Crohn’s Nutrition Guide

Organ System Defined

Modified Barium Swallow
In this lesson, students will explore systems; they will think about their schools as systems, focusing on a social rather than scientific understanding of the concept. Refer to the Calcium Page for more information. The overuse of antimicrobials is beginning to be discouraged as scientific evidence is emerging to support the use of other therapies. Water is absorbed here and the remaining waste matter is stored prior to defecation. When mixed with water, it forms a gelatinous mass that carries ingesta along the GI tract.

Children and Teens

What Are Probiotics?

Guide to Pesticides in Produce ]. Some researchers say not to worry about pesticides. Apple seeds, also called pips, contain a substance called amygdalin, which can release cyanide, a powerful poison, when it comes into contact with digestive enzymes.

Whole seeds will pass through your digestive system relatively untouched, but if you chew the seeds you may be exposed to the toxins. One or two will not be harmful, as the body can handle small doses of cyanide, but if you or a child chews and swallows a lot of seeds, you should seek medical attention immediately. A very large helping of apple seeds may be fatal. How many seeds are harmful? Apples seeds contain about mg of cyanide per kilogram; so about grams of apple seeds would be enough to kill a kg pound adult.

However, a seed weighs 0. Apples typically have about eight pips, so you'd have to eat the seeds of 18 apples in one sitting to get a fatal dose.

He manages articles that explain scientific concepts, describe natural phenomena and define technical terms. Previously, he was a Technology Editor at nytimes.

He was also a copy editor at several newspapers. Before joining Purch, Tim was a developmental editor at the Hazelden Foundation. He has a journalism degree from the University of Kansas. Live Science Health Reference: Apples may help reduce the risk of cancer, cardiovascular disease and diabetes.

Nutrition Facts Serving size: Health risks "Eating apples in excess will not cause many side effects," said Flores. Apples and pesticides "Most apples will have pesticides on them, unless they are certified organic," Flores said. Are apple seeds poisonous? Apples come in all shades of red, green and yellow. There are 7, varieties, or cultivars, of apples grown throughout the world.

There are 2, varieties of apples grown in the United States. Apples are grown in all 50 states. In , China led the world in commercial apple production with 24,, metric tons, followed by the United States with 4,, metric tons.

Total apple production in the United States in was In , 58 percent of the apples produced in the United States were grown in Washington state, 11 percent in New York, 8 percent in Michigan, 5 percent in Pennsylvania, 4 percent in California and 2 percent in Virginia.

That was 24 percent of the total U. The Red Delicious variety is the most widely grown apple in the United States, with 62 million bushels harvested in Commercial grade wax is applied to many apples after they are harvested and cleaned.

These waxes are made from natural ingredients. Apple consumption In , the average U. Sixty-three percent of the U. Also in , 36 percent of apples were processed into apple products, Apples were also used in the making of baby food, apple butter or jelly, and vinegar. A "peck" of apples weighs A bushel of apples weighs about 42 lbs. It takes about 36 apples to create one gallon of apple cider. The Lady or Api apple is one of the oldest varieties in existence.

Archeologists have found evidence that humans have enjoyed apples since at least B. Charred apples have been found in prehistoric dwellings in Switzerland.

Consequently, conditions that impede the normal aboral movement of gas and fluid through the small intestine may result in severe dilation and rupture of the stomach. Because of its position, the stomach is difficult to visualize with radiography or ultrasonography in large adult horses. The smaller size of the foal, however, permits assessment of gastric emptying by contrast radiography. The small intestine comprises the duodenum, jejunum, and ileum, with the latter joining the cecum at a distinct ileocecal junction.

Consequently, the duodenum is not involved in small-intestinal displacements involving the mesentery volvulus. At the base of the cecum in the right paralumbar fossa region, the duodenum turns toward the midline. It is at this point that the duodenum, if distended with gas or fluid eg, in horses with proximal enteritis , can be felt on rectal examination. As the small intestine reaches the dorsal midline, it turns anteriorly, its mesentery lengthens, and it becomes known as the jejunum.

The characteristic long mesentery allows loops of the jejunum to rest on the contents of the ventral portion of the abdomen. At the end of the jejunum, the wall of the intestine becomes more muscular, the lumen is narrowed, and an additional mesenteric attachment becomes apparent. The last 18 in. This junction is identified by the attachment of the ileocecal fold from the ileum to the dorsal band of the cecum. This ileocecal fold is used as a landmark to locate the ileum during abdominal surgery.

The cecum is 4—5 ft 1. Under the influence of the cecal musculature, the ingesta in the cecum is massaged, mixed with microorganisms capable of digesting cellulose, and eventually passed through the cecocolic opening into the right ventral colon.

The attachment of the cecum to the dorsal body wall is wide, thus minimizing the likelihood the cecum can become displaced or twisted on its own. The right ventral colon is divided into sacculations that help mix and retain plant fibers until they are digested.

It is positioned on the ventral aspect of the abdomen, extending from the flank region to the rib cage. The ventral colon then turns toward the left, becoming the sternal flexure and then the left ventral colon. The left ventral colon, which also is large and sacculated, passes caudally to the left flank area.

Near the pelvic region, the diameter of the colon decreases markedly, and the colon folds back on itself. This region, called the pelvic flexure, is the initial portion of the unsacculated left dorsal colon.

Presumably because of the abrupt decrease in diameter, the junction between the left ventral colon and pelvic flexure is the most common location for impactions. Equine GI anatomy relevant to colic, median section. The diameter of the dorsal colon is largest either at its diaphragmatic flexure or in the right dorsal colon. There are no sacculations in either the left or right portion of the dorsal colon. The right dorsal colon is closely attached to the right ventral colon by a short intercolic fold and to the body wall by a tough, common mesenteric attachment with the base of the cecum.

In contrast, neither the left ventral nor left dorsal colons are attached directly to the body wall, allowing these portions of the colon to become displaced or twisted. The transverse colon is located cranial to the cranial mesenteric artery. Finally, the ingesta enters the sacculated descending colon, which is 10—12 ft 3—3. The celiac and cranial mesenteric arteries branches of the abdominal aorta supply blood to the GI tract. The celiac artery supplies arterial blood to the stomach, pancreas, liver, spleen, and the first portion of the duodenum.

The cranial mesenteric artery supplies arterial blood to the remaining portion of the duodenum; to all of the jejunum, ileum, cecum, large colon, and transverse colon; and to the first portion of the descending colon. Because the large colon is attached to the body wall only in the region near the cranial mesenteric artery, the blood supplying all portions of the colon must traverse the entire length of the colon.

The pelvic flexure receives its blood supply from two branches of the cranial mesenteric artery; one branch supplies the right and left dorsal colons before reaching the pelvic flexure, and the other branch supplies the right and left ventral colons before reaching the pelvic flexure. Thus, volvulus of the large colon near the junction of the colon and cecum may impede the flow of blood to the entire left colon. The major branches of the cranial mesenteric artery can be damaged by the migrating forms of Strongylus vulgaris see Large Strongyles in Horses.

There are several natural openings or spaces within the abdominal cavity that can be important in conditions causing colic. The inguinal canal provides an opening through which intestine might pass and become trapped. Although inguinal hernias are common in young foals, they rarely cause clinical problems; the situation is considerably different in stallions. Similarly, if the ventral abdominal wall fails to form properly around the umbilicus, an opening remains and the potential exists for intestinal problems to develop secondary to an umbilical hernia.

The epiploic foramen, a natural opening between the portal vein, the caudal vena cava, and the caudate lobe of the liver, can be the site of intestinal incarcerations. Finally, there is a natural space between the dorsal aspect of the spleen and the left kidney. This space is bounded by the renosplenic ligament, a strong band of tissue that connects the dorsomedial aspect of the spleen with the fibrous capsule of the left kidney.

Normograde peristalsis in the left ventral colon moves ingesta toward the left dorsal colon, and the muscles in the wall of the left dorsal colon contract to move the ingesta toward the diaphragmatic flexure. There is evidence, however, that the muscles in the left ventral colon contract in a retrograde fashion, from the pelvic flexure region toward the sternal flexure. Furthermore, these contractions appear to originate from a pacemaker region in the pelvic flexure.

It has been hypothesized that this pacemaker senses either the size or the consistency of the feed particles in the ingesta and then initiates the appropriate motility pattern. If the ingesta has been digested sufficiently, it is moved in a normograde direction; if additional digestion is necessary, the ingesta is moved in a retrograde direction to retain it in the ventral colon.

This theory has been proposed to help account for the common clinical occurrence of obstruction at or near the pelvic flexure.

Numerous clinical signs are associated with colic. The most common include pawing repeatedly with a front foot, looking back at the flank region, curling the upper lip and arching the neck, repeatedly raising a rear leg or kicking at the abdomen, lying down, rolling from side to side, sweating, stretching out as if to urinate, straining to defecate, distention of the abdomen, loss of appetite, depression, and decreased number of bowel movements.

It is uncommon for a horse with colic to exhibit all of these signs. Although they are reliable indicators of abdominal pain, the particular signs do not indicate which portion of the GI tract is involved or whether surgery will be needed. A diagnosis can be made and appropriate treatment begun only after thoroughly examining the horse, considering the history of any previous problems or treatments, determining which part of the intestinal tract is involved, and identifying the cause of the particular episode of colic.

In most instances, colic develops for one of four reasons: This stimulates the stretch-sensitive nerve endings located within the intestinal wall, and pain impulses are transmitted to the brain. Under such circumstances, proinflammatory mediators in the wall of the intestine decrease the threshold for painful stimuli.

The list of possible conditions that cause colic is long, and it is reasonable first to determine the most likely type of disease and begin appropriate treatments and then to make a more specific diagnosis, if possible.

The history of the present colic episode and previous episodes, if any, must be considered to determine whether the horse has had repeated or similar problems or whether this episode is an isolated event.

The duration of the present episode, the rate of deterioration of the horse's cardiovascular status, the severity of pain, whether feces have been passed, and the response to any treatments are important pieces of information.

The physical examination should include assessment of the cardiopulmonary and GI systems. The oral mucous membranes should be evaluated for color, moistness, and capillary refill time.

The mucous membranes may become cyanotic or pale in horses with acute cardiovascular compromise and eventually hyperemic or muddy as peripheral vasodilation develops later in shock. The membranes become dry as the horse becomes dehydrated. The heart rate increases due to pain, hemoconcentration, and hypotension; therefore, higher heart rates have been associated with more severe intestinal problems strangulating obstruction.

However, it is important to note that not all conditions requiring surgery are accompanied by a high heart rate. An important aspect of the physical examination is the response to passing a nasogastric tube.

Because horses can neither regurgitate nor vomit, adynamic ileus, obstructions involving the small intestine, or distention of the stomach with gas or fluid may result in gastric rupture. If fluid reflux occurs, the volume and color of the fluid should be noted. In healthy horses, it is common to retrieve The abdomen and thorax should be auscultated and the abdomen percussed.

The abdomen should be auscultated over several areas cecum on the right, small intestine high on the left, colon lower on both the right and left. Intestinal sounds associated with episodes of pain may indicate an intraluminal obstruction eg, impaction, enterolith. Gas sounds may indicate ileus or distention of a viscus. Fluid sounds may indicate impending diarrhea associated with colitis.

A complete lack of sounds is usually associated with adynamic ileus or ischemia. Percussion helps identify a grossly distended segment of intestine cecum on right, colon on left that may need to be trocarized. The respiratory rate may be increased due to fever, pain, acidosis, or an underlying respiratory problem. Diaphragmatic hernia is also a possible cause of colic. The most definitive part of the examination is the rectal examination.

The veterinarian should develop a consistent method of palpating for the following: The intestine should be palpated for size, consistency of contents gas, fluid, or impacted ingesta , distention, edematous walls, and pain on palpation. In healthy horses, the small intestine cannot be palpated; with small-intestinal obstruction, strangulating obstruction, or enteritis, the distended duodenum can be palpated dorsal to the base of the cecum on the right side of the abdomen, and distended loops of jejunum can be identified in the middle of the abdomen.

A sample of peritoneal fluid obtained via paracentesis performed aseptically on midline often reflects the degree of intestinal damage. The color, cell count and differential, and total protein concentration should be evaluated. Normal peritoneal fluid is clear to yellow, contains The age of the horse is important, because a number of age-related conditions cause colic.

The more common of these include the following: Ultrasonographic evaluation of the abdomen may help differentiate between diseases that can be treated medically and those that require surgery. The technique also can be applied transrectally to clarify findings noted on rectal palpation. In foals, echoes from the large colon and small intestine are commonly identified from the ventral abdominal wall, whereas only large-colon echoes are usually seen in adult horses.

The large colon can be identified by its sacculated appearance. The duodenum can be identified in the tenth intercostal space and traced around the caudal aspect of the right kidney.

The jejunum is rarely identified during transabdominal ultrasonographic examination of normal adult horses, whereas the thick-walled ileum can be identified by transrectal examination. The most common abnormalities identified by ultrasonography include inguinal hernia, renosplenic entrapment of the large colon, sand colic, intussusception, enterocolitis, right dorsal colitis, and peritonitis. Stallions with inguinal hernia have incarcerated intestine on the affected side; it is possible to identify the intestine and to obtain information concerning the thickness of its wall as well as the presence or lack of peristalsis.

In horses with renosplenic entrapment of the large colon, the tail of the spleen or the left kidney cannot be imaged, or the gas-filled large colon is present in the caudodorsal aspect of the abdomen in the region of the renosplenic space.

Horses with sand colic have granular hyperechoic echoes originating from the affected portion of the colon. Very often the intestine proximal to the intussusception is distended, and the strangulated portion is thickened. Horses with enterocolitis frequently have evidence of hyperperistalsis, thickened areas of the bowel wall, and fluid distention of the intestine. In contrast, horses with right dorsal colitis commonly have marked thickening of the wall of the right dorsal colon.

In horses with peritonitis, the peritoneal fluid may be anechoic, or there may be evidence of flocculent material and fibrin between serosal surfaces of the viscera. Horses with colic may need either medical or surgical treatments. Almost all require some form of medical treatment, but only those with certain mechanical obstructions of the intestine need surgery. The type of medical treatment is determined by the cause of colic and the severity of the disease.

In some instances, the horse may be treated medically first and the response evaluated; this is particularly appropriate if the horse is mildly painful and the cardiovascular system is functioning normally. Ultrasonography can be used to evaluate the effectiveness of nonsurgical treatment. If necessary, surgery can be used for diagnosis as well as treatment. If evidence of intestinal obstruction with dry ingesta is found on rectal examination, a primary aim of treatment is to rehydrate and evacuate the intestinal contents.

If the horse is severely painful and has clinical signs indicating loss of fluid from the bloodstream high heart rate, prolonged capillary refill time, and discoloration of the mucous membranes , the initial aims of treatment are to relieve pain, restore tissue perfusion, and correct any abnormalities in the composition of the blood and body fluids see Table: If damage to the intestinal wall as a result of either severe inflammation or a displacement or strangulating obstruction is suspected, steps should be taken to prevent or counteract the ill effects of bacterial endotoxins that cross the damaged intestinal wall and enter the bloodstream.

Finally, if there is evidence the colic episode is caused by parasites, one aim of treatment is to eliminate the parasites. Adapted, with permission, from Zimmel DN, Management of pain and dehydration in horses with colic. In most cases of colic, pain is mild, and analgesia is all that is needed.

In these instances, the cause of colic is presumed to be spasm of intestinal muscle or excessive gas in a portion of the intestine.

If, however, the pain is due to an intestinal twist or displacement, some of the stronger analgesics may mask the clinical signs that would be useful in making a diagnosis.

For these reasons, a thorough physical examination should be completed before any medications are given. However, because horses with severe colic or pain may hurt themselves and become dangerous to people nearby, analgesics often must be given first. Additionally, many horses with less severe problems may need pain relief until the other treatments have time to be effective. Medications used commonly for abdominal pain are NSAIDs that reduce the production of prostaglandins.

When these drugs are used as recommended, their toxic effects on the kidneys and GI tract occur infrequently. Clinical experience suggests that flunixin meglumine may mask the early signs of conditions that require surgery and, therefore, must be used carefully in horses with colic. Within a few minutes after administration, the horse stands quietly and is less responsive to pain.

Unfortunately, the effects of xylazine are short-lived, and it inhibits intestinal muscular activity; it also decreases cardiac output and thus reduces blood flow to the tissues. Of the narcotic analgesics, butorphanol is used most often in horses with colic. Butorphanol has few adverse effects on the GI tract or heart.

However, when given in large doses, narcotics can cause excitement, and the horse may become unstable. Although pain relief usually is provided by analgesics, there are other important ways to reduce the degree of pain. For example, passing a nasogastric tube also an important part of the diagnostic evaluation may remove any fluid that has accumulated in the stomach because of an obstruction of the small intestine.

The removal of this fluid not only relieves pain from gastric distention but also prevents rupture of the stomach. Horses with displacement of the colon over the renosplenic ligament ie, left dorsal displacement of the colon may benefit from administration of phenylephrine.

This drug is given to contract the spleen and often is followed by light exercise on a lunge line in an effort to dislodge the entrapped colon. Many horses with colic benefit from fluid therapy to prevent dehydration and maintain blood supply to the kidneys and other vital organs. The fluids may be given either through the nasogastric tube or IV, depending on the particular intestinal problem see General Concepts Regarding Fluid Needs in Dehydrated Horses.

Horses with strangulating obstruction or enteritis must be given fluids IV, because absorption of fluids from the diseased intestine is impaired and fluid may be secreted into the lumen of the intestine.

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