Changes

==== ''Chhidrodara'' ====

==== ''Chhidrodara'' ====

The component terms ''chhidra'' and ''udara'' together forms ''chhidrodara''. '''Chhidra''' refers to perforation and ''udara'' refers to distension of the abdomen. Thus, the illness characterized by the perforation of the intestines is known as ''chhidrodara''33 [42-43].

The component terms ''chhidra'' and ''udara'' together forms ''chhidrodara''. '''Chhidra''' refers to perforation and ''udara'' refers to distension of the abdomen. Thus, the illness characterized by the perforation of the intestines is known as ''chhidrodara''<ref>Tadataka Yamada, textbook of gastroenterology, 5th edition, volume 1, 2009 Blackwell Publishing. ISBN: p 3413, pg no 1078</ref> [42-43].

The foreign substances consumed with the food may traverse along the length of intestines without hurting it. At times these foreign substances may traverse across the length and hurt the intestines leading to perforation. Thus, if the foreign substances traverse along the length of the intestines without hurting, then the patient do not suffer from the ''chhidrodara''34.

The foreign substances consumed with the food may traverse along the length of intestines without hurting it. At times these foreign substances may traverse across the length and hurt the intestines leading to perforation. Thus, if the foreign substances traverse along the length of the intestines without hurting, then the patient do not suffer from the ''chhidrodara''. Foreign substances consumed along with food causes perforation of the intestines. Even consumption of excessive food and yawing with excessive stretching of the body may lead to perforation. The intestines contain liquid chyle consisting of both nutrients and waste. This liquid leaks out of the intestines through the rent caused by the perforation into the space between the abdominal skin and flesh. Note that, fluids also leak into the abdomen in ''doshaja udara'' but not through the rent, but by the method of diffusion. The fluid leaked out of the intestines again re-enters into the rectum. Over filled fluid with the space between the skin and viscera may re-enter into the intestines through the end of perforation. Or else the fluid may seep into the rectum. Thus, the rectum gets filled with the undigested food consisting of nutrients and waste which is defecated out<ref>Raja radha kanta deva, Shabdakalpadruma, part 2 chaukhambha Sanskrit siries, varanasi 3rd edition 1967,  P555; Pg no 226</ref>.

Foreign substances consumed along with food causes perforation of the intestines. Even consumption of excessive food and yawing with excessive stretching of the body may lead to perforation34.

The accumulation of the chyle within the abdomen that does not diffuse into the rectum causes ''jalodara''. This ''jalodara'' of ''chhidrodara'' is different from the ''jalodara''. ''Jalodara'' as type of ''udara'' is caused by distinct causes as an independent disease and the fluid accumulates by the process of diffusion. ''Jalodara'' is a phase in ''chhidrodara'' and is due to the leakage of fluids form the perforated intestines<ref>Raja radha kanta deva, Shabdakalpadruma, part 5 chaukhambha Sanskrit siries, varanasi 3rd edition 1967,  P555; Pg no 466</ref>.

The intestines contain liquid chyle consisting of both nutrients and waste. This liquid leaks out of the intestines through the rent caused by the perforation into the space between the abdominal skin and flesh. Note that, fluids also leak into the abdomen in ''doshaja udara'' but not through the rent, but by the method of diffusion34.

Since the fluid tends to occupy the dependent parts, the accumulation of the chyle in the abdomen causes distention of the lower part of the abdomen below the umbilicus<ref>Raja radha kanta deva, Shabdakalpadruma, part 2 chaukhambha Sanskrit siries, varanasi 3rd edition 1967,  P937; Pg no 482 </ref>.

The fluid leaked out of the intestines again re-enters into the rectum. Over filled fluid with the space between the skin and viscera may re-enter into the intestines through the end of perforation. Or else the fluid may seep into the rectum. Thus, the rectum gets filled with the undigested food consisting of nutrients and waste which is defecated out34.

The etiopathogenesis of ''chhidrodara'' matches with that of secondary peritonitis. Perforation with in any part of gastrointestinal tract leading to spillage of luminal contents into the peritoneal cavity causes peritonitis and is referred as secondary peritonitis. Perforation can happen in conditions like appendicitis, diverticulitis, peptic ulcer, and trauma. More to add hollow organs are more susceptible to athletic injury when they are full of waste and food products leading to peritonitis. The common pathogens causing such peritonitis include Escherichia coli, Streptococcus faecalis, Pseudomonas aeruginosa, Klebsiella mirabilis, Bacteroides fragilis, Clostridium species, and anaerobic streptococci. Also, aseptic peritonitis is possible if sterile bile, digestive juice leak into the peritoneal cavity. In this condition infection is possible later during the course of the illness.

 

The accumulation of the chyle within the abdomen that does not diffuse into the rectum causes ''jalodara''. This ''jalodara'' of ''chhidrodara'' is different from the ''jalodara''. ''Jalodara'' as type of ''udara'' is caused by distinct causes as an independent disease and the fluid accumulates by the process of diffusion. ''Jalodara'' is a phase in ''chhidrodara'' and is due to the leakage of fluids form the perforated intestines35.

 

Since the fluid tends to occupy the dependent parts, the accumulation of the chyle in the abdomen causes distention of the lower part of the abdomen below the umbilicus36.

Sudden development of abdominal pain is the initial and typical of any acute diffuse peritonitis. Characteristically it is the constant pain. Pain may be diffuse or referred to the umbilicus. At times the pain may happen at sites corresponding to the site of perforation. Patients usually lie motionless with knees drawn up which prevents stretching of nerve fibers in the peritoneal cavity. Activities like coughing and sneezing that increases the pressure within the peritoneal cavity increases pain.  During the coarse, the peritonitis may subside or localize, and accordingly the abdominal pain may show partial remission.  

Sudden development of abdominal pain is the initial and typical of any acute diffuse peritonitis. Characteristically it is the constant pain. Pain may be diffuse or referred to the umbilicus. At times the pain may happen at sites corresponding to the site of perforation. Patients usually lie motionless with knees drawn up which prevents stretching of nerve fibers in the peritoneal cavity. Activities like coughing and sneezing that increases the pressure within the peritoneal cavity increases pain.  During the coarse, the peritonitis may subside or localize, and accordingly the abdominal pain may show partial remission.  

On palpation, abdominal tenderness, voluntary guarding and involuntary abdominal rigidity, and rebound tenderness can be appreciated. Abdominal rigidity is typical and is referred as board like rigidity. This rigidity may be absent in elderly and immune-compromised patients. Hypovolemia (dry mucous membranes, tachycardia, hypotension), nausea fever and vomiting may co exist this initial phase of illness.  

On palpation, abdominal tenderness, voluntary guarding and involuntary abdominal rigidity, and rebound tenderness can be appreciated. Abdominal rigidity is typical and is referred as board like rigidity. This rigidity may be absent in elderly and immune-compromised patients. Hypovolemia (dry mucous membranes, tachycardia, hypotension), nausea fever and vomiting may co exist this initial phase of illness.  

Paralytic ileus supervenes in the pathology of peritonitis. Ileus is characterized by diminishing of the bowel sounds. Percussion note becomes tympanitic. Further as the disease advances the tachycardia progressively worsens and temperature gradually falls indicating impending peritoneal shock from bacterial toxemia and septicemia. Investigation may reveal leukocytosis. Free air under the diaphragm may be seen in an upright chest radiograph if a ruptured viscus is the cause37 [43-44]

Paralytic ileus supervenes in the pathology of peritonitis. Ileus is characterized by diminishing of the bowel sounds. Percussion note becomes tympanitic. Further as the disease advances the tachycardia progressively worsens and temperature gradually falls indicating impending peritoneal shock from bacterial toxemia and septicemia. Investigation may reveal leukocytosis. Free air under the diaphragm may be seen in an upright chest radiograph if a ruptured viscus is the cause<ref>Sushrut,  Sushruta samhita, with nibandha sangraha commentary of dhallahan & Nyayachandrika commentary of of gayadasa, yadavji trikamji , nirnaya sagar press, 1915, P713, Pgno 236</ref> [43-44]

==== ''Jalodara'' ====

==== ''Jalodara'' ====