle-relaxant activity, cardiotonic activity like that of digitalis and antispasmodic,

CNS-depressant, diuretic and hydro- choleretic activities. Saponins show significant anti-inflammatory and an- tiarthritic activity.

The seeds also contain saponins and exhibit potent and sustained hypoten- sive and bradycardiac activities in dogs with low toxicity and without any haemolytic activity; also weak spasmolytic activity on isolated guinea-pig ileum.

All parts of the plant yield steroidal sapogenin, diogenin (quantity varies from 0.32 to 4%).

(Not to be confused with Kushtha of Indian medicine, Saussurea lappa.)... costus speciosus

Linn.

Family: Euphorbiaceae.

Habitat: Throughout drier parts of India.

Unani: Kanochaa, Isfahaan Marv.

Siddha/Tamil: Mela-nelli.

Action: Leaves—an infusion is used in headache. Seeds—carminative, diuretic.

Whole plant revealed antispasmod- ic action in isolated guinea-pig ileum, CNS depressant and hypothermic effects in mice.... phyllanthus maderaspatensis

A small, narrow tube that projects out of the caecum (the 1st part of the colon) at the lower right-hand side of the abdomen. It may lie behind or below the caecum, or in front of or behind the ileum (part of the small intestine). The appendix has no known function, but it contains a large amount of lymphoid tissue which provides a

defence against local infection. The position of an individual’s appendix partly determines the set of symptoms produced by acute appendicitis (inflammation of the appendix).... appendix

The first section of the large intestine, joining the ileum (the end of the small intestine) to the colon. The appendix projects from the caecum.

(See also digestive system).... caecum

(ileo-) combining form denoting the ileum. Examples: ileocaecal (relating to the ileum and caecum); ileocolic (relating to the ileum and colon).... ile

Lindl.

Family Rosaceae.

Habitat: Native to China; now cultivated mainly in Saharanpur, Dehradun, Muzaffarnagar, Meerut, Kanpur, Bareilly districts of Uttar Pradesh, Amritsar, Gurdaspur and Hoshiarpur districts of Punjab.

English: Loquat, Japanese Medlar.

Ayurvedic: Lottaaka (non-classical).

Unani: Lokaat.

Siddha: Ilakotta, Nokkotta (Tamil).

Action: Leaves—used in China and India for the treatment of diabetes mellitus and skin diseases. Fruit— sedative, antiemetic. Flower— expectorant.

The plant contains lipopolysaccha- rides (LPS), which exhibit antirheu- matic activity. LPS is also found useful for treating diabetes mellitus and lowering high cholesterol level. The ethanolic extract of the leaves showed anti-inflammatory activity on carra- geenan-induced oedema in rats and significant hypoglycaemic effect in normal rabbits like the standard drug tolbutamide. The sesquiterpene gly- coside and polyhydroxylated triterpe- noids showed a marked inhibition of glycosuria in genetically diabetic mice; also reduced blood glucose level in nor- moglycaemic rats. The hypoglycaemic effect is mediated through the release of insulin from pancreatic beta cells.

The leaves gave ionone-derived gly- cosides and triterpenes. Maslinic and ursolic acids have also been isolated. Maslinic acid possesses significant anti-inflammatory activity. It also exhibits inhibitory effect on histamine- induced contraction in isolated ileum of guinea pig.

Hot aqueous extract of the leaves showed hepatoprotective activity experimentally.

The leaves yield an essential oil containing nerolidol (61-74%).

The presence of an antifungal compound, eriobofuran, is also reported.

The methanolic extract of the plant exhibits antioxidant and radical scavenging activity.... eriobotrya japonica

Linn.

Synonym: E. pilulifera auct. non Linn.

Family: Euphorbiaceae.

Habitat: Throughout warmer regions of India.

English: Euphorbia, Australian Asthma Weed, Pill-bearing Spurge.

Ayurvedic: Dudhi, Dudhikaa, Naagaarjuni, Vikshirini.

Unani: Dudhi Khurd.

Siddha/Tamil: Amman pachharisi.

Action: Pectoral, antiasthmatic, antispasmodic. Used for asthma, laryngitis, chronic nasal and bronchial catarrh; diarrhoea, dysentery, intestinal parasitosis Also used in postnatal complaints, failure of lactation. Latex— vermifuge. Used in diseases of urinogenitory tract.

The herb contains several terpenes, anthocyanins, alcohols and steroids. Aerial parts also gave shikimic acid, choline, L-inositol and free sugars.

Antiasthmatic activity is attributed to choline and shikimic acid. Shikimic acid and choline showed relaxant and contracting properties on guinea-pig ileum.

The aqueous extract of the herb exhibited sedative, anxiolytic, analgesic, antipyretic and anti-inflammatory activities; exerted an inhibitory effect on platelet aggregation.

Quercitrin is reported to be responsible for antidiarrhoeal activity.

Methanolic extract of the leaves exhibits antibacterial and antifungal activities.

Dimeric hydrolysable tannins, eu- phorbains, have been isolated from the plant.... euphorbia hirta

Linn.

Family: Mimosaceae.

Habitat: Native to tropical America; naturalized in tropical and subtropical regions of India.

English: Sensitive-plant, Humble- Plant.

Ayurvedic: Lajjaalu, Laajavanti, Namaskaari, Samangaa, Sankochini, Shamipatraa, Khadirkaa, Raktapaadi.

Unani: Chhuimui, Sharmili, Laajwanti.

Siddha/Tamil: Thottalsurungi.

Action: Leaf—astringent, alterative, antiseptic, styptic, blood purifier. Used for diarrhoea, dysentery, haemophilic conditions, leuc- orrhoea, morbid conditions of vagina, piles, fistula, hydrocele and glandular swellings. Root—used in gravel and urinary complaints. A decoction is taken to relieve asthma.

The plant contains mimosine and turgorin. The periodic leaf movements exhibited by the plant are due to presence of derivatives of 4-O- (beta-D-glucopyranosyl-6'-sulphate)

Family: Sapotaceae.

Habitat: Cultivated in North India, Western Peninsula and South India.

English: Spanish-Cherry, West Indian Medlar, Bullet Wood.

Ayurvedic: Bakula, Keshara, Simhakeshara, Sthiraa, Sthira- pushpa, Vishaarada, Dhanvi, Madhupushpa, Madhugandha, Chirpushpa, Maulsiri.

Unani: Molsari.

Siddha: Magilam.

Action: Pulp of ripe fruit—astringent; used in chronic dysentery Flowers, fruit and bark—astringent. Bark—given for promoting fertility in women. Seeds—purgative. The leaves contain sterols, reducing sugars and tannins; roots, a steroidal saponin; stem bark, spinasterol and taraxerol; flowers, D-mannitol, beta-sitosterol and beta-sitosterol- D-glycoside; seeds, pentacyclic triterpene acids, mimusopic and mimusopsic acids.

Essential oil obtained from the plant is reported to be mycotoxic. Antimicrobial activity of the root extract has been reported. Saponins isolated from the seeds have been found to effect the cardiovascular activity in dogs and haemolytic activity in human beings. Spasmolytic activity in isolated ileum of guinea-pigs has also been recorded. Saponins from seeds also showed spermicidal activity.

Dosage: Seed, bark—10-20 g paste; 50-100 ml decoction. (CCRAS.)... mimusops elengi

a segment of small intestine (ileum) used to convey urine from the ureters to the exterior into an appliance (see also urinary diversion). The ureters are implanted into an isolated segment of bowel, usually ileum but sometimes sigmoid colon, one end of which is brought through the abdominal wall to the skin surface. This end forms a spout, or stoma, which projects into a suitable urinary appliance. The ureters themselves cannot be used for this purpose as they tend to narrow and retract if brought through the skin. The operation is performed if the bladder has to be removed or bypassed; for example, because of cancer.... ileal conduit

The daily requirement of iron for an adult is 12 mg, and 15–20 mg for an adult woman during pregnancy. This is well covered by an ordinary diet, so that by itself it is not a common cause. But if there is a steady loss of blood, as a result of heavy menstrual loss or ‘bleeding piles’, the intake of iron in the diet may not be su?cient to maintain adequate formation of haemoglobin.

Symptoms These depend upon whether the anaemia is sudden in onset, as in severe haemorrhage, or gradual. In all cases, however, the striking sign is pallor, the depth of which depends upon the severity of the anaemia. The colour of the skin may be misleading, except in cases due to severe haemorrhage, as the skin of many Caucasian people is normally pale. The best guide is the colour of the internal lining of the eyelid. When the onset of the anaemia is sudden, the patient complains of weakness and giddiness, and loses consciousness if he or she tries to stand or sit up. The breathing is rapid and distressed, the pulse is rapid and the blood pressure is low. In chronic cases the tongue is often sore (GLOSSITIS), and the nails of the ?ngers may be brittle and concave instead of convex (koilonychia). In some cases, particularly in women, the Plummer-Vinson syndrome is present: this consists of di?culty in swallowing and may be accompanied by huskiness; in these cases glossitis is also present. There may be slight enlargement of the SPLEEN, and there is usually some diminution in gastric acidity.

CHANGES IN THE BLOOD The characteristic change is a diminution in both the haemoglobin and the red cell content of the blood. There is a relatively greater fall in the haemoglobin than in the red cell count. If the blood is examined under a microscope, the red cells are seen to be paler and smaller than normal. These small red cells are known as microcytes.

Treatment consists primarily of giving suf?cient iron by mouth to restore, and then maintain, a normal blood picture. The main iron preparation now used is ferrous sulphate, 200 mg, thrice daily after meals. When the blood picture has become normal, the dosage is gradually reduced. A preparation of iron is available which can be given intravenously, but this is only used in cases which do not respond to iron given by mouth, or in cases in which it is essential to obtain a quick response.

If, of course, there is haemorrhage, this must be arrested, and if the loss of blood has been severe it may be necessary to give a blood transfusion (see TRANSFUSION – Transfusion of blood). Care must be taken to ensure that the patient is having an adequate diet. If there is any underlying metabolic, oncological, toxic or infective condition, this, of course, must be adequately treated after appropriate investigations.

Megaloblastic hyperchromic anaemia There are various forms of anaemia of this type, such as those due to nutritional de?ciencies, but the most important is that known as pernicious anaemia.

PERNICIOUS ANAEMIA An autoimmune disease in which sensitised lymphocytes (see LYMPHOCYTE) destroy the PARIETAL cells of the stomach. These cells normally produce INTRINSIC FACTOR, the carrier protein for vitamin B12 (see APPENDIX 5: VITAMINS) that permits its absorption in the terminal part of the ILEUM. Lack of the factor prevents vitamin B12 absorption and this causes macrocytic (or megaloblastic) anaemia. The disorder can affect men and women, usually those over the age of 40; onset is insidious so it may be well advanced before medical advice is sought. The skin and MUCOSA become pale, the tongue is smooth and atrophic and is accompanied by CHEILOSIS. Peripheral NEUROPATHY is often present, resulting in PARAESTHESIA and numbness and sometimes ATAXIA. A rare complication is subacute combined degeneration of the SPINAL CORD.

In 1926 two Americans, G R Minot and W P Murphy, discovered that pernicious anaemia, a previously fatal condition, responded to treatment with liver which provides the absent intrinsic factor. Normal development requires a substance known as extrinsic factor, and this depends on the presence of intrinsic factor for its absorption from the gut. The disease is characterised in the blood by abnormally large red cells (macrocytes) which vary in shape and size, while the number of white cells (LEUCOCYTES) diminishes. A key diagnostic ?nd is the presence of cells in the BONE MARROW.

Treatment consists of injections of vitamin B12 in the form of hydroxocobalamin which must be continued for life.

Aplastic anaemia is a disease in which the red blood corpuscles are very greatly reduced, and in which no attempt appears to be made in the bone marrow towards their regeneration. It is more accurately called hypoplastic anaemia as the degree of impairment of bone-marrow function is rarely complete. The cause in many cases is not known, but in rather less than half the cases the condition is due to some toxic substance, such as benzol or certain drugs, or ionising radiations. The patient becomes very pale, with a tendency to haemorrhages under the skin and mucous membranes, and the temperature may at times be raised. The red blood corpuscles diminish steadily in numbers. Treatment consists primarily of regular blood transfusions. Although the disease is often fatal, the outlook has improved in recent years: around 25 per cent of patients recover when adequately treated, and others survive for several years. In severe cases promising results are being reported from the use of bone-marrow transplantation.

Haemolytic anaemia results from the excessive destruction, or HAEMOLYSIS, of the red blood cells. This may be the result of undue fragility of the red blood cells, when the condition is known as congenital haemolytic anaemia, or of acholuric JAUNDICE.

Sickle-cell anaemia A form of anaemia characteristically found in people of African descent, so-called because of the sickle shape of the red blood cells. It is caused by the presence of the abnormal HAEMOGLOBIN, haemoglobin S, due to AMINO ACID substitutions in their polypeptide chains, re?ecting a genetic mutation. Deoxygenation of haemoglobin S leads to sickling, which increases the blood viscosity and tends to obstruct ?ow, thereby increasing the sickling of other cells. THROMBOSIS and areas of tissue INFARCTION may follow, causing severe pain, swelling and tenderness. The resulting sickle cells are more fragile than normal red blood cells, and have a shorter life span, hence the anaemia. Advice is obtainable from the Sickle Cell Society.... inadequate intake of iron

(perineal pouch) a reservoir made from loops of ileum to replace a surgically removed rectum, avoiding the need for a permanent *ileostomy. This is commonly constructed in patients who have had their colon surgically removed for various disorders (e.g. ulcerative colitis or familial adenomatous polyposis).... ileal pouch

n. surgical removal of the ileum (small intestine) or part of the ileum.... ileectomy

An autoimmune disease in which sensitised lymphocytes (see LYMPHOCYTE) destroy the parietal cells of the STOMACH. These cells normally produce intrinsic factor, which is the carrier protein for vitamin B12 that permits its absorption in the terminal ileum. Without intrinsic factor, vitamin B12 cannot be absorbed and this gives rise to a macrocytic ANAEMIA. The skin and mucosa become pale and the tongue smooth and atrophic. A peripheral NEUROPATHY is often present, causing paraesthesiae (see under TOUCH), numbness and even ATAXIA. The more severe neurological complication of sub-acute combined degeneration of the cord is fortunately more rare. The anaemia gets its name from the fact that before the discovery of vitamin B12 it was uniformly fatal. Now a monthly injection of vitamin B12 is all that is required to keep the patient healthy.... pernicious anaemia

a valve at the junction of the small and large intestines consisting of two membranous folds that close to prevent the backflow of food from the colon and caecum to the ileum.... ileocaecal valve

n. inflammation of the ileum and the colon (small and large intestines). The most likely cause is *Crohn’s disease.... ileocolitis

n. a surgical operation in which the ileum is joined to part of the colon. It is usually performed when the right side of the colon has been removed or if it is desired to bypass either the terminal part of the ileum or right side of the colon.... ileocolostomy

(ileoproctostomy) a surgical operation in which the ileum is joined to the rectum, usually after surgical removal of the colon (see colectomy).... ileorectal anastomosis

n. an operation in which part of the jejunum is joined to the distal ileum following the removal or bypass of diseased segments of small bowel. It was formerly used for the treatment of obesity but has been abandoned because of deleterious side-effects.... jejunoileostomy

n. a surgical operation in which the rectum and colon are removed. In panproctocolectomy the entire rectum and colon are removed, necessitating either a permanent opening of the ileum (see ileostomy) or the construction of an *ileal pouch. This is usually performed for *ulcerative colitis.... proctocolectomy

(enteroclysis) a radiological technique for examining the jejunum and ileum by passing a tube through the nose, oesophagus, and stomach into the small bowel and directly injecting *barium sulphate. Images are captured in real time as the contrast moves through the small bowel. It produces highly detailed images of the small bowel, making it particularly useful for investigating coeliac disease and Crohn’s disease, as well as strictures, tumours, and obstructions. It can be combined with X-ray imaging, CT, or MRI.... small-bowel enema

Burm. f.

Synonym: S. carpinifolia auct. non Linn f.

Family: Malvaceae.

Habitat: Throughout the warmer parts of India.

English: Hornbeam-Leaved Sida.

Ayurvedic: Balaa (white-flowered var.).

Folk: Jangali Methi.

Action: Root—astringent, cooling, stomachic, febrifuge, diuretic; used for nervous and sexual debility, haemorrhoids, biliary disorders. Leaves—demulcent; applied to testicular swellings and elephantiasis.

The root contains alkaloids—phen- ethylamine, ephedrine (major), si- ephedrine, vasicinol, vasicinone, va- sicine, choline, hypaphorine and betaine. (These alkaloids are also present in aerial parts.) The root also contains alpha-amyrin and an hormone, ecdys- terone. Whole plant, as well as the root, contains an alkaloid cryptolepine. Cryptolepine exhibits hypotensive and antimicrobial activity.

The seeds contain 0.26% of the alkaloids and roots 0.066%.

The water-soluble portion of the alcoholic extract of the plant exerts spasmodic action of the smooth muscles of ileum, trachea, uterus and heart of experimental animals. (The activity bears similarity to that of acetylcholine.)... sida acuta

Linn.

Synonym: S. alba Linn.

Family: Malvaceae.

Habitat: Throughout the hotter parts of India, ascending to an altitude of 1,350 m.

English: Prickly Sida.

Ayurvedic: Naagabalaa, Balaa- kantakini, Gangaati.

Siddha/Tamil: Arivalmanai-poondu.

Folk: Gulasakari, Gangeti, Jangali- methi.

Action: Root—nervine tonic and diaphoretic; used in debility and fevers. Decoction given as a demulcent in irritability of bladder and genitourinary tract. Leaves—demulcent and refrigerant; used for scalding urine.

The root contains alkaloids—beta- phenethylamine, ephedrine, si-ephed- rine, vasicinol, vasicinone, vasicine, choline, hypaphorine, methyl ester, hy- paphorine and betaine. These alkaloids are present in aerial parts as well.

Ethanolic extract of the plant exhibits hypoglycaemic activity. It depressed the normal blood pressure and lowered the activity ofsmooth muscles of the ileum of experimental animals.... sida spinosa

Sw.

Family: Solanaceae.

Habitat: Throughout tropical parts of India, in waste places.

English: West Indian Turkey Berry.

Ayurvedic: Brihati (White-flowered- var.), Goshtha-vaartaaku.

Siddha/Tamil: Chundai.

Folk: Ran-Baingan, Goth-begun.

Action: Plant—digestive, diuretic, sedative. Leaves—haemostatic. Fruits—useful in liver and spleen enlargement (cooked and eaten as a vegetable); decoction used for cough. Root—used for poulticing cracks in feet.

Unripe fruits and leaves contain the glycoalkaloid, solasonine (0.37% total alkaloids in air-dried fruits of the plant from Khasi and Jaintia hills). Hydrolysis of the neutral glucosidal fraction yields a steroidal sapogenin, chloro- genin, which is rare in Solanum sp.

The fruits gave sitosterol-D-gluco- side.

Extracts of the plant affect the rate and amplitude of respiration, also blood pressure. They also contract isolated ileum of guinea-pig. Leaves contain no vitamin K or derivatives of naphthoquinone; their haemostatic action may be due to the oil or pectins or both.... solanum torvum

DC.

Synonym: S. acmella auct. non (L.) Murr.

S. paniculata auct. non-DC. S. pseudoacmella auct. non (L.) Murr.

Family: Asteraceae.

Habitat: Tropical and sub-tropical parts of India, in waste places and open moist fields.

English: Paracress.

Ayurvedic: Marahattikaa.

Folk: Marethi, Desi Akarkaraa.

Action: Plant—antidysenteric. Decoction, diuretic and lithotriptic, also used in scabies and psoriasis. Seeds—used in xerostomia, throat infections and neurological affection of tongue. Root—purgative.

Whole plant gave alpha-and beta- amyrin ester, myricyl alcohol, stigmas- terol and its glucoside. A tincture made from flower heads is used as a substitute for the tincture of pyrethrum to treat inflammation of jaw-bones and caries.

Ethanolic extracts of the herb were found to affect the blood pressure of dogs and cats, and also the isolated ileum of guinea pigs. Spilanthol, obtained from the ether as well as pen- tane extracts, shows a strong sialogogic action, acts as a local anaesthetic and a powerful insecticide.... spilanthes calva

n. (pl. stomata) 1. (in anatomy) the mouth or any mouthlike part. 2. (in surgery) the artificial opening of a hollow organ (e.g. the colon or ileum) that has been brought to the abdominal surface (see colostomy; ileostomy). Stoma therapists are nurses specially trained in the care of these artificial openings and the appliances used with them. —stomal adj.... stoma

(Thunb.) Miq.

Synonym: S. crataegoides Buch. Ham. ex Don. S. chinensis (Lour.) Druce. Prunus paniculatus Thunb.

Habitat: The Himalayas from Kashmir to Arunachal Pradesh and Assam; Khasi Hills at 1,0002,500 m.

English: Sapphire Berry.

Ayurvedic: Lodhra-Pattikaa.

Unani: Lodh Pathaani.

Action: Leaf—spasmolytic, antiviral, antiprotozoal, anthelmintic. Bark— used as a tonic for preventing abortion. Other uses same as of S. racemosa.

The water-soluble fraction from the bark has been reported to exhibit anti- oxytocic activity. Ethanolic extract of the leaves showed activity against Entamoeba histolytica strain STA, Ascaridia galli and Ranikhet-disease virus. It also affected blood pressure in dogs and cats, and showed activity on the ileum of guinea-pigs. The extract of stem also affected the blood pressure.

The leaf and stem are CVS active.... symplocos paniculata

Linn.

Family: Labiatae; Lamiaceae.

Habitat: Native to North America; also found in temperate Himalayas from Kashmir to Nepal; grown in gardens in western India.

English: Mother-of-thyme, Wild Thyme. Thymus vulgaris (Garden Thyme) is found in the Nilgiris at higher elevations.

Ayurvedic: Ajagandhaa, Vana- Yavaani. (Not to be confused with Yavaani, Ajmodaa, Shataahvaa, Raajikaa and Tilaparni.)

Unani: Haashaa, Jangali Pudinaa. Thysanolaena agrostis Nees.

Action: Antiseptic, antibacterial, antifungal, antiviral, antispasmodic, mild sedative, expectorant. T. serpyllum and T. vulgaris L. are used for coughs and common cold.

Key application: German Commission E approved T. vulgaris for symptoms of bronchitis, whooping cough and catarrhs of the upper respiratory tracts. Also to treat stomatitis. (ESCOP.)

The British Herbal Pharmacopoeia recognizes expectorant activity of T. serpyllum.

T. serpyllum contains more linalool and p-cymol than Garden Thyme (T. vulgaris). Major constituent of the volatile oil of both the species (highly variable) is thymol; with carvacrol (lesser amount in T. serpyllum, higher in T. vulgaris), 1,8-cineole, borneol, geraniol, linalool. bornyl and lina- lyl acetate, thymol methyl ether and alpha-pinene.

Flavonoids include apigenin, lute- olin, thymonin, naringenin; other constituents include labiatic acid, caffeic acid, tannins.

The flavonoid fraction has shown to have a potent effect on smooth muscle on guinea-pig trachea and ileum.

Thymol is expectorant and antiseptic. Thymol and carvacrol are spasmolytic. Thymol is also urinary tract antiseptic and anthelmintic.

Dosage: Whole plant—3–5 g powder. (CCRAS.)... thymus serpyllum

Roxb.

Synonym: Z. montanum (Koen.) Link ex. A. Dietr. Z. purpureum Rosc.

Family: Zingiberaceae.

Habitat: Wild throughout India, also cultivated in tropical parts of India.

English: Cassumunar Ginger.

Ayurvedic: Vanardraka, Peja, Peyu, Aardikaa, Shringaberikaa.

Folk: Adarakhi, Bana-adarakhi.

Action: Rhizome—carminative, stimulant, antispasmodic. Used for diarrhoea and colic.

The occurance of an active diastase in the rhizome has been reported.

The enzyme resembles in its activity with alpha-amylase of Aspergillus oryzae. The rhizome gave an essential oil consisting of terpinen-4-ol (about 35%); other constituents are alpha- and beta-pinene, sabinene, myrcene, terpinene, limonene, p-cymene and terpinolene. The fresh rhizomes contain phenyl butenoic dimers, along with cyclohexane derivatives. Hex- ane extract of the rhizome contained (E)-4-(3'4'-dimethoxyphenyl)-but-3- en-l-ol, known as compound D. Compound D showed antispasmodic effect on guinea-pig ileum and tracheal smooth muscle, also a dose-related uterine relaxant effect in situ in non- pregnant rats; in pregnant rats the response varied with the period of pregnancy. Aqueous extract of the rhizome showed smooth muscle relaxant and anti-inflammatory activity Antioxi- dant activity was found to be more intense than that of known curcum- inoid antioxidants. It is attributed to cassumunin A.... zingiber cassumunar

Flushing of the face and neck caused by an active malignant tumour in the stomach or intestines with secondary growths in the liver. Often accompanied by an explosive diarrhoea. The lesion is usually found in the ileum yet it may also appear in the bile duct, ovaries or bronchi. Other symptoms include low blood pressure, drastic reduction in weight due to loss of body fluids.

Symptoms: flushing of face and neck, diarrhoea, low blood pressure, weight loss.

Treatment: relief of symptoms only. Diarrhoea – Fenugreek seed tea. Flushing: Chamomile tea.

Vitamin and Mineral Supplementation: Because of severe drain on these food elements Multivitamins should be taken daily together with additional 1000ius Vitamin E for the disturbed circulatory system. The heart should be sustained with a preparation of the Hawthorn berry.

To be treated by or in liaison with a qualified medical practitioner. ... carcinoid syndrome

The group of organs responsible for digestion. It consists of the digestive tract (also known as the alimentary tract or canal) and various associated organs. The digestive tract consists of the mouth, pharynx, oesophagus, stomach, intestines, and the anus. The intestines are the small intestine (comprising the duodenum, jejunum, and ileum) and the large intestine (comprising the caecum, colon, and rectum). The associated organs, such as the salivary glands, liver, and pancreas, secrete digestive juices that break down food as it goes through the tract.

Food and the products of digestion are moved from the throat to the rectum by peristalsis (waves of muscular contractions of the intestinal wall).

Food is broken down into simpler substances before being absorbed into the bloodstream.Physical breakdown is performed by the teeth, which cut and chew, and the stomach, which churns the food. The chemical breakdown of food is performed by the action of enzymes, acids, and salts.

Carbohydrates are broken down into simple sugars. Proteins are broken down into polypeptides, peptides, and amino acids. Fats are broken down into glycerol, glycerides, and fatty acids.

In the mouth, saliva lubricates food and contains enzymes that begin to break down carbohydrates. The tongue moulds food into balls (called boli) for easy swallowing. The food then passes into the pharynx. From here, it is pushed into the oesophagus and squeezed down into the stomach, where it is mixed with hydrochloric acid and pepsin. Produced by the stomach lining, these substances help break down proteins. When the food has been converted to a semi-liquid consistency, it passes into the duodenum where bile salts and acids (produced by the liver) help to break down fats. Digestive juices released by the pancreas into the duodenum contain enzymes that further break down food. Breakdown ends in the small intestine, carried out by enzymes produced by glands in the intestinal lining. Nutrients are absorbed in the small intestine. The residue enters the large intestine, where water is absorbed. Undigested matter is expelled via the rectum and anus as faeces.... digestive system

A common problem, present at birth, in which a small, hollow, wide-mouthed sac protrudes from the ileum. Symptoms only occur when the diverticulum becomes infected, obstructed, or ulcerated. The most common symptom is painless bleeding, which may be sudden and severe, making immediate blood transfusion necessary. Inflammation may cause symptoms very similar to those of acute appendicitis. Meckel’s diverticulum occasionally causes intussusception or volvulus of the small intestine. Diagnosis of Meckel’s diverticulum may be made by using technetium radionuclide scanning. If complications occur, they are treated by surgical removal of the diverticulum.... meckel’s diverticulum

Any surgical procedure (temporary or permanent) that allows urine flow when the outlet channel of the urinary tract, via the bladder and urethra, is obstructed or cannot be used, or the bladder has been surgically removed.

Temporary urinary diversion is sometimes needed when urine passage is blocked by prostate gland enlargement or by urethral stricture.

A tube is passed directly into the bladder through a small opening in the abdomen (see catheterization, urinary).

Temporary diversion is also required after some urinary tract operations; a small tube is introduced into the kidney and brought to the abdominal surface.

Permanent diversion is needed when the bladder has been surgically removed, when neurological bladder control is severely disturbed, such as after severe spinal injury, or if there is an irreparable fistula between a female patient’s bladder or urethra and her vagina.

A section of the ileum is removed to create a substitute bladder, into one end of which the surgeon implants the ureters. The other end of the substitute bladder is then brought out through an incision in the abdominal wall. The patient wears a bag attached to the skin to collect urine.... urinary diversion

n. an invasive endoscopic procedure for examining the interior of the colon and the terminal ileum. A colonoscope is a flexible, steerable telescopic instrument that houses a high-definition digital video camera to allow direct visualization of the colonic mucosa. It is inserted into the anus and guided around the loops of the large bowel to the caecum and terminal ileum. Its progress may be aided by using an external *3-D magnetic imager (e.g. ScopeGuide). It is possible to obtain biopsies for microscopic examination using flexible forceps passed through the colonoscope (diagnostic colonoscopy) and to remove polyps, dilate strictures with endoscopic balloons, or insert self-expandable metal stents (SEMS) into benign or malignant strictures (therapeutic colonoscopy).... colonoscopy

n. surgical removal of the urinary bladder. This is necessary in the treatment of certain bladder conditions, notably cancer, and necessitates subsequent *urinary diversion. The ureters draining the urine from the kidneys are reimplanted into an isolated segment of intestine (usually the ileum), which is brought to the skin surface as a spout (see ileal conduit). Alternatively, in bladder replacement, a segment of ileum or colon is reconstructed to form a pouch (the Studer pouch is created from approximately 50 cm of ileum), which is anastomosed to the urethra and acts as a reservoir for the urine. Emptying may be achieved by abdominal straining or *intermittent self-catheterization.... cystectomy

n. an operation to enlarge the capacity of and to decrease the pressure within the bladder by incorporating a segment of bowel. In a clam cystoplasty, the bladder is cut across transversely from one side of the neck to the other side through the dome (fundus) of the bladder and a length of the ileum, jejunum, or colon is inserted as a patch. In the operation of ileocaecocystoplasty, the dome is removed by cutting across the bladder transversely or sagittally above the openings of the ureters; it is replaced by an isolated segment of caecum and terminal ileum. In ileocystoplasty the bladder is enlarged by an opened-out portion of small intestine. The bladder may be totally replaced by a reservoir constructed from either small or large intestine (see cystectomy).... cystoplasty

n. (pl. diverticula) a sac or pouch formed at weak points in the walls of the gastrointestinal tract. They may be caused by increased pressure from within (pulsion diverticula) or by pulling from without (traction diverticula). A pharyngeal diverticulum occurs in the pharynx and may cause difficulty in swallowing. Oesophageal diverticula occur in the middle or lower oesophagus (gullet); they may be associated with muscular disorders of the oesophagus but rarely cause symptoms. Gastric diverticula, which are rare, affect the stomach (usually the upper part) and cause no symptoms. Duodenal diverticula occur on the concave surface of the duodenal loop; they are usually asymptomatic but a small minority may be associated with *dyspepsia, choledocholithiasis, and an increased risk of pancreatitis. Jejunal diverticula affect the small intestine, are often multiple, and may give rise to abdominal discomfort, diarrhoea, and *malabsorption due to overgrowth of bacteria within them. Meckel’s diverticulum occurs in the ileum, about 35 cm from its termination, as a congenital abnormality. It may become inflamed, mimicking *appendicitis; if it contains embryonic remnants of stomach mucosa it may form a *peptic ulcer, causing pain, bleeding, or perforation. Colonic diverticula, affecting the colon (particularly the left side), become commoner with increasing age and often cause no symptoms. However they are sometimes associated with abdominal pain or altered bowel habit (see diverticular disease) or they may become inflamed (see diverticulitis).... diverticulum

n. intestinal obstruction, usually obstruction of the small intestine (ileum). Clinical symptoms include abdominal pain and distension, vomiting, and absolute constipation. Paralytic or adynamic ileus is functional obstruction of the ileum due to loss of intestinal movement (peristalsis), which may be caused by abdominal surgery (see laparotomy); spinal injuries; electrolyte abnormalities, particularly of potassium (hypokalaemia); peritonitis; or ischaemia. Treatment consists of intravenous administration of fluid and removal of excess stomach secretions by nasogastric tube until peristalsis returns (the ‘drip and suck’ approach). If possible, the underlying condition is treated. Mechanical ileus may be caused by gallstones entering the bowel through a fistula or widened bile duct (gallstone ileus); tumour; *intussusception; intestinal *volvulus; foreign bodies; thickened *meconium in newborn babies (meconium ileus); or parasitic infestation, for example with the threadworm Enterobius vermicularis (verminous ileus).... ileus