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Listening to bowel sounds: an evidence-based practice project: nurses find that a traditional practice isn't the best indicator of returning gastrointestinal motility in patients who've undergone abdominal surgery.

Nurses' practice of listening to bowel sounds was first proposed in 1905 and continues today, largely unquestioned. The authors developed a project to determine whether any compelling evidence exists for using this method to assess for the return of gastrointestinal (GI) motility following abdominal surgery. Literature on the subject was evaluated and an assessment of nursing practice was conducted. Based on the literature review and the assessment, a nursing practice guideline was developed, implemented, and evaluated. (Note that the nursing practice guideline outlined in this article was evaluated for use with abdominal surgery patients only and has not been evaluated in and may not be appropriate for other patient populations). The results were positive and indicate that clinical parameters other than bowel sounds, such as the return of flatus and the first postoperative bowel movement, are appropriate in assessing for the return of GI motility after abdominal surgery. Bowel sound assessment was discontinued and patient outcomes were evaluated to make sure that the practice change had no adverse effect on patients' recovery.

Abdomen↗

Gut hormones and gastrointestinal motility in children with cystic fibrosis.

Intestinal dysmotility may be an important factor contributing to various gastrointestinal complications associated with cystic fibrosis. Motilin, enteroglucagon, neurotensin, and peptide YY may each play a role as endocrine hormones influencing gastrointestinal motor activity. Fasting children with cystic fibrosis (N = 8) and controls (N = 18) received a liquid nutrient test meal (fat 4 g/100 ml, protein 4 g/100 ml, carbohydrate 20 g/100 ml, 125 kcal/100 ml; 200 ml/m2) containing lactulose (5 g/100 ml), and the plasma concentrations of these peptides were studied. Mouth-to-cecum transit time was simultaneously studied using the breath H2 technique. Fasting levels of peptide YY and the postprandial response of all four peptides were significantly increased in those with cystic fibrosis. In repeat studies on those with cystic fibrosis after a period of altered pancreatic enzyme supplementation, no significant changes in peptide concentrations were observed. A rise in breath H2 permitting estimation of mouth-to-cecum transit time was noted in 17 control subjects (70-220 min, median 140). In contrast, a rise occurred in only two with cystic fibrosis after low-dose enzyme (70 and 180 min), and four after high-dose enzyme replacement (120-230 min, median 155). Altered gut hormone secretion may play a role in the pathophysiology of intestinal dysmotility in patients with cystic fibrosis.

Adolescent↗

Interdigestive gastrointestinal motility and secretion of gastric acid and pancreatic enzymes in young cigarette smokers.

The basal (interdigestive) gastrointestinal motor activity and the interdigestive gastric acid and pancreatic amylase secretion were determined in 10 young smokers (mean age 23 years) and 7 nonsmokers (mean age 26 years). There was no significant difference in the length of the interdigestive motor complex between smokers and nonsmokers, but the speed of transmission of the activity front (phase III) in the upper intestine was significantly (p less than 0.05) greater in smokers than in nonsmokers. No significant overall changes in the interdigestive gastric acid and pancreatic amylase outputs were observed between the two groups studied.

Adult↗

The effects of tramadol and fentanyl on gastrointestinal motility in septic rats.

In this study, we investigated the effects of tramadol and fentanyl on gastrointestinal transit (GIT) during acute systemic inflammation in an experimental model of cecal ligation and perforation (CLP). One-hundred-twenty male Swiss-Albino rats were divided randomly into 6 groups: Group I = sham-operated + saline; Group II = sham-operated + fentanyl; Group III = sham-operated + tramadol; Group IV = CLP + saline; Group V = CLP + fentanyl; Group VI = CLP + tramadol. Suspension of charcoal was administered as an intragastric meal to measure the GIT. GIT% (mean +/- sd) were 46.1% +/- 9.8%, 43.2% +/- 9.8%, 45.9% +/- 10.2%, 33.2% +/- 9.2%, 24.9% +/- 4.1%, and 31.8% +/- 8.4% in Groups I, II, III, IV, V, and VI, respectively. GIT% was significantly less in Group V than in Groups I, II, III, and IV (P < 0.05). The Group VI mean value was significantly lower than those of Groups I, II, and III (P < 0.05) but not different from those of Groups IV and V (P > 0.05). The antitransit effect of fentanyl was shown to have increased in the experimental sepsis model, but no decrease in GIT was obtained with tramadol. This was thought to be the result of an associated endogenic opioid system activation and receptor upregulation in sepsis.

Animals↗

[Effects of various natural prostaglandins on human gastrointestinal motility in vitro].

The effects of three natural prostaglandins, E1, E2 and F2alpha, on the human gastrointestinal tract were investigated by means of an in vitro technique. Prostaglandin F2alpha showed a stimulatory effect on all the segments examined and its activity was comparable to that of acetylcholine (threshold doses 0.5-2 mug). Prostaglandin E1 relaxed the circular muscles of the stomach (minimum active dose was 1 mug/ml) but contracted the longitudinal ones and taenia coli. Prostaglandin E2 showed an interesting inhibition of the stimulant effect of acetylchooline on circular muscles of the stomach (1 mug/ml) and a weak spasmogenic activity on the other tracts. The mechanism of action of prostaglandins has not been completely elucidated; it seems plausible to suggest a direct effect of the drugs on the smooth muscle, however the release of an unknown mediator cannot be excluded.

Gastrointestinal Motility↗

Current concepts of gastrointestinal motility and electrical activity.

The motor and electrical events in the gastrointestinal tract correlate far better than do motor activity and transit of intraluminal contents. Two types of electrical phenomenon can be recorded from the smooth muscle of the bowel, namely slow waves and action potentials. Action potentials, which are superimposed on the slow waves, initiate the gastrointestinal contractions and are directly related to changes in intraluminal pressure. The characteristics of the electrical activity in the different parts of the alimentary tract are described, these being dependent on the anatomical recording site, the animal species, and the recording technique. Alterations in motility by neural and hormonal stimuli reflect the changes that these stimuli produce in the gastrointestinal myoelectrical activity.

Action Potentials↗