In young children prone scanning remains a useful approach (see Chapter 71). The thick paraspinal muscles distort both the transmitted and reflected sound waves, impairing the quality of the image, and the ribs may obscure parts of the upper poles, particularly on the left. The posterior approach is rarely required in adults (except for renal biopsy localisation) as modern real-time equipment is usually able to provide adequate images from more anterior approaches. Renal length measurement: ensure longest axial length is obtained by rotating transducer around its longitudinal axis.

Renal artery origins: may be seen from a transhepatic scan in the coronal plane. If an effective bowel routine cannot be achieved with the above techniques, pulsed water irrigation has been shown to be effective for some people in decreasing the time it takes to complete a bowel routine and reducing the incidence of bowel accidents and constipation.Īccess to the right kidney: usually through the liver which acts as an acoustic window.Īccess to the left kidney: usually best from a lateral, or posterolateral approach.ĭoppler of renal vessels: initial location and targeting performed during quiet respiration, final assessment with suspended respiration. Two mechanical methods are used to evacuate the rectum: digital stimulation and digital evacuation. A bowel program should be scheduled at the same time every day, usually in the morning. The anal sphincter of an LMN bowel is typically atonic and prone to leakage of stool.Ī bowel program is a treatment plan for managing neurogenic bowel with the goal of allowing effective and efficient colonic evacuation while preventing incontinence and constipation. There is only slow stool propulsion coordinated by the intrinsically innervated myenteric plexus. In contrast, an SCI that includes destruction of the S2-S4 anterior horn cells or cauda equina produces an areflexic or lower motor neuron (LMN) bowel, in which there is no reflex-mediated colonic peristalsis. An SCI that damages segments above the sacral segments produces a reflexic or upper motor neuron (UMN) bowel, in which defecation cannot be initiated by voluntary relaxation of the external anal sphincter, although there can be reflex-mediated colonic peristalsis. The somatic pudendal nerve, also originating from segments S2-S4, innervates the external anal sphincter and pelvic floor musculature. Parasympathetic innervation to the descending colon and rectum is provided by the pelvic nerve, which exits from the spinal cord at segments S2-S4. Parasympathetic innervation to the portion of bowel extending from the esophagus to the splenic flexure of the colon, which modulates peristalsis, is provided by the vagus nerve. If there is concern that the parenchyma of the pancreas was injured, a closed-suction drain should be left in place.Ĭhen-Yu Hung, in Braddom's Rehabilitation Care: A Clinical Handbook, 2018 Bowel Management Of note, care should be taken to inspect the tail of the pancreas. The specimen is extracted in the same manner described for the right adrenal gland. Once the dissection is complete, the specimen is placed in an impermeable bag and the retroperitoneum is irrigated and inspected for hemostasis. The superior and posterior attachments to the diaphragm and retroperitoneal fat are divided. Mobilization and Detachment of the Left Adrenal Gland A.ĭissection is continued along the medial and lateral edges of the gland. Isolation and Division of the Left Adrenal Vein A.Ī dissector is used to expose the left adrenal vein circumferentially. D.ĭissection is continued inferiorly to identify the left adrenal vein, a branch of the left renal vein, which exits the gland in an inferiomedial position. The medial and lateral borders of the adrenal gland are defined using electrocautery dissection. The splenorenal ligament (between the inferior pole of the spleen and the superior pole of the kidney) is divided close to the spleen to allow medial rotation of the spleen and access to the left retroperitoneum. The splenic flexure of the colon is mobilized by dividing the splenocolic ligament, allowing retraction of the colon away from the left kidney and the inferior pole of the spleen ( Fig.

Splinex flexture