Pneumonia

Medical Author: George Schiffman, MD

Medical Editor: Melissa Conrad Stppler, MD http://www.medicinenet.com/pneumonia/article.htm

What is pneumonia?
Pneumonia is an infection of one or both lungs which is usually caused by bacteria, viruses, or fungi. Prior to the discovery of antibiotics, one-third of all people who developed pneumonia subsequently died from the infection. Currently, over 3 million people develop pneumonia each year in the United States. Over a half a million of these people are admitted to a hospital for treatment. Although most of these people recover, approximately 5% will die from pneumonia. Pneumonia is the sixth leading cause of death in the United States.

How do people "catch pneumonia"?

Some cases of pneumonia are contracted by breathing in small droplets that contain the organisms that can cause pneumonia. These droplets get into the air when a person infected with these germs coughs or sneezes. In other cases, pneumonia is caused when bacteria or viruses that are normally present in the mouth, throat, or nose inadvertently enter the lung. During sleep, it is quite common for people to aspirate secretions from the mouth, throat, or nose. Normally, the body's reflex response (coughing back up the secretions) and their immune system will prevent the aspirated organisms from causing pneumonia. However, if a person is in a weakened condition from another illness, a severe pneumonia can develop. People with recent viral infections, lung disease, heart disease, and swallowing problems, as well as alcoholics, drug users, and those who have suffered a stroke or seizure are at higher risk for developing pneumonia than the general population. As we age, our swallowing mechanism can become impaired as does our

immune system. These factors, along with some of the negative side effects of medications, increase the risk for pneumonia in the elderly. Once organisms enter the lungs, they usually settle in the air sacs and passages of the lung where they rapidly grow in number. This area of the lung then becomes filled with fluid and pus (the body's inflammatory cells) as the body attempts to fight off the infection.

What are pneumonia symptoms and signs?

Most people who develop pneumonia initially have symptoms of a cold (upper respiratory infection, for example, sneezing, sore throat, cough), which are then followed by a high fever (sometimes as high as 104 F), shaking chills, and a cough with sputum production. The sputum is usually discolored and sometimes bloody. Depending on the location of the infection, certain symptoms are more likely to develop. When the infection settles in the air passages, cough and sputum tend to predominate the symptoms. In some, the spongy tissue of the lungs that contain the air sacs is more involved. In this case, oxygenation of the blood can be impaired, along with stiffening of the lung, which results in shortness of breath. At times, the individual's skin color may change and become dusky or purplish (a condition known as "cyanosis") due to their blood being poorly oxygenated. The only pain fibers in the lung are on the surface of the lung, in the area known as the pleura. Chest pain may develop if the outer aspects of the lung close to the pleura are involved in the infection. This pain is usually sharp and worsens when taking a deep breath and is known as pleuritic pain or pleurisy. In other cases of pneumonia, depending on the causative organism, there can be a slow onset of symptoms. A worsening cough, headaches, and muscle aches may be the only symptoms. Children and babies who develop pneumonia often do not have any specific signs of a chest infection but develop a fever, appear quite ill, and can become lethargic. Elderly people may also have few symptoms with pneumonia.

How is pneumonia diagnosed?

Pneumonia may be suspected when the doctor examines the patient and hears coarse breathing or crackling sounds when listening to a portion of the chest with a stethoscope. There may be wheezing or the sounds of breathing may be faint in a particular area of the chest. A chest X-ray is usually ordered to confirm the diagnosis of pneumonia. The lungs have several segments referred to as lobes, usually two on the left and three on the right. When the pneumonia affects one of these lobes, it is often referred to as lobar pneumonia. Some pneumonias have a more patchy distribution that does not involve specific lobes. In the past, when both lungs were involved in the infection, the term "double pneumonia" was used. This term is rarely used today. Sputum samples can be collected and examined under the microscope. Pneumonia caused by bacteria or fungi can be detected by this examination. A sample of the sputum can be grown in special incubators, and the offending organism can be subsequently identified. It is important to understand that the sputum specimen must contain little saliva from the mouth and be delivered to the laboratory fairly quickly. Otherwise, overgrowth of noninfecting bacteria from the mouth may predominate. As we have used antibiotics in a broader uncontrolled fashion, more organisms are becoming resistant to the commonly used antibiotics. These types of cultures can help in directing more appropriate therapy. A blood test that measures white blood cell count (WBC) may be performed. An individual's white blood cell count can often give a hint as to the severity of the pneumonia and whether it is caused by bacteria or a virus. An increased number of neutrophils, one type of WBC, is seen in most bacterial infections, whereas an increase in lymphocytes, another type of WBC, is seen in viral infections, fungal infections, and some bacterial infections (like tuberculosis). Bronchoscopy is a procedure in which a thin, flexible, lighted viewing tube is inserted into the nose or mouth after a local anesthetic is administered. Using this device, the doctor can directly examine the breathing passages (trachea and bronchi).

Simultaneously, samples of sputum or tissue from the infected part of the lung can be obtained. Sometimes, fluid collects in the pleural space around the lung as a result of the inflammation from pneumonia. This fluid is called a pleural effusion. If a significant amount of fluid develops, it can be removed. After numbing the skin with local anesthetic a needle is inserted into the chest cavity and fluid can be withdrawn and examined under the microscope. This procedure is called a thoracentesis. Often ultrasound is used to prevent complications from this procedure. In some cases, this fluid can become severely inflamed (parapneumonic effusion) or infected (empyema) and may need to be removed by more aggressive surgical procedures. Today, most often, this involves surgery through a tube or thoracoscope. This is referred to as video-assisted thoracoscopic surgery or VATS.

Adult Brain Tumors

http://www.medicinenet.com/adult_brain_tumors/article.htm

Adult brain tumor facts*

*Adult brain tumor facts Medically Edited by: Charles P. Davis, MD, PhD

The brain is a soft mass of tissue that has three major parts, the cerebrum, cerebellum and the brain stem, all of which are effectively surrounded and protected by the bones of the skull; the brain is the tissue that controls people's voluntary and involuntary actions.

Cancer is the unregulated growth of abnormal cells in the body (cancer cells are also termed malignant cells).

Malignant brain tumors contain cancer cells; benign brain tumors do not contain cancer cells but do contain abnormally replicating cells that do not metastasize (spread to other organs) but may still cause problems, often because of their size and are regulated to grow in a specific area.

Primary brain tumors are composed of abnormal types of brain cells with unregulated growth; the most common type is termed gliomas that arise from brain glial cells, but there are many other types (for example, astrocytomas, ependymomas, medulloblastomas and others).

Secondary brain tumors are tumors that have spread to the brain tissue, but are composed of cancer cells from other organs (for example, breast, lung).

The exact cause of brain tumors is unknown; however, people at higher risk for them are children and the elderly, white males, people with family members that have brain tumors, radiation exposure, and exposures to many different chemicals.

Symptoms of brain tumors, many of which are non-specific and occur in other diseases, may include headaches, nausea, vomiting, speech, hearing or vision changes, memory problems, personality changes and paresthesias (an abnormal sensation of the skin such as numbness, tingling, prickling, burning, or creeping on the skin that has no objective cause).

Brain tumors are diagnosed preliminarily by many methods including detailed physical exam, CT and/or MRI exams, angiograms, and X-rays; definitive diagnosis is by removing tissue from the tumor (tumor biopsy) and examining the cells microscopically.

Treatment choices for a brain tumor depends on joint decisions made by the patient and the patient's physician team (team members may include oncologists, surgeons, therapists and others the patient may choose, including other doctors who may give a second opinion); treatment methods are based on the individual's disease and may consist of surgery, chemotherapy, radiation therapy, combinations of these methods or no treatment.

Side effects of treatments are common and numerous but vary from patient to patient depending on the disease, method(s) used and the effectiveness of medications and other methods to reduce them; some of the most common side effects are weakness, nausea, edema, skin changes and hair loss but may include more serious problems such as infections, seizures, disabilities such as speech problems, mental changes and occasionally, death.

Rehabilitation is frequently included in the treatment plan; specialists like physical, occupational and speech therapists can help the patient improve.

Follow-up appointments are part of the treatment plan for brain tumors to catch any recurrent disease and to help with rehabilitation treatments.

Support groups are available to patients with brain tumors and to patients who have and are undergoing treatments; for example, the American Cancer Society, American Brain Tumor Society.

What are adult brain tumors?

Adult brain tumors are diseases in which cancer (malignant) cells begin to grow in the tissues of the brain. The brain controls memory and learning, senses (hearing, sight, smell, taste, and touch), and emotion. It also controls other parts of the body, including muscles, organs, and blood vessels. Tumors that start in the brain are called primary brain tumors.

What are metastatic brain tumors?

Often, tumors found in the brain have started somewhere else in the body and spread (metastasized) to the brain. These are called metastatic brain tumors.

What are the symptoms of an adult brain tumor?

A doctor should be seen if the following symptoms appear:

Frequent headaches. Vomiting. Loss of appetite. Changes in mood and personality. Changes in ability to think and learn. Seizures.

What tests are used to find and diagnose adult brain tumors?
Tests that examine the brain and spinal cord are used to detect (find) adult brain tumor. The following tests and procedures may be used:

CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called

computed tomography, computerized tomography, or computerized axial tomography.

MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of the brain and spinal cord. A substance called gadolinium is injected into the patient through a vein. The gadolinium collects around the cancer cells so they show up brighter in the picture. This procedure is also called nuclear magnetic resonance imaging (NMRI).

Adult brain tumor is diagnosed and removed in surgery. If a brain tumor is suspected, a biopsy is done by removing part of the skull and using a needle to remove a sample of the brain tissue. A pathologist views the tissue under a microscope to look for cancer cells. If cancer cells are found, the doctor will remove as much tumor as safely possible during the same surgery. An MRI may then be done to determine if any cancer cells remain after surgery. Tests are also done to find out the grade of the tumor.

INTESTINAL OBSTRUCTION IN ADULTS

Rolf Zelmanowicz, MD., Gastroenterology. Report of our 17-year medical experience in Gastroenterology, in which we have participated in the treatment of 500 adult acute abdomen cases, of which 80% had intestinal obstruction. . Intestinal obstruction is the partial or total interruption of transit of the alimentary bolus through the intestinal tract. Main mechanical causes

The

main

causes

for

occurrence

of

intestinal

obstruction

are:

Penyebab utama terjadinya obstruksi intestinal Adhesions (chiefly in individuals that have already undergone abdominal surgery); Adhesi (terutama pada individu yang telah menjalani operasi abdomen); Inflammation (peritonitis, Crohn's disease) Peradangan (Peritonitis, Penyakit Crohn) Tumors Tumor Invagination Invaginasi Volvulus/ twisting of loops of intestine Volvulus / loop dari intestinal yang memutar Bilious calculus (bilious ileus)

Bezoar (foreign bodies) Bezoar Postoperative (complications) post operasi (komplikasi) Worms (Ascaris) cacing (ascariasis) Abdominal herniae (internal and external) Hernia Abdominalis (internal dan external) Diverticulitis Radiation-induced enteritis Enteritis yang disebabkan radiasi Traumatisms Spastic ileus ileus spasme Non-mechanical causes penyebab non-mekanik Paralytic (adynamic) ileus, which has different clinical causes ileus paralitik (adinamik) yang mempunyai penyebab klinis yang berbeda Acute mesenteric ischemia iskemia mesenterika akut Metabolic disorders kelainan metabolik Lead poisoning (saturnism) Keracunan timbal (saturnism) Clinical characterization of intestinal obstruction The initial characteristic of an intestinal obstruction is an abdominal distension caused by accumulation of swallowed air (several daily litters), food and digestive apparatus secretions- comprised of saliva, gastric, pancreatic, bilious and intestinal fluids - which can amount up to six to eight daily litters. Therefore, food, swallowed air and secretions together, while not absorbed in the low portions of the intestine, won't be able to perform the normal intestinal transit and, consequently, will dilate the intestine, leading to a dramatic scenery of acute abdomen, known as intestinal obstruction.

This

condition

may

be

sudden

or

insidious,

primarily

depending

on:

if the intestinal lumen was completely or partially closed jika lumen intestinal itu sepenuhnya atau sebagian tertutup

if it happened suddenly - cases of twisting of the bowel, also called volvulus or strangulated hernia - or if it occurred gradually, as in postoperative adhesion cases, or due to tumors jika hal itu terjadi tiba-tiba - kasus memutar dari intestinal, juga disebut hernia volvulus atau strangulasi - atau jika terjadi secara bertahap, seperti dalam kasus adhesi pascaoperasi, atau karena tumor

Diagnosis The differential diagnosis of intestinal obstruction, despite being complex and multidisciplinary, is relatively easy to achieve by a physician knowledgeable in acute abdomen, due to the unique characteristics of the struggle between the loops and the obstacle. It's important to take action before the onset of fecaloid vomits, which are symptoms of obstruction in the low intestinal loop (distant from the stomach).

With a simple stethoscope used at abdominal examination, the physician can hear, at the same time, the patient's complaint due to colic pain (intensive, crampy pain) and the characteristic sound -the borborygmus, the rumbling noise of fluids passing - which makes it different from bilious and renal colic, where the unique sound of bowel twisting is not present.

Initially, menstrual colic and the possibility of ectopic pregnancy, imminent miscarriage, etc. must be ruled out. This data must also be looked at during the radiological examination. Acute intestinal infections, in which there's also presence of colic, are not associated to intensive abdominal distension, usually with diarrhea. Even in partial obstructions, when elimination of feces and gases may occur, the intestinal loop becomes more distended than usual as a result of air-fluid accumulation. When the obstruction is not caused by a mechanical factor, as in the case of mesenteric artery infarction (the artery that irrigates the intestine), despite the abdominal distension, in the clinical finding, colic and rumbling sounds through the intestinal lumen won't be noticed at examination - it's the so called adynamic ileus. This is associated to a very severe condition owing to vascular suffering. There's another adynamic ileus condition, which is quite rare, caused by a metabolic disorder resulting from lack of potassium.

A few situations take part in the differential diagnosis; for instance, myorcardium infarction, acute pancreatitis and herpes zoster, with strong abdominal pain and gas in the colons; in these, however, the characteristic air-fluid noises of the struggle of the bowel against the obstacle are absent. The diagnosis is comprised of tests, symptoms and signs, which guide the clinical treatment. When the mechanical obstructive condition causes vascular suffering, as in the case of volvulus (twisting of the bowel) or strangulated hernia, the patient's general status is quickly aggravated. In intestinal obstruction there's great endogenous (internal) dehydration due to fluid accumulation in the intestine.

Intestinal obstruction may occur at any age and gender. Mortality rate may range from 2% to 25% and is related to delay in obstruction removal. Partial obstructions allow us to evaluate for a longer time the best measure to take. These represent more than 50% of obstructions and most can be treated without surgical intervention. Other conditions allow us to place the patient in a better clinical status for a less risky surgical intervention. Therefore, a differential diagnosis can be achieved by a physician with experienced hearing and with adequate examinations. The clinical examination is imperative examinations only support the diagnosis.

X-ray examination

This examination may be performed in a hospital or even in a simpler facility by a trained technologist and then interpreted by a physician, if no radiologist is available. It was scientifically proven that all the air in the small intestine is simply swallowed air. The action of bacteria on non-digested food forms gas in the large intestine. In a few

hours after the obstruction, there's air enough (dark area) to allow its viewing on radiographs. The examination that supports the clinical diagnosis is the simple abdominal radiography, with the patient in an upright position (standing up). At this position, we can identify the fluid levels, which are easily viewed. By interpreting the localization of the fluid levels below the dark areas, we can arrive at conclusions and identify the obstructed region, as the loops above this region will be dilated, full of fluids and gases. The loops of intestine below the obstruction will be shrunk. As the intestines, the jejunum, the ileum and the colons have different morphological features, an experienced physician will observe that the accumulated gases draw the walls of these organs. With these signs, he can determine the possible obstruction site; for instance, if the occlusion is high or low. They also allow identifying whether the occlusion is partial or total. In total obstruction, no air is found in the colon and rectum. Fluid levels in the same loop, at different heights, demonstrate a mechanical obstruction (struggle of the loop). When these levels are at the same height, they indicate adynamia, that is, paralytic ileus. Ultrasound and magnetic resonance imaging must be used in case of doubt in the interpretation of simple abdominal radiographs. Likewise, over the last years abdominal laparoscopy has been a useful aid in the hands of experienced endoscopists. Sebagai intestinal, jejunum, ileum dan titik dua memiliki fitur morfologi yang berbeda, seorang dokter yang berpengalaman akan melihat bahwa akumulasi gas menggambar dinding organ-organ ini. Dengan tanda-tanda ini, dia bisa menentukan situs obstruksi mungkin, misalnya, jika oklusi yang tinggi atau rendah. Mereka juga memungkinkan mengidentifikasi apakah oklusi parsial atau total. Pada obstruksi total, udara tidak ditemukan di intestinal besar dan rektum. Kadar cairan pada loop yang sama, pada ketinggian yang berbeda, menunjukkan obstruksi mekanis (perjuangan loop). Ketika tingkat ini berada pada ketinggian yang sama, mereka menunjukkan adynamia, yaitu, ileus paralitik. USG dan pencitraan resonansi magnetik harus digunakan dalam kasus

keraguan dalam penafsiran radiografi abdomen sederhana. Demikian juga, selama tahun terakhir laparoskopi abdomen telah menjadi bantuan yang berguna di tangan endoscopists berpengalaman.

Ultrasound and magnetic resonance examinations must be used in case of doubt in the interpretation of simple abdominal radiographs. USG dan magnetik resonansi pemeriksaan harus digunakan dalam kasus keraguan dalam penafsiran radiografi abdomen sederhana.

In our clinical experience, we've had the chance to describe a sign of total occlusion, which we call "necklace sign", with the simple verification of small pearl-shaped amounts of residual gas in shrunken loops of intestine (after the obstruction). Dalam pengalaman klinis kami, kami punya kesempatan untuk menjelaskan tanda oklusi total, yang kita sebut "kalung tanda", dengan verifikasi sederhana kecil mutiara berbentuk jumlah gas sisa dalam loop menyusut dari intestinal (setelah obstruksi) . The possibility of extra-intestinal gas due to hollow viscus perforation (stomach and intestine) must always be ruled out. To do so, an x-ray examination must be performed. The patient lies down in lateral position, and a simple abdomen radiograph is taken with horizontal rays. If there's even a small amount of gas in the abdominal cavity, the gas will tend to go up and draw, with a sharp shadow, the upper and lateral portion of the abdomen, between the abdominal wall and the membrane involving the viscera (peritoneum). That's air outside the viscera, and the logical conclusion is that there's a perforation, which may occur, for instance, when a perforated ulcer results in peritonitis. Kemungkinan ekstra-intestinal gas karena perforasi viskus berongga (lambung dan intestinal) harus selalu dikesampingkan. Untuk melakukannya, pemeriksaan x-ray harus dilakukan. Pasien berbaring pada posisi lateral, dan radiografi abdomen yang sederhana

diambil dengan sinar horizontal. Jika ada bahkan sejumlah kecil gas dalam rongga abdomen, gas akan cenderung naik dan menggambar, dengan bayangan yang tajam, bagian atas dan lateral abdomen, antara dinding abdomen dan membran melibatkan viscera (peritoneum) . Itu udara di luar jeroan, dan kesimpulan logis adalah bahwa ada perforasi, yang mungkin terjadi, misalnya, ketika hasil perforasi ulkus di peritonitis. The use of contrasts - barium- in addition to leading to controversial results, impairs the interpretation of air-fluid levels, thus the patient, especially with upper obstruction, vomits the content, and in case of a patient presenting lower obstruction in the small intestine, the contrast takes too long to arrive at the place. Penggunaan kontras - barium di samping mengarah ke hasil yang kontroversial, merusak interpretasi udara-cairan tingkat, sehingga pasien, terutama dengan obstruksi atas, muntah konten, dan dalam kasus seorang pasien menyajikan obstruksi rendah di intestinal kecil , kontras waktu terlalu lama untuk tiba di tempat itu.

Barium will only be indicated for lower obstruction in cases of colon and rectum obstructions. Barium hanya akan diindikasikan untuk obstruksi rendah dalam kasus penghalang intestinal besar dan rektum.

Fighting delay is our main goal; therefore, in our experience, the use of barium does nothing but impairs the emergency diagnosis. Memerangi delay adalah tujuan utama kami, karena itu, dalam pengalaman kami, penggunaan barium tidak apa-apa tetapi merusak diagnosis darurat

At the same time that the diagnosis is confirmed, the patient is subjected to clinical conditions: Pada saat yang bersamaan dengan ditegakannya diagnosis, pasien mengalami kondisi klinis :

with a nasogastric probe for decompression of the upper digestive tract; dengan probe nasogastrik untuk dekompresi saluran pencernaan bagian atas; with adequate compensation of the hydro-electrolytic imbalance. dengan kompensasi yang memadai dari ketidakseimbangan hidro-elektrolitik. Based on our experience and on a recent literature research, we understand there's room for the use of long intestinal probes, particularly in upper jejunum obstructions, when the duodenum (1st portion of the intestine) is also subjected to swelling. As the duodenum has a singular irrigation in its wall, this situation causes suffering, aggravating the clinical status. The new techniques of enteroscopy help place the long probe into the upper portions of the intestine. Berdasarkan pengalaman kami dan penelitian literatur terbaru, kita memahami ada ruang untuk menggunakan probe intestinal yang panjang, terutama di jejunum bagian atas penghalang, ketika duodenum (1 bagian dari intestinal) juga dikenakan pembengkakan. Sebagai duodenum memiliki irigasi tunggal di dinding nya, situasi ini menyebabkan penderitaan, intestinal. memperparah status klinis. Teknik-teknik baru membantu enteroscopy tempat probe panjang ke bagian atas

Next, if the obstruction is total, we proceed to traditional surgery or laparoscopy. Selanjutnya, apabila obstuksinya total, dilanjutkan dengan operasi tradisional atau laparoskopi. It is unclear which the best method is - laparoscopy or laparotomy (traditional surgery). We feel that laparoscopy would be the first choice in most obstruction cases, provided that suitable screening is performed and the surgeon knows the benefits and limitations of this technique. However, we know that in many a case this will have to be converted into a traditional abdomen surgery. Tidak jelas mana metode yang terbaik adalah - laparoskopi atau laparotomi (pembedahan tradisional). Kami merasa laparoskopi yang akan menjadi pilihan pertama dalam kasus obstruksi sebagian besar, asalkan skrining yang cocok dilakukan dan ahli bedah mengetahui manfaat dan keterbatasan dari teknik ini. Namun, kita tahu bahwa dalam banyak kasus, hal ini akan harus diubah menjadi operasi abdomen tradisional.

Surgery in an intestinal obstruction patient, carried out by a physician experienced in emergencies, is highly likely to succeed in relieving such dramatic event.

Operasi pada pasien obstruksi intestinal, dilakukan oleh seorang dokter yang berpengalaman dalam keadaan darurat, sangat mungkin untuk berhasil dalam mengurangi kejadian dramatis seperti itu.

Obstructions associated with peritonitis are always treated with abdominal cavity rinsing for cleaning the infection in this cavity, in addition to obstruction removal. The peritoneum (membrane covering the intestine) defends itself in a better way when acting against the aggressor agent throughout its surface. Hambatan yang terkait dengan peritonitis selalu diperlakukan dengan rongga abdomen pembilasan untuk membersihkan infeksi dalam rongga ini, selain penghapusan obstruksi. Peritoneum (selaput yang menutupi intestinal) membela dirinya dalam cara yang lebih baik ketika bertindak melawan agresor agen seluruh permukaannya.

We always had doubts as to the use of drains in the abdominal cavity following its extensive rinsing, in peritonitis cases. The benefit of draining was small when compared to the great risk of taking an infection from the outside to the inside. Therefore, this riskbenefit equation would have us recommend not using drains. Kami selalu memiliki keraguan untuk penggunaan saluran dalam rongga abdomen berikut pembilasan yang luas, dalam kasus peritonitis. Manfaat pengeringan itu kecil jika dibandingkan dengan risiko besar mengambil infeksi dari luar ke dalam. Oleh karena itu, persamaan risiko-manfaat akan kita sarankan tidak menggunakan saluran.

We've never found an intestinal perforation exclusively due to swelling of bowel loops. Intestinal obstructions with vascular suffering are hastily referred to resection (removal) of the affected bowel loop.

Some particularities in an intestinal obstruction condition. Kami belum pernah menemukan sebuah perforasi intestinal eksklusif karena pembengkakan Penghalang intestinal dengan dari (pengangkatan) loop loop penderitaan vaskular intestinal buru-buru yang intestinal. disebut reseksi terkena.

Beberapa kekhasan dalam kondisi obstruksi intestinal.