Intestinal gas looks black on an x-ray and is useful at providing a natural contrast for detecting abdominal disease.  The best way to evaluate an x-ray showing abdominal gas is to determine the bowel gas pattern.  There is normally air or gas in the stomach, small intestine, colon and rectum.  It is important to recognize abnormal amounts of air in the gastrointestinal tract.  It is important to determine if there is there too much or too little bowel gas in a particular area or in the wrong places.  If you are interested in ultrasound, you may be interested in X-rays or how to become a radiologist.  There are many different things that you can do in the allied health fields.

Too much bowel gas can be a sign of adynamic ileus or bowel obstruction. A systematic approach should be taken to determine the correct diagnosis.  Adynamic ileus (often called paralytic ileus or ileus) is the result of too much bowel gas in the entire gastrointestinal tract.  This includes the small and large intestines.  This condition can be caused form intra-abdominal cases or as a reflex phenomenon from a disease located elsewhere.

Major causes of adynamic ileus:

Intra-abdominal

-Postoperative or posttraumatic

-Postinflammatory: pancreatitis, enteritis, colitis

-Pain-related: renal colic, epidural disease

Extra-abdominal

-Septicemia

-Metabolic disease: hyperkalemia, uremia

-Medications like narcotics

-Prolonged bed rest

Intestinal bowel obstruction can also result in too much bowel gas.  Air usually fills and dilates the intestine near the area of the obstruction and little to no air farther from that point.  Often if the small and large bowels contain too much air, the air-fluid levels will be seen on both upright and decubitis radiographs.

If will be necessary to do additional tests if the radiograph can not determine if the excess gas is caused by an obstruction versus adynamic ileus.  Barium studies, computed tomography, and ultrasound are additional studies that can be done to determine the correct diagnosis.

If it is determined that the excess gas is due to an intestinal obstruction, the next step is to determine the location of the obstruction.  Is the obstruction in the small or large bowel?  If the obstruction is in the small bowel, there will be loops of dilated small bowel nest to the obstruction site and little to no gas in the colon or the rectum.  If the obstruction is in the large bowel, the colon will be dilated next to the obstruction and there will be very little to no air further from that point and minimal air in the rectum.

It can be difficult to tell the difference between a small or large dilated bowel.  One way to identify between the two is to observe the valvula conniventes, located in the small bowel and colon haustra, located in the large bowel.  The valvulae conniventes are spaced regularly across the entire small bowel lumen.  The colon will have irregularly spaced transverse bands, called colon septa or haustral folds that do not extend completely across the colon lumen.

Elderly patients with a long history of constipation are often diagnosed with sigmoid volvulus.  Having chronic constipation for several years can result in a redundant sigmoid mesentery that can twist on it self.  The twisting can cause complete or partial obstruction.  A radiograph will look like a dilated sigmoid colon.  A barium enema is often administered to confirm if this diagnosis is correct.  The obstruction is often relieved by gently passing a sigmoidoscope past the point of the obstruction or twist in the colon.

Too little bowel gas can be due to the following conditions and should be considered carefully.

-Enlarged abdominal organs

-Intra-abdominal tumor

-Fluid-filled intestines

-Gastroenteritis

-Neurological deficit (with reduced swallowing)

Several situations can cause gas to be found outside of the intestinal lumen.  Sometimes free air is found in the peritoneal cavity.  This is usually the result of a perforation in the intestinal tract.  An abdominal radiograph should be done in the supine and upright position if a gut perforation is suspected.  The upright radiograph will allow the free intrapertoneal air to rise to the subdiaphragmatic regions of the abdomen.  A decubitis radiograph can also be done.  Both techniques are able to identify as little as 2 cc of free intraperitoneal air, as long as the patient is in the upright or decubitus position for approximately 5 minutes before the radiograph is done.

Pneumatosis intestinalis is another potential reason why air may be in the wrong place.  This condition is usually caused by the following:

-Bowel ischemia

-Steriod and immunosuppressive therapy

-Proximal to intestional obstruction

-Collagen disease

-Neonatal necrotizing enterocollitis

-Benign idiopathic pneumatosis

Gas filled abscesses can be found in any location and should be evaluated to determine the cause.

No tags

Everyone knows about the pains associated with childbirth.  There is no doubt that labor is probably the most painful natural experience a woman can have.  There have been movies, documentaries, and reality television shows that remind us of just how painful childbirth is.  I agree completely that labor and delivery is excruciating but I don’t think we give enough consideration to the pains associated with breastfeeding a newborn.  I decided to ask my midwife what she thought.  She said this is a midwife F.A.Q. and this is how she answered.

I was in labor with my first child for 12 hours, my second child for three hours and my third child for two hours.  I remember the pain of nursing each baby those first two weeks.  I am not surprised that many mothers give up breastfeeding after those first few weeks and opt for bottle feeding.

The breasts become extremely engorged after the baby is born causing the breast to increase several cup sizes.  Although this may bring many fathers great pleasure, most mothers find the engorgement too painful to enjoy.  Here is some important advice to all fathers- don’t be surprised if the next few months after the baby is born are strictly hands off.

I have heard several recommendations about how you can prepare yourself for breastfeeding.  Honestly, I don’t think there is anything that can prepare you for what you are about to experience.  Here is why.  Most newborns have to learn how to latch on to the breast.  In many instances, this can be an awkward and clumsy experience.  If a baby does not latch on correctly, when he/she sucks it can become very painful for the mother.  Also, the constant sucking can cause the nipples to get blisters or crack.  It takes about two weeks before you and the baby get used to this new experience.

I encourage every mother to do their best to work through the initial two weeks of breastfeeding pain.  It will be excruciating.  You will want to quit and you may even cry, but if you can overcome it, you will greatly benefit your baby and yourself.

Breastfeeding is the best form of nutrition for a baby.  Although there are decent formulas available, nothing can beat breast milk.  Breast milk contains protein, fat, carbohydrates vitamins and enzymes.  An infant’s immune system is not fully operational at birth.  The mother’s breast milk contains components that protect the infant against infective and inflammatory episodes.

Breastfed babies reduce the risk of some diseases and the development of allergies.  It has been reported that formula-fed babies are more likely to have breathing and gastric problems, like asthma and colic.   Also, important enzymes are found in breast milk which may help strengthen the baby’s digestive system.  Of course, who doesn’t want a smart child?  Breastfeeding may also increase a child’s IQ.

Motherhood can be a self-less job.  Even though, breastfeeding will require a lot of sacrifice on your part, there are many benefits you should consider.  My favorite benefit is the free 500 plus calorie burn.  Breastfeeding actually helps you to burn more calories and loose weight.  I noticed that I was able to lose most of my pregnancy pounds when I was breastfeeding.  I even gained some weight after I weaned each of my children.

Breastfeeding can save you a substantial amount of money and time.  Formula can be expensive.  Breastfeeding is absolutely free and does not require sterilizing or warming bottles in the middle of the night.  You can not fully appreciate being able to stay in bed and feed the baby almost instantly until you have had to get out of bed.  Find a bottle. Warm the water.  Add the formula.  Shake the bottle.  Make sure it is at the right temperature.  Return to bed.   Feed the baby and then finally clean the bottle in the morning.  Try doing that two to three times a night.  What little sleep you can get is precious.  Breastfeeding is the best way of maximizing it.

No tags

Most babies born with a congenital bowel abnormality are diagnosed with atresia of the bowel.  Atresia commonly occurs due to a number of complex intrauterine processes that usually involve the vascular supply to the bowel wall.  A radiograph can show the severity of the atresia.  Not every case looks exactly the same but all cases will have common features.  First, there will be no gas distal to the level of the atresia, and second, the bowel proximal to the atresia will be disproportionately dilated.   To determine the level of the atresia you will need to identify where it is located.  If the stomach is dilated and loop in the right upper quaderant than it is likely that duodenal atresia is present.  If the bowel loops largely to the right of the spine then an ileal artesia is likely.  If the loops are confined in the upper abdomen and predominantly to the left, then jejunal atresia is likely.  These rules of observation work 70 percent of the time when trying to identify types of atresia.

Meconium ileus is a condition that is similar to distal bowel atresia.  It is commonly found in caucasion babies.  In meconium ileus, the contents of the bowel (meconium) are abnormal.  A lack of digestive enzymes causes the meconium to become thick and viscous.  The material will compact in the ileum and eventually causing a complete obstruction.  This condition is similar to an atresia in that the bowel becomes completely obstructed by the intraluminal content.  There are several ways to differentiate between meconium ileus and ileal atresia.  When looking at a radiograph, a meconium ileus problem usually traps air so that an bubbles are seen at the level of the meconium filled bowel.  The meconium is very thick and will not form air-fluid levels with the swallowed intestinal gas.   A radiograph of an ileal atresia will likely show the fluid contents of the bowel interact with the swallowed gas to form multiple air-fluid levels.

No tags

Before birth the placenta in the mother passes maternal antibodies to the developing baby.  These antibodies provide protection against pathogens that can last for several weeks to months.  Once the baby is born, the mother’s first breastfeeding provides the baby with colostrum.  This first feeding of colostrum is full of concentrated anti-infective properties designed to protect the young baby. Compared to other mammals, human babies have a proportionally longer duration of colostrum feedings.  This is most likely due to the fact that human babies are the most dependant of all mammal offspring.  We decided to ask a midwife today.

The probiotic milk components in the mother’s breast milk help to protect the infant and the lactating breast.  These components actively bind to pathogens, preventing them from being able to pass through the infant’s gut mucosa.  These natural components are highly targeted to foreign pathogens and are able to ignore the infant’s healthy gut flora.  This binding to the pathogens reduces the pathogens ability to obtain nutrients, vitamins and minerals.  The infant’s own immune system benefits from breast milk because the probiotic organisms in the milk help to trigger and enhance the development and maturation of the infant’s own immune system.

These components have also been found to prevent or reduce inflammation in the organs and tissues of breastfed infants compared to bottle fed infants.  The reduction in inflammation helps to protect the infant from infection and supports the maturation of the infant gut, respiratory, and urogenital tracts.

There are several reasons why human milk is ideal for human babies.  One of the best reasons to consider nursing or expressing breast milk over artificial milk formulas is the enhanced immunity the mother will be able to pass on to her baby.  Good health is the best gift a person can have and feeding your baby breast milk is the best way of helping your child to have it.

No tags

When I had my first two children I used a manual breast pump because it was cheaper than the electric pumps on the market and I didn’t need to express milk very often.  When I had my third child I decided to purchase an electric pump.  There are several advantages and disadvantage to using a manual or hand pump.  Here are a few things you may want to consider before making your first purchase.

Affordability:  Manual breast pumps are the least expensive.  They range in price from $15 to $60 depending on the brand and available options.  My first breast pump was an Advent that cost about $29.

Availability:  Manual breast pumps are usually sold in drug stores and are easily found in most communities.

Portability:  Manual breast pumps do not require electricity or batteries.  Good old fashion manual labor is what makes these pumps work.

Clean up:  Most manual pumps have few parts to assemble and are easy to set up and easy to clean.

There are several disadvantages to using a manual pump.

Inconsistency:  Manual breast pumps can be inconsistent and unreliable in the quality of suction.

Time:  Manual pumps take about 15 to 20 minutes to drain each breast.

Fatigue:  Manual pumps require manual power and can be very exhausting to use.

Part time use:  A manual pump is best suited for part-time use.  People who require frequent full time milk expression should use an electric pump instead.

No tags

I didn’t appreciate the miracle of life until my first child was born.  My amazement with the body, its ability to create and sustain life is extremely humbling.  There are so many processes that occur automatically.  Many life sustaining automatic reflexes start at birth with out which humans could not survive.  All healthy infants are born with different automatic reflexes.  Considering that a newborn has no experience in the world as we know it, automatic reflexes are built into the body for life sustaining purposes.  There are four different infant feeding reflexes.  Without these reflexes an infant could die.   Rooting, sucking, swallowing, the gag and the cough reflexes are all natural and automatic responses that help newborns to eat.  The rooting reflex is the first reflex an infant uses in the process of feeding.  While studying in the Allied Health fields, infants can be a very rewarding focus.  Not very many things are more inspiring of love and protection then an new infant or baby.

The rooting reflex is important because it helps the infant to locate the nipple.  This reflex is stimulated by touching any part of a baby’s head and is especially obvious when the sides of the cheeks are touched.  This reflex begins at birth and will continue on average for two to four months of age.  If this reflex is absent or weak the baby may have poor tactile receptivity or poor neural integration.  A hypersensitive rooting reflex can make latching on to a nipple difficult for an infant.  A baby with an excessive rooting reflex can take several minutes to latch on.  Reducing environmental stimuli can help babies who have hypersensitive rooting reflexes.  It is also helpful not to touch the infant’s head and best to feed when the infant is tired.

No tags

Parents often joke that they wish their children came with an instruction manual.  Unfortunately, they do not.  We decided the closest thing we could get to a manual would be our ask a midwife series.  Here is where a midwife schools us on midwife F.A.Q. I wonder how many parents would follow the manual if their child actually came with one anyways.  Infants may not come with instruction manuals but they do come with perfectly made food that many parents choose not to use.

Breast milk is the optimal baby food.  Naturally made by the mother’s body, breast milk contains all of the necessary components for a growing baby.  The artificial baby milk industry has been trying to create the closest possible laboratory made version of naturally occurring breast milk.  Although many artificial milk formulas have many of the same ingredients they also lack many components.

Colostrum is the first food a baby receives from breast milk.  Colosturm secretion begins approximately 12 to 16 weeks of gestation.  This highly dense, almost gel-like substance is generally yellow-colored due the high level of beta-carotene.  The primary function of colostrum is to prevent pathogens form adhering to the gut as well as promoting gut closure.  Appoximately 90% of the cells in colostrum are white cells called polymorphonucleocytes.  They help with immunity.  Lactoferrin, lysozyme epidermal growth factor and interleukin 10 are also found in colostrum.

Compared to mature milk, colostrum is lower in lactose, fat and water-soluble vitamins.  It is higher in Vitamins A and E, carotenoids, protein, sodium, zinc, chloride and potassium.

Colostrum also has a laxative effect that helps to clear the meconium out of the infant’s intestines.  Meconium is a thick tar like substance that lines the intestines and is made up of amniotic fluid, mucus, bile, and skin/intestinal tract cells.  Once the meconium is expelled an infant’s stool with appear mustard color.

Colostrum is available in mother’s milk for the first 72-hours after delivery.

No tags

I am constantly amazed at how many bodily functions occur automatically.  From conception, the body is organizing, building and maintaining the operations necessary to sustain life without conscious effort.  This is especially evident in babies born with innate reflexes that allow for the sustaining of life.  We decided to ask a midwife……

The root and sucking reflexes in babies help to ensure that food can be ingested without the need for learning or experience.  Thanks goodness for these natural innate reflexes.  There are three other reflexes that are equally important in the feeding process.  Swallowing, gagging and coughing are several natural abilities that we tend to take for granted.  Without these natural reflexes that start at or before birth we could die.

The swallowing reflex starts early during fetal development- usually between 12 to 14 weeks gestation.  This reflex is triggered by chemical receptors in the tongue and also by the delivery of a bolus of fluid to the back of the tongue.  If a baby has difficulty swallowing the result could be poor weight gain and not wanting to feed.  This aversion to feeding is usually caused by reflux.  Reflux is a swallowing disorder that most infants experience in some degree.  However, serious cases can be painful and feeding aversion usually results.  Often a baby with severe reflux will limit the amount of food consumed causing a failure to thrive.

The gag reflex protects the airway from large objects that might be consumed.  It is generally triggered by pressure on the rear of the tongue.  Young infants with shallow depth in the mouth may have a greater gag reflex.  Infants with sensitive gag reflexes may out grow this sensitivity with maturity or may need occupational therapy to train the body to accept objects in the mouth without gagging.

The cough reflex protects fluids from entering into the airways.  This reflex may be immature in preterm babies.  Coughing during feedings usually occurs when fluids descend into airway.  Coughing can also occur between feedings if fluids reflux.

No tags

What is it?

It is a technique that utilizes an ultrasound to visualize organs.  A generator of high frequency waves is placed on the area of the body to be examined; the waves propagate deep into the organ from which they are then reflected: complex equipment is able to convert echoes from sound signals into images, which are then viewable on a monitor.  The examiner, the ultrasound technician, can photograph the most important details in or to register the clinical data and make an initial diagnosis.

How is it used?  To observe the structure of the organs and the presence of any unusual change like cysts, nodules, deformations and presence of fluids etc….

When is it used?

Mainly to verify the organs of the abdominal cavity such as the liver, the pancreas, the bladder, female reproduction apparatus, the kidneys and the intestine.  Ultrasounds are also used to inspect the thoracic cavity which includes the lungs, mammary glands, and the heart.

The various details of an ultrasound clearly shows the contours of the head and of the trunk of a baby fetus.  During examination, the ultrasound technician gains an image for the outside world by moving the sound wave generator over different organs that it wishes to highlight.

Who invented the first radiographic equipment?

Marie Curie created the first radiographic equipment used in medicine.  After having mounted it on a car, she traveled along the eastern French side during World War I, allowing surgeons for the first time, to rapidly and safely detect fragments of shells and bone fractures.  For this type commitment during the war, she became the first person to receive two Nobel Peace Prizes for her contribution to the knowledge of radioactive substances.  She also received the French Legion of Honor.

No tags

Penicillian has been very instrumental in shaping the allied health industry.  Once site that I have found that has a lot of good general information if you are in the allied health fields or are looking for a general allied health blog, I was impressed.  Our blog today regards the powerful agent of Penicillian.

Penicillian was originally discovered by a French medical student in 1896 and was rediscovered by bacteriologist, Andrew Fleming, in 1928.  He observed that colonies of the bacteria Staphylococcus aureus could be destroyed by a particular mold.  The mold he observed destroying the staphylococcus bacteria was Penicillium nonatum.  This observation solidified the theory that antibacterial agents exist.  Further research led to medicines capable of killing certain disease-causing bacteria inside the body.  In 1940, Howard Florey and Ernest Chain isolated the active ingredient in the Penicillium nonatum bacteria.  It wasn’t used to treat bacterial infection until they developed a powdery form of the medicine that year.

Penicillin is derived from molds that are common on bread and fruit.  It is effective at weakening the cell walls of bacteria causing the cells to rupture and die.  Penicillin is most active against gram-positive bacteria and some gram-negative bacteria.

There are four types of penicillin:

1. Basic (natural) Penicillins:  Penicillin G, Procaine, Penicillin G, Penicillin V, and  Benzathine are examples of basic penicillins.  They are the first penicillins that were introduced for medical use.
2. Penicillinase-resistant Penicillins:  Types of Penicillinase resistant penicillins include Cloxacillin, Dicloxacillin, Methicillin, Nafcillin and Oxacillin.  These have a narrow spectrum of activity compared to basic penicillins.
3. Aminopenicillins: These penicillins were the first ever discovered to be active against gram negative bacteria such as E. coli.  Examples of aminopenicillins include, Ampicillin, Amoxicillin and Bacampicillin.
4. Extended Spectrum Penicillins: Include both alpha-carboxypenicillins (carbenicillin and ticarcillin) and acylaminopenicillins (piperacillin, azlocillin, and mezlocillin).

No tags