WordNet

(medicine) cleaning a wound or body organ by flushing or washing out with water or a medicated solution
supplying dry land with water by means of ditches etc
relating to or involving the stomach; "gastric ulcer" (同)stomachic, stomachal

PrepTutorEJDIC

潅漑(かんがい) / (傷口などの)洗浄
胃の,胃に発生する

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/09/05 10:12:32」(JST)

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Gastric lavage, also commonly called stomach pumping or gastric irrigation, is the process of cleaning out the contents of the stomach. It has been used for over 200 years as a means of eliminating poisons from the stomach. Such devices are normally used on a person who has ingested a poison or overdosed on a drug such as alcohol. They may also be used before surgery, to clear the contents of the digestive tract before it is opened.

Apart from toxicology, gastric lavage (or nasogastric lavage) is sometimes used to confirm levels of bleeding from the upper gastrointestinal tract.^[1] It may play a role in the evaluation of hematemesis. It can also be used as a cooling technique for hyperthermic patients.^[2]

Technique

Gastric lavage involves the passage of a tube (such as an Ewald tube) via the mouth or nose down into the stomach followed by sequential administration and removal of small volumes of liquid. The placement of the tube in the stomach must be confirmed either by air insufflation while listening to the stomach, by pH testing a small amount of aspirated stomach contents, or x-ray. This is to ensure the tube is not in the lungs. In adults, small amounts of warm water or saline are administered and, via a siphoning action, removed again. In children, normal saline is used, as children are more at risk of developing hyponatremia if lavaged with water. Because of the possibility of vomiting, a suction device is always on hand in case of pulmonary aspiration of stomach contents. Lavage is repeated until the returning fluid shows no further gastric contents. If the patient is unconscious or cannot protect their airway then the patient should be intubated before performing lavage. The person must be put to sleep for a period of time during the operation due to its high risk of shock and hyponatremia.

Indications

Gastric lavage is used infrequently in modern poisonings and some authorities have suggested that it not be used routinely, if ever, in poisoning situations.^[3] Lavage should only be considered if the amount of poison ingested is potentially life-threatening and the procedure can be performed within 60 minutes of ingestion.^[4] Lavage is also the initial treatment for duodenal atresia in newborns, a condition where the small intestine is closed distal to the stomach, causing food and fluid to accumulate in the stomach.

Contraindications

Lavage is contraindicated when patients have a compromised, unprotected airway and in patients at risk of gastrointestinal hemorrhage or perforation. Relative contraindications include when the poisoning is due to a corrosive substance (T54), hydrocarbons (T53), or for poisons that have an effective antidote.

Complications

Many complications have been reported, although it appears serious complications are uncommon. The most dangerous risk is aspiration pneumonia, which is more likely to occur if hydrocarbons are ingested in patients without a protected airway. Other complications include laryngospasm, hypoxia, bradycardia, epistaxis, hyponatremia, hypochloremia, water intoxication, or mechanical injury to the stomach.

References

^ Gary R. Fleisher; Stephen Ludwig; Benjamin K. Silverman (2002). Synopsis of pediatric emergency medicine. Lippincott Williams & Wilkins. pp. 409–. ISBN 978-0-7817-3274-1. Retrieved 4 August 2010.
^ Laura W Kates; Erik D Schraga (12 December 2008). "Cooling Techniques for Hyperthermia: Treatment & Medication". eMedicine. Omaha, Nebraska, USA: Medscape. p. 2. Retrieved 3 Nov 2010.
^ Vale JA, Kulig K; American Academy of Clinical Toxicology; European Association of Poisons Centres and Clinical Toxicologists. (2004). "Position paper: gastric lavage". J Toxicol Clin Toxicol 42 (7): 933–43. doi:10.1081/CLT-200045006. PMID 15641639.
^ "BestBets: Method of gut decontamination".

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1. 中毒患者における胃洗浄 gastrointestinal decontamination of the poisoned patient
2. 経鼻胃管と経鼻腸管 nasogastric and nasoenteric tubes
3. 小さな創傷部の処置および洗浄 minor wound preparation and irrigation
4. 急性鉄中毒 acute iron poisoning
5. 成人における急性上部消化管出血へのアプローチ approach to acute upper gastrointestinal bleeding in adults

English Journal

Use of intravenous lipid emulsion in the resuscitation of a patient with cardiovascular collapse after a severe overdose of quetiapine.

Bartos M, Knudsen K.SourceDepartment of Anesthesia and Intensive Care Medicine, Södra Älvsborg Hospital , Borås , Sweden.
Clinical toxicology (Philadelphia, Pa.).Clin Toxicol (Phila).2013 Jul;51(6):501-504. Epub 2013 Jun 14.
Abstract Background. Quetiapine is an atypical antipsychotic medication that is increasingly being used in the treatment of psychotic disorders and depression. An overdose of quetiapine is associated with hypotension, sinus tachycardia, and sedation. The clinical effects of its overdose are often mi
PMID 23768031

Recurrent tonic-clonic seizures and coma due to ingestion of Type I pyrethroids in a 19-month-old patient.

Giampreti A, Lampati L, Chidini G, Rocchi L, Rolandi L, Lonati D, Petrolini VM, Vecchio S, Locatelli CA, Manzo L.SourceIRCCS Maugeri Foundation Clinical Institute and University of Pavia, Pavia Poison Centre and National Toxicology Information Centre , Pavia , Italy.
Clinical toxicology (Philadelphia, Pa.).Clin Toxicol (Phila).2013 Jul;51(6):497-500. Epub 2013 Jun 14.
Abstract Context. Pyrethroids are synthetic pyrethrin analogues that induce sodium-channel depolarization and hyperexcitation. Severe pyrethroid poisoning is manifested by a "Tremor Syndrome" (Type I cyano-agents) or a "Choreoathetosis/Salivation Syndrome" (Type II non cyano-agents). Very few report
PMID 23768029

Suicidal overdose with relapsing clomipramine concentrations due to a large gastric pharmacobezoar.

Magdalan J, Zawadzki M, Słoka T, Sozański T.SourceToxicological Unit, T Marciniak Hospital, Wroclaw, Poland; Department of Pharmacology, Wroclaw Medical University, Wroclaw, Poland.
Forensic science international.Forensic Sci Int.2013 Jun 10;229(1-3):e19-22. doi: 10.1016/j.forsciint.2013.03.025. Epub 2013 Apr 6.
The paper presents a case of fatal intoxication after massive sustained-release clomipramine overdosage with prolonged toxicity related to a large gastric pharmacobezoar. 42-year-old female was admitted to the toxicology unit 14h after drugs ingestion. At admission patient was deeply unconscious, re
PMID 23570967

Japanese Journal

Acute Gastric Dilatation and Acute Pancreatitis in a Patient with an Eating Disorder: Solving a Chicken and Egg Situation

Kim Hyung Hun,Park Seun Ja,Park Moo In,Moon Won
Internal Medicine 50(6), 571-575, 2011
… Abdominopelvic computed tomography scan revealed a massive gastric dilatation and completely compressed duodenum. … After nasogastric tube decompression and irrigation, her abdominal pain subsided. …
NAID 130000649887

膵膿瘍に対する経胃的超音波内視鏡下ドレナージ術に関連した瘻孔出血に対し covered Expandable Metallic Stent 留置にて止血し得た1例

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