Ka Paʻi Fecal Koʻikoʻi i ka poʻe ʻelemakule: No ke aha e uhi ai ka wai "Overflow Diarrhea" i kahi poloka-paʻakikī a me ka pilikia o ka ʻōpū o ka ʻōpū.¶

Ke hoʻomaka koke ka ʻeleʻele ʻeleʻele, ʻeleʻele, ʻeleʻele, ma hope o ka hana ʻana, dementia, a i ʻole opioid i mālama ʻia i ka wai ʻeleʻele i loko o kā lākou pōkole makua i kēlā me kēia 30 mau minuke, hiki i nā mea mālama ʻohana a me nā mea kōkua kahu hānai ʻike ʻole i nā manawa a pau e loaʻa i ka mea like: "He maʻi ʻōpū a i ʻole ka maʻi maʻi ʻo Mama; ka ma'i ma'i, a oki i ka hā'awi 'ana aku i nā mea ho'oma'ema'e stool."

I ka lāʻau lapaʻau geriatric, hiki i kēlā kuhi hewa ke make. Aia a hiki i ka 70 pakeneka o ka home kahu hānai a me ka poʻe ʻelemakule, ʻaʻole i hoʻopaʻa ʻia ka fecal fecal hikiwawe, ʻoi aku ma hope o 4 a 10 mau lā o ka neʻe ʻana o ka ʻōpū liʻiliʻi, paʻakikī, a ʻaʻole hoʻi i ʻike ʻia, ʻo ia ka "Overflow Diarrhea" (encopresis): he wai maloʻo, calcified, pōhaku paʻa i loko o ka fecaloma. vault a i ʻole ʻāpana sigmoid e like me ka ʻōmole i loko o ka ʻōmole. Ma muli o ka hiki ʻole o ka ʻili paʻa ke hele ma mua o ka paʻa ʻana, hoʻomoʻa ka bacteria colonic i ka pahu i hoʻopaʻa ʻia ma luna o ke plug i loko o ke kinoea wai ʻino a me ka mucus, e ʻomi ana a puni nā ʻaoʻao o ka pōhaku-paʻa paʻa a kahe i waho me ka makemake ʻole. Inā hāʻawi ʻoe i kēlā loperamide kiʻekiʻe (Imodium) no ka hoʻopale ʻana i ka ʻōpū, a inā ʻoe e ninini ** i nā laxatives hoʻoikaika waha (senna, bisacodyl, magnesium citrate) i loko o ko lākou ʻōpū mai luna mai e hoʻoikaika ikaika i ka ʻōpū o luna e ʻoki ikaika i ka pōhaku ʻāʻī ʻaʻole hiki ke hoʻoneʻe ʻia, ʻo ka ischemic, pepa ʻiʻo ʻiʻo paʻa paʻa paʻa ma luna o ka fecal mass paʻakikī hiki ke haehae (stercoral ulceration and stercoral perforation), e hoʻolei ana i nā feces maka i loko o ka ʻōpū o ka ʻōpū a hoʻoulu i ka ** fecal peritonitis a me ka 5%. Inā loaʻa i kahi kanaka makua i manaʻo ʻia ʻo ka constipation a i ʻole ka maʻi pāpaʻi ʻana i ka ʻōpū oolea/e like me ka papa, ka ʻeha ʻōpū nui, ka luaʻi ʻana (ʻoi aku ka luaʻi ʻōmaʻomaʻo ʻeleʻele a i ʻole ka luaʻi ʻeleʻele ʻeleʻele), ke kahe koko, hypotension, a i ʻole huikau nui, e kelepona i kāu helu ulia pōpilikia.911 ma ʻAmelika Hui Pū ʻIa a me Kanada, 112 ma waena o ka European Union, 999 ma United Kingdom) a i ʻole e nīnau i kā mākou helu pilikia papa kuhikuhi. No nā ulia pōpilikia pili kino, e nānā huikau koke i ka poʻe ʻelemakule: ʻo UTI urosepsis vs. stroke a no ke aha e nele ai ka maʻi maʻi ʻelemakule, ʻO ka delirium o ka haukapila a me ke kākoʻo olakino no ka poʻe ʻelemakule, a polypharmacy, overdose lāʻau lapaʻau, hala hala, a me nā hewa hoʻonohonoho pila.

E hana i kēia i kēia manawa¶

1. ** MAI hāʻawi i ka lāʻau anti-diarrheal (Imodium / loperamide, Lomotil / diphenoxylate-atropine, a i ʻole Pepto-Bismol / bismuth) i ke kanaka makua i hoʻoheheʻe koke ʻia ka wai a hiki i ka nānā ʻana o ke kauka no ka hoʻopā ʻana i ka fecal.** Hāʻawi Imodium i ka mea ma'i me ka paradoxical overflow diarrhea e ho'opale loa i ka colonic motility, e ho'ohuli ana i ka hopena o ka fecal i loko o ke ke'ake'a nui a i 'ole ka megacolon 'ona.
2. ** ʻAʻole hāʻawi i ka mea hoʻoikaika kino ORAL a i ʻole nā ​​​​laxative osmotic kiʻekiʻe (Senna, Dulcolax / nā papa bisacodyl waha, Magnesium Citrate nā ʻōmole, Castor Oil, a i ʻole Golytely / high-dose PEG-3350) mai luna mai MAMUA o ka nānā ʻana a hoʻomaʻemaʻe ʻia ka plug rectal haʻahaʻa mai lalo.** Ke hoʻopaʻa nei kahi fecaloma paʻakikī pōhaku i ka ʻāʻī, e koi ana i ka ʻāʻī o luna e ʻoki ikaika mai luna mai e hoʻokuʻu pololei i ke kaomi hydraulic i ka paia sigmoid ischemic (stercoral perforation). ** Rula o Geriatric Gastroenterology: E hoʻomaʻemaʻe mau i ka hopena o ka fecal mai BELOW mua (lubricated digital disimpaction + oil-retention/warm-water enema) ma mua o ka hāʻawi ʻana i nā laxative waha mai luna mai.**
3. E nānā i ka 5 "Stercoral Colitis / Bowel Perforation Emergency Red Flags" e koi ana i kahi huakaʻi kaʻa kaʻa koke i ka Halemai ER no kahi CT Scan Abdominal:
4. ʻO ka ʻeha nui, ʻeha a i ʻole ka ʻeha ʻōpū/pelvic ʻoi, a i ʻole ka ʻōpū paʻa, ʻākea, ʻoluʻolu (kaʻi peritoneal).
5. Nausea mau a me ka luaʻi (hiki ʻole ke mālama i ka wai, a i ʻole ka luaʻi ʻana i ka bile ʻōmaʻomaʻo ʻeleʻele a i ʻole ka wai pilau ʻeleʻele).
6. ʻO ke koko ʻulaʻula ʻulaʻula a i ʻole ke koko ʻeleʻele ʻeleʻele e hele ana mai ka ʻāʻī (ischemic stercoral ulcer bleeding).
7. ʻAʻole hiki ke hele i ke kinoea (flatus) i hui pū ʻia me ka ʻōpū a me ka hanu pāpaʻu wikiwiki.
8. ʻO ka delirium / huikau, ka puʻuwai wikiwiki (>100 bpm), ke koko haʻahaʻa, ke kuni, a i ʻole ka hypothermia (<36.0°C / 96.8°F).
9. E nānā inā he "Urinary Retention" ko ke kanaka makua (ʻaʻole hiki iā ia ke pipi a i ʻole ka ʻū ʻana o ka mimi liʻiliʻi) ma ka ʻaoʻao o ka puka ʻana o ka ʻōpū. Ma ke pelvis o kahi ʻelemakule, ua paʻi kino ʻia ka **urethra a me ka ʻāʻī o ka ʻāʻī ** i ka iwi pubic ma hope, e ālai ana i ka kahe ʻana o ka mimi a me ka hoʻoulu ʻana i ka kiʻi.
10. Noi i ka ʻaoʻao moe haʻahaʻa "Digital Rectal Exam (DRE)" e kekahi kahu ola kino/hospice home, kauka kipa, a i ʻole mālama koʻikoʻi/ER clininic i kēia lā. Lawe ʻia ke kauka ma lalo o 15 kekona me ka manamana lima lubricated e ʻike inā he pālolo paʻakikī a i ʻole pōhaku paʻakikī paha e noho ana i loko o ka ʻaoʻao: ʻO ka ʻāʻī haʻahaʻa i hiki ke loaʻa i ka manamana lima lima lima, ʻoiai he 30 pakeneka e noho kiʻekiʻe aʻe i ka ** sigmoid colon** a koi i ka ʻōpū X-ray a i ʻole CT scan e ʻike ai).
11. Inā loaʻa i ka mea maʻi ka maʻi puʻuwai, ka moʻolelo pacemaker/arrhythmia, a i ʻole e lawe i nā beta-blockers, e nānā no ka "Vasovagal Drop" (hoʻolohi koke ka puʻuwai a me ka maule) i ka wā o ka rectal disimpaction, a ʻaʻole loa e hoʻohana i ka "Fleet Sodium Phosphate Enema" ma ANY senior ma mua o 65 makahiki.

lāʻau hoʻoholo: ka hoʻāʻo palekana ʻana o ka hopena i manaʻo ʻia he fecal impaction vs. infectious diarrhea¶

flowchart TD
    A["Hoʻokumu ʻo Senior i ka lele ʻana o ka wai wai ('Diarrhea'), ʻo ka ʻōpū o ka ʻōpū, delirium, a ʻaʻole i hala i kahi waihona i hoʻokumu ʻia i loko o 4+ mau lā."] --> B{"Loaʻa nā Hae ʻulaʻula i ka ʻōpū / keakea? (Ka ʻeha ʻōpū nui, ʻoʻoleʻa ka ʻōpū, ka luaʻi ʻana, ke kahe ʻana o ke koko, ke kuni, a i ʻole ka hypotension)"}
    B -->|"ʻAe: ʻO kēlā me kēia 1 Hae ʻulaʻula i loaʻa"| C["KALE 911 / HELE KOE I KA HOSPITAL ER (Hawi i ka ZERO meaʻai, ZERO wai, ZERO laxatives, a me ZERO Imodium ma ka waha)"]
    C --> D["ER Protocol: Non-Contrast/IV-Contrast CT Scan of Abdomen & Pelvis to Rule Out Stercoral Colitis, Volvulus, or Perforation -> IV Fluids, NG Decompression, & Monitored Disimpaction"]
    B -->|"ʻAʻole: ʻAʻole palupalu ka ʻōpū, ʻaʻohe luaʻi, ʻaʻohe koko, paʻa nā mea ola."| E["Hoʻopiʻi i ka PARADOXICAL OVERFLOW DIARRHEA a puni ka Fecal Impaction (Maikaʻi inā lawe ʻia nā Opioids, Iron, Calcium, a i ʻole Anticholinergics)"]
    E --> F["Loaʻa i ke kahu hānai a i ʻole ke kauka e hana i ka hoʻomaʻamaʻa hoʻomaʻamaʻa maʻemaʻe lubricated digital (DRE)"]
    F -->|"1. ʻIke ʻia ka nui o ka moʻo paʻa i loko o ka Rectal Vault (Hoʻopilikia ʻia - 70% o nā hihia)"| G["KANAWAI 1 (MAI LOA): E hoʻopili i ka 2% Lidocaine Jelly -> Gentle Digital Fragmentation + Mineral Oil Enema (I ukali ʻia 1-2 Hours Ma hope e Warm Saline/Tap-Water Enema; NEVER Sodium Phosphate)"]
    F -->|"2. ʻAʻohe ʻo Rectal Vault, Akā, Piha ka ʻōpū i ka Stool ma Palpation/X-Ray (High Sigmoid Impaction - 30% o nā hihia)"| H["Ka Papahana Hoʻoluʻu Alakaʻi ʻia e ke Kauka: ʻO ka wai mehana kiʻekiʻe/mineral oil Enema a i ʻole Polyethylene Glycol (PEG-3350) i hoʻokaʻawale ʻia ke hoʻopau ʻia e ka X-Ray."]
    G --> I["KANAWAI 2 (MAI LU'A - MAHOPE ANA I KA HO'OMA'I O KA RECTAL PLUG): E hoʻomaka i ka mālama ʻana i kēlā me kēia lā Polyethylene Glycol (MiraLAX 17g) + Senna (Inā ma Opioids) e pale i ka hoʻi hou ʻana."]
    H --> I

Paradoxical "Overflow Diarrhea" vs. True Infectious Diarrhea: Pehea e ʻike ai i ka ʻokoʻa¶

Ma mua o kou hāʻawi ʻana i kahi kanaka makua i ka pila no ka hoʻopau ʻana i ka maʻi maʻi, a i ʻole ka laxative e hoʻomaʻemaʻe i ka constipation, e hoʻohana i kēia papa ʻaina diagnostic no ka hoʻokaʻawale ʻana i ka Paradoxical Overflow Incontinence mai ka maʻi gastroenteritis a i ʻole C. pilikia colitis:

No ke aha e make ai ka Fecal Impaction: "Stercoral Colitis" a me "Stercoral Perforation"¶

Manaʻo ka poʻe he nui i ka constipation he mea hoʻonāukiuki maikaʻi ʻole. I loko o kahi kanaka makua he 80 makahiki, ʻo ka hoʻomaʻamaʻa ʻole ʻana i ka fecal impaction he ticking surgical time bomb e holomua ana ma ʻekolu mau hanana make:

flowchart TD
    A["Ka Papa 1: Hoʻokumu ʻia ʻo Fecaloma (Nā lā 4 a 10)"] --> B["Hoʻopili mau ʻia ka wai mai ka ʻāʻī paʻa i loko o ka ʻāʻī a me ka sigmoid colon -> Paʻa ka ʻōpala i loko o kahi 'Stercoraceous Fecaloma' like me ka pōhaku ʻaʻole hiki ke hele ma ke kahawai anal."]
    B --> C["Ka Papa 2: Stercoral Colitis & Pressure Ischemia (Nā lā 7 a 14)"]
    C --> D["Paʻi ka fecaloma paʻa pōhaku i ka paia mucosal o ka rectosigmoid colon me ke kaomi ma mua o ke kahe o ke koko capillary (>32 mmHg) -> ʻoki ʻia ke kahe koko i ka paia o ka ʻōpū, e hoʻoulu ai i nā 'Pressure Ulcers' (Stercoral Ulcers) i loko o ka ʻōpū."]
    D --> E["Ka Papa 3: ʻO ka Stercoral Perforation & Fecal Peritonitis (35-50% Mortality)"]
    E --> F["Inā hāʻawi kekahi i nā laxatives hoʻoikaika waha mai luna mai (a i ʻole e hoʻomāinoino ʻia ka mea maʻi), ua hāmama ka paia o ka ʻōpū necrotic ʻoi aku ka pepa -> E kahe ana nā feces wai i loko o ka lua peritoneal sterile -> Rapid Gram-negative/anaerobic septic shock"]

Pehea e ʻike ai nā kauka i ka "Stercoral Colitis" ma kahi ER CT Scan¶

Inā ʻaʻole i loaʻa i kāu mea aloha i ka ʻōpū maoli i loko o hoʻokahi pule a ua ulu ʻo ia i ka ʻeha o ka ʻōpū, ka huikau, ke kuni, a i ʻole ke koko keʻokeʻo kiʻekiʻe a i ʻole ka pae o ka lactic acid, ** hoʻomau i ka Non-Contrast (a i ʻole IV-Contrast) CT Scan o ka ʻōpū a me ka Pelvis** ma ke Keʻena Emergency, ʻaʻole i kahi X-ray pālahalaha wale nō (KUB).

• Hōʻike ka CT scan i nā hōʻailona lekiō maʻamau ʻekolu o ** Ke hoʻomaka nei ka Stercoral Perforation**:
• Massive Fecaloma Distension: He nui, paʻa, calcified fecal mass e hoʻokaʻawale ana i ka rectosigmoid colon i >6 cm (2.4 in) anawaena.
• ** Hoʻopaʻa paʻa i ka ʻōpū o ka ʻōpū (>3 mm):** Edematous, ʻaʻa ʻia ka paia colonic i ʻōwili ʻia a puni ka fecaloma.
• Pericolonic Fat Stranding & Mucosal Discontinuity: Ka hū ʻana i loko o ka momona a puni ke kolonā (a i ʻole nā ​​ʻōpuʻu liʻiliʻi o extraluminal free air e hōʻike ana ua micro-perforated ke kolon).
• No ke aha e hoʻololi ai ka ʻike ʻana i ka Stercoral Colitis i nā mea a pau: Ke loaʻa ʻo Stercoral Colitis ma kahi CT scan, hiki i ka nānā ʻole ʻia ʻana o nā enemas hānai ma ka ʻaoʻao moe a i ʻole ka hoʻāʻo kikohoʻe makapō ikaika e hiki ke hoʻopololei i ka paia o ka ʻōpū necrotic ulcerated bowel. Pono nā poʻe maʻi me Stercoral Colitis e komo i ka haukapila, IV broad-spectrum antibiotics (e uhi ana i ka Gram-negative-negative rods), a me nā lāʻau lapaʻau palupalu. disimpaction ma kahi hoʻonohonoho nānā ʻia, a i ʻole ka laparotomy pilikia inā loaʻa ka ea manuahi.

ʻO ka protocol clinical protocol: Pehea e hoʻomaʻemaʻe ʻia ai kahi hopena fecal distal ("Mai lalo o ka mua, ʻaʻole ma luna")¶

Ke hōʻoia ʻia e ke kauka a i ʻole kahu hānai kipa ʻana i kahi ka hopena o ka fecal rectal me ka ʻole o nā hōʻailona o ka perforation, peritonitis, a i ʻole ke kahe ʻana o ke koko, eia ke kaʻina lapaʻau palekana i hoʻohana ʻia e nā maʻi maʻi a me nā kahu hānai no ka hoʻomaʻemaʻe pono ʻana i ka paʻa.

KaʻAnuʻu Hana 1: Hoʻomaʻamaʻa mua a hoʻopili i ka lubricant anesthetic topical (Kaohi ʻana i ka ʻeha a me Vasovagal Syncope)¶

• No ke aha ʻaʻole pono ʻoe e ʻae i kekahi e hana i ka "maloʻo" a i ʻole ka helu ʻole ʻana i ka manual disimpaction: ʻO ka hoʻopaʻa ʻana i ke awāwa anal a me ka rectum e hoʻoikaika i ka pelvic parasympathetic vagus nerve fibers. Ma kahi kanaka makua nawaliwali, ho'omaka koke ka 'eha o ka rectal distension i ka Vasovagal Reflex: hā'ule ka pu'uwai i nā makahiki he 30 (severe bradycardia), piʻi ke koko, a hiki i ka mea maʻi ke maule a loaʻa i ka arrhythmia naʻau ma luna pono o kahi moe.
• Ka Hoʻomākaukau Palekana:
• E hoʻonoho i ka mea maʻi me ka ʻoluʻolu ma ka Left Lateral Sims' Position (e moe ana ma ko lākou ʻaoʻao hema me ke kuli ʻākau e kūlou i luna i ka umauma, kahi e hoʻolike ai i ka ʻaʻe maoli o ka ʻāʻī a me ka piko iho).
• E nānā i ka pae o ka naʻau a me ke kahe koko ma mua o ka hoʻomaka ʻana.
• Hoʻokomo 5 to 10 mL o ka sterile 2% Lidocaine Hydrochloride Jelly (Anesthetic Lubricant) i loko o ka anal canal a me ka ʻaoʻao haʻahaʻa e hoʻohana ana i ka wēlau syringe ʻole a i ʻole ka manamana lima lima, a kali i 5 a 10 mau minuke holoʻokoʻa no ka anesthetic kūloko e hoʻopau i ka sphincter anal a hoʻomaha i ka spasm ma mua o ka hoʻāʻo ʻana e hemo.

KaʻAnuʻu Hana 2: Hoʻomaʻamaʻa i kahi pōhaku paʻakikī ma mua o ka wāwahi ʻana (Ka "Oil-Retention First" Rule)¶

• Inā paʻi ka manamana lima lima o ke kauka i ka fecaloma e like me ka palolo maloʻo a i ʻole ka sima a nui loa ʻaʻole hiki ke hele i loko o ka sphincter paʻa, mai hoʻāʻo e huki i kahi pōleʻa paʻa pōhaku nui me ka ikaika (e haehae ana i ka anal sphincter a me ka mucosa rectal).
• Ke Kaʻina Enema ʻElua (Aila Mua, Wai Pumehana ʻElua):
• ** ʻO ka mua, e hoʻokomo i kahi Enema Paʻa ʻAila (100 to 150 mL o ka aila mineral mehana a i ʻole ka aila ʻoliva):** E hoʻopaʻa ka mea maʻi i ka ʻaila i loko o ka ʻāʻī no 30 a 60 mau minuke. Komo ka aila i loko o nā māwae o ka fecaloma maloʻo, lubricates i nā paia rectal, a hoʻololi i ka sima paʻa i ka lepo palupalu.
• ** Ka lua, Gentle Digital Fragmentation ("Scissoring / Scooping"):** Ke komo ʻana i nā mīkina lima pālua i lubricated me ka wai-soluble lubricant (Surgilube / K-Y) a i ʻole 2% Lidocaine jelly, hoʻokomo ke kauka i hoʻokahi manamana lima hoʻokahi ma ka ʻaoʻao o ka paia ʻaoʻao o ka ʻaoʻao i loko o ke kikowaena palupalu o ka fecal mass, hoʻohana i ka neʻe ʻana mālie e wāwahi i nā ʻāpana liʻiliʻi, a unuhi iki ʻia, ** hoʻomaha i kēlā me kēia 2 mau minuke e hoʻomaha i ka mea maʻi a nānā i ko lākou puʻuwai**, a kū koke ka ʻeha a i ʻole ka ʻeha.
• ** ʻEkolu, ʻO ka wai wela wela haʻahaʻa, ka paʻakai maʻamau, a i ʻole ka palapala (Enemeez) Enema:** I ka wā e haki ai ka puʻupuʻu nui haʻahaʻa, e kaomi haʻahaʻa haʻahaʻa Warm Normal Saline (0.9% NaCl) a i ʻole Enema Piʻi-Wai Pumehana (250 to 500 mL, kau ʻaʻole i kiʻekiʻe aʻe ma mua o 30 to 45 cm [12 to 18 in] ma luna o nā pūhaka), a i ʻole a 5 mL Docusate Sodium (Enemeez) liʻiliʻi-enema, hoʻokahe mālie i nā ʻāpana i koe. (Mai hoʻohana i nā enemas soapsuds, hydrogen peroxide enemas, a i ʻole sodium phosphate enema, nā mea a pau e hoʻoulu ai i ka colitis kemika).

KaʻAnuʻu Hana 3: E hoʻomaka ana i ka "Daily Bowel Regimen Mai luna" (WALE ma hope o ka maopopo ʻana o ke ala haʻahaʻa)¶

I ka wā e pau loa ai ka ʻāʻī o ka ʻāʻī a hele ka mea maʻi i ka ʻūhā palupalu a me ke kinoea me ka manuahi, pono ʻoe e hoʻomaka koke i kahi Daily Preventative Bowel Regimen no ka mea, ʻo ka ʻāʻī, atonic rectum (megarectum) e hana hou i loko o 5 mau lā ke waiho ʻole ʻia.

E hoʻohālikelike i nā lāʻau lapaʻau waha e hoʻohana ai, a ʻo wai ka mea pono ʻole a weliweli paha, i nā poʻe ʻelemakule:

Nā helu ulia pōpilikia āpana a me nā protocols oihana¶

E hoʻohana i kēia mau lawelawe ulia pōpilikia, hoʻāʻo maʻi maʻi, a me nā lawelawe hānai home i ka wā e hoʻomohala ai kahi ʻelemakule i manaʻo ʻia he hopena fecal, kahe nui ʻana, a i ʻole nā ​​hae ʻulaʻula o ka ʻōpū:

• ʻAmelika Hui Pū ʻIa:
• EMS ulia pōpilikia (No ka ʻōpū ʻoʻoleʻa, ʻeha nui, luaʻi ʻana, ke kahe koko ʻana, a i ʻole Sepsis): Kāhea 911.
• Homebound / Hospice Skilled Nurse Disimpaction Visit: Inā ua kākau inoa ʻia kou makua i Medicare Home Health Care a i ʻole Hospice, e kelepona i ka 24/7 On-Call Registered Nurse (RN) Line ma mua o ka hele ʻana i ka ER no ka hopena paʻakikī ʻole; Hiki i ke olakino home a i ʻole ka hale hospice RN ke hana i kahi hōʻike hōʻike kikohoʻe kikohoʻe ma ka ʻaoʻao o kahi moe, lawelawe i ka ʻaila mineral/saline enema a i ʻole. Enemeez mini-enema, a e nānā no ka mālama ʻana i ka mimi me ka mīkini paʻi maʻi maʻi i loko o ka lumi moe o kou makua.
• Ka ʻōlelo aʻo ʻana o FDA MedWatch ma nā huahana Sodium Phosphate: E nānā i ka ʻōlelo kūhelu FDA Drug Safety Communication (Oral and Rectal Over-the-Counter Sodium Phosphate Drugs: Rare Akā Koʻikoʻi nā Risks o ka Dehydration a me Renal/Cardiac Toxicity in Old Adults) ma fda.gov.
• Kanada:
• Pūkia: Kāhea 911.
• Ka hoʻokolokolo kahu hānai 24/7 a me nā kahu mālama home (811): Kāhea 811 (Health811 ma Ontario, Info-Santé ma Quebec, HealthLink BC) a i ʻole kāu hui Home and Community Care Support Services ka hui kahu hānai wikiwiki e noi i kahi loiloi o ka ʻōpū hānai a me ka ʻōpū.
• United Kingdom:
• Pūkia: Kāhea 999 no nā hōʻailona ʻeha o ka ʻōpū/puʻu, a i ʻole e kelepona iā NHS 111 (24/7) no ka hoʻouna ʻana i ka Nā kahu hānai / Community Urgent Care Team (2-Hour Urgent Community Response - UCR) i ka home o ke kanaka makua.
• NICE Clinical Guideline on Faecal Incontinence & Impaction (CG49): Ma lalo o NICE Guideline CG49 (Faecal incontinence in adults) a me Royal College of Nursing (RCN) Bowel Care: Management of Lower Bowel Dysfunction protocols, NHS District Nurses ua aʻo ʻia e hana i ka home digital rectal examining oil, hoʻoponopono mua i ka ʻaila no ka home digital pectoral rectal examination, hoʻomaʻamaʻa mua i ka aila nullergy peʻa. aiʻole ʻaila ʻoliva e mālama ai i nā enemas** / sodium citrate (Micralax) micro-enemas, a i ʻole e hoʻomaka i kahi Macrogol (Movicol / Cosmocol / Laxido) escalating disimpaction regimen (a hiki i 8 sachets i kēlā me kēia lā i hoʻoheheʻe ʻia i loko 1 liter o ka wai ma mua o 6 mau hola ke hoʻopau ʻia ka ʻākea ʻana o ka ʻōpū.
• Uni ʻEulopa:
• Pūkia: Kāhea 112 (a i ʻole 116 117 ma Kelemānia no ke kauka kelepona hale Ärztlicher Bereitschaftsdienst, 15 / SOS Médecins ma Farani). Ma lalo o nā kūlana lāʻau lapaʻau geriatric ʻEulopa, ʻo * Macrogol 3350/4000 * ka mālama maʻamau a me ka disimpaction therapy me ka rectal * Clyss-Go / Normacol * a i ʻole nā ​​enemas e mālama ai i ka aila (e pale ana i ka hypertonic phosphate enemas i nā poʻe maʻi. >65 a i ʻole me ka hōʻino ʻana i ka renal).
• Australia a me Aotearoa:
• Pūkia: Kāhea 000 (Australia) a i ʻole 111 (Nuilani).
• Ka Hoʻokolo ʻana i nā ʻĀpana Kanaka Noho Noho / Community Nursing Triage: Ma Australia, e kelepona iā healthdirect ma 1800 022 222 a i ʻole kāu halemai kūloko Geriatric Rapid Evaluation and Treatment (GREAT) / Halemaʻi ma ka Home (HITH) hui kahu hānai kelepona; ma New Zealand, e kelepona iā Healthline ma 0800 611 116 a i ʻole kāu lawelawe kahu hānai apana no ka hoʻopau ʻana i ka home me ka hoʻohana ʻana iā Microlax (sodium citrate/lauryl sulfoacetate) aiʻole Macrogol (Movicol).
• India a me Asia-Pākīpika:
• Pūkia: Kāhea 112 aiʻole 108. No ka poʻe ʻelemakule ma ka home ma nā kūlanakauhale ʻo India, hiki i nā hui kahu hānai mālama home ke hana i ka catheterization mimi ma ka ʻaoʻao moe a me ka maʻalahi ** Liquid Paraffin / Olive Oil Retention Enemas** a ukali ʻia e kahi Glycerin a i ʻole Proctoclyss (inā wale nō ka hana maʻamau; makemake i ka saline / ʻaila mahana i ka poʻe kahiko) enema, a hoʻololi i ka mea maʻi i kēlā me kēia lā Polythylene.Pegmove / Looz-PEG) aiʻole Lactulosa (Duphalac).

Nīnau pinepine¶

Pehea e hiki ai i koʻu makua ke paʻa loa i ka wā e loaʻa ana i ka maʻi maʻi wai 6 manawa i ka lā?¶

Ua kapa ʻia kēia ʻano maʻi ʻo paradoxical overflow diarrhea (a i ʻole overflow incontinence), a ʻo ia ke kumu maʻamau o ka leaka ʻana o ka wai i ka poʻe ʻelemakule nāwaliwali, moe moe, a i ʻole nā ​​opioid. Ke wili ʻia ka ʻōpala nui a maloʻo (he fecaloma) e like me ka pahu paʻa pōhaku i loko o ka ʻāʻī, ʻaʻole hiki ke hele hou i loko. E hoʻoheheʻe ʻia ka ʻōpala i ka ʻōpala i loko o ka wai ʻeleʻele ʻala a me ka mucus, e ʻimi ana a puni nā ʻaoʻao o ka pahu paʻa pōhaku a hū me ka hiki ʻole ke hoʻopaʻa ʻia no ka mea e paʻa ana ka sphincter anal kūloko.

No ke aha he mea pōʻino ke hāʻawi ʻana i ka Imodium (loperamide) a i ʻole nā ​​laxative waha ikaika i kahi kanaka makua me ka maʻi ʻawaʻawa?¶

ʻO ka hāʻawi ʻana i ka lāʻau anti-diarrheal e like me Imodium (loperamide) i kahi kanaka makua nona ka maʻi maʻi e kahe maoli ana a puni ka fecal impaction e hoʻopale i nā ʻiʻo o ke kolonā, e hoʻohuli ana i kahi paʻa ʻāpana i loko o ka ʻōpū o ka ʻōpū a i ʻole ka megacolon ʻona. ʻO ka mea ʻē aʻe, ʻo ka hāʻawi ʻana i nā laxatives hoʻoikaika waha (e like me ka senna kiʻekiʻe, ka pills bisacodyl, a i ʻole ka magnesium citrate) mai luna mai ma mua o ka hoʻomaʻemaʻe ʻana i ka plug rectal e hoʻoikaika i ka ʻōpū o luna e ʻaelike ikaika i ka pōhaku hiki ʻole ke nahā i ka pā koko-pōloli (stercoral perforation).

No ke aha i pāpā ʻia ai nā enemas ma luna o ka counter (Sodium Phosphate) no ka poʻe ʻelemakule?¶

Loaʻa i ka hale kūʻai lāʻau maʻamau ʻo Fleet enemas ka hypertonic sodium phosphate. Ke loaʻa ka ʻenema sodium phosphate i ka ʻeleʻele sodium phosphate, ka phosphate a me ka sodium i loko o ke kahe koko. I loko o nā hola, hiki iā ia ke hoʻoulu i ka hyperphosphatemia make, hāʻule koʻikoʻi i loko o ke koko calcium (no ka hoʻopaʻa ʻana i ka naʻau a me ka tetany), a me ka hōʻole ʻole ʻana o ka puʻupaʻa. E hoʻohana mau i ka ʻenema hoʻopaʻa ʻana i ka ʻaila Minerale, kahi wai mehana maʻemaʻe a i ʻole enema paʻakai maʻamau, kahi ʻenema liʻiliʻi Docusate (Enemeez), a i ʻole kahi suppository glycerin/bisacodyl ma kahi.

He aha ka Stercoral Colitis, a i ka manawa hea e pono ai au e lawe koke i ko'u makua i ka Halemai ER?¶

Hana ʻia ka stercoral colitis i ka wā e kaomi paʻa ai ka pā o ka ʻāʻī a i ʻole ka sigmoid colon e ʻoki ai i ke kahe o ke koko capillary i ka ʻiʻo o ka ʻōpū, e hana ana i nā maʻi ʻeha necrotic hohonu i loko o ke kolone e kokoke ana e haehae (stercoral perforation). E kāhea iā 911 a hele koke i ka haukapila ER, ʻaʻole hāʻawi i ka waha, inā loaʻa ka ʻeha o ka ʻōpū o ka mea makua constipated, ka ʻōpū paʻakikī a ʻeha paha, ka luaʻi ʻana, ka ʻulaʻula ʻulaʻula a i ʻole ka maroon rectal koko, ke kuni, ka wikiwiki o ka naʻau, a i ʻole ka lethargy a me ka huikau.

No ke aha i ho'ōki ai koʻu makua i ka mimi i ka manawa like i loaʻa ai iā lāua ka hopena me ka pehu?¶

ʻO ka ʻāʻī a me ka ʻāʻī o ka ʻōpū/urethra e kū pono ana kekahi i kekahi i loko o ke pelvis iwi haiki. Ke hoʻopiha ka fecaloma nui a paʻa i ka pōhaku i ka ʻāʻī ʻāʻī, hoʻoneʻe ʻo ia i mua a hoʻopaʻa kino i ka urethra a me ka puka o ka ʻōpū i ka iwi pubic. ʻO kēia ke kumu o ka paʻa ʻana o ka mimi (he ʻōpū ʻeha a piha i ka ʻōpū e hiki ke hoʻoheheʻe wale i nā kulu o ka mimi a hoʻihoʻi i ke kaomi i loko o nā puʻupaʻa), ʻo ia hoʻi ka mea e hoʻoulu ai i ka delirium kiʻekiʻe o ka haukapila i ka poʻe ʻelemakule. Hoʻihoʻi pinepine ka hoʻomaʻemaʻe ʻana i ka fecal fecal i ka mimi maʻamau i loko o nā minuke.

No ke aha i pale ʻole ai nā lāʻau Colace (docusate) a i ʻole Metamucil fiber i ka hopena fecal o koʻu makua?¶

Ua hōʻike pinepine ʻia nā hoʻokolohua lapaʻau ʻaʻole ʻoi aku ka maikaʻi o nā capsules Docusate Sodium (Colace) waha ma mua o kahi placebo no ka pale ʻana a mālama ʻana i ka constipation i nā poʻe ʻelemakule a i ʻole nā ​​​​maʻi e lawe ana i nā lāʻau lapaʻau opioid. ʻOi aku ka maikaʻi, ʻo nā pauka fiber e like me Metamucil (psyllium) e koi i ka nui o ka wai i kēlā me kēia lā e neʻe i loko o ka ʻōpū; i loko o kahi kanaka makua moe moe e inu ana i ka wai liʻiliʻi a i ʻole ka neʻe ʻana o ka ʻōpū mai ka opioids a i ʻole ka maʻi o Parkinson, mānoanoa ka fiber psyllium i loko o ka ʻiʻo i loko o ke kolonā a hoʻoulu i ka hopena o ka fecal. E hoʻololi i kēlā me kēia lā Polyethylene Glycol 3350 (MiraLAX) i hui pū ʻia me Senna inā e lawe ana i ka opioids.

Nā alakaʻi pili¶

• Huikau koke i ka poʻe ʻelemakule: ʻo UTI urosepsis vs. stroke a no ke aha i nele ai ka poʻe maʻi i ke kuni.
• ʻO ka delirium o ka haukapila a me ke kākoʻo olakino no ka poʻe ʻelemakule
• ʻO ka Polypharmacy, ka nui o ka lāʻau lapaʻau, ka hala ʻole, a me nā hewa hoʻonohonoho pila
• ʻO ka mea maʻi o Parkinson i ka haukapila: no ke aha e nalo ai ʻo Sinemet/levodopa i ka manawa a i ʻole ka loaʻa ʻana o Haldol ke kumu o ka paʻakikī make.

Nā kumu a me ke alakaʻi kūhelu¶

• U.S. Food and Drug Administration (FDA): *FDA Drug Safety Communication: Ka ʻōlelo aʻo ʻana i nā pilikia o ka maloʻo ʻana akā ke koʻikoʻi o ka hoʻoheheʻe ʻia ʻana o ka wai, ka hāʻule ʻana o ka Renal, a me ka make me ka over-the-counter Sodium Phosphate Laxative/Enema Products i loko o nā ʻelemakule *.
• American Geriatrics Society (AGS): Hōʻano hou ʻia ʻo AGS Beers Criteria® no ka hoʻohana ʻana i ka lāʻau lapaʻau kūpono ʻole i ka poʻe ʻelemakule (Ka pale ʻana i ka Sodium Phosphate Enema, Anticholinergics, a me nā Opioid Unopposed Me ka ʻole Stimulant/Osmotic Bowel Prophylaxis).
• American College of Gastroenterology (ACG) & American Gastroenterological Association (AGA): Nā Hoʻomaʻamaʻa Hoʻomaʻamaʻa Kauka no ka mālama ʻana i ka maʻi maʻi maʻi maʻi maʻi, ʻo ka Opioid-Induced Constipation, a me Distal Fecal Impaction.
• UK National Institute for Health and Care Excellence (NICE) & Royal College of Nursing (RCN): NICE Clinical Guideline CG49 (Faecal Incontinence and Faecal Loading/Impaction in Older Adults) & RCN Digital Rectal Examination and Manual Removal of Faeces Guidance.
• ʻO ka World Society of Emergency Surgery (WSES): *Nā kuhikuhi kuhikuhi no ka hōʻoia ʻana i ka pilikia a me ka mālama ʻana i nā ʻokiʻoki / lāʻau lapaʻau o Stercoral Colitis a me Stercoral Perforation o ke Koko *.