Changes

The word kshatodara is formed by the component terms kshata and udara. The Sanskrit term kshata refers to the perforation caused by substances like sand particles. Kshatodara is caused by perforation of the intestines due entangling of the foreign substances that are consumed along with the food. Thus, the distension of the abdomen caused by the perforation of the intestines is termed as kshatodara31.  

The word kshatodara is formed by the component terms kshata and udara. The Sanskrit term kshata refers to the perforation caused by substances like sand particles. Kshatodara is caused by perforation of the intestines due entangling of the foreign substances that are consumed along with the food. Thus, the distension of the abdomen caused by the perforation of the intestines is termed as kshatodara31.  

Parisrāavi udara :

==== Parisrāavi udara ====

 

Parisrāvi and udara are the component terms of parisrāvi udara. Parisrāvi is again formed by the verb sraāi with the addition of the prefix pari. The prefix pari gives the meaning of extensive from all the sides. The verb srāvi refers to the secretion. Thus the term parisrāvi refers to the pathology of morbid flow or extensive secretion from all sides. Pathologically this illness is characterized by intestinal contents oozing into the abdomen and the abdominal contents in turn oozing into the rectum. Hence the illness is called as parisrāvi udara 32.

Parisrāvi and udara are the component terms of parisrāvi udara. Parisrāvi is again formed by the verb sraāi with the addition of the prefix pari. The prefix pari gives the meaning of extensive from all the sides. The verb srāvi refers to the secretion. Thus the term parisrāvi refers to the pathology of morbid flow or extensive secretion from all sides. Pathologically this illness is characterized by intestinal contents oozing into the abdomen and the abdominal contents in turn oozing into the rectum. Hence the illness is called as parisrāvi udara 32.

Chhidrodara:

 

==== Chhidrodara ====

 

The component terms chidra 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 chhidrodara33 [42-43].

The component terms chidra 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 chhidrodara33 [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 chidrodara34.

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 chidrodara34.

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.

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 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.

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.

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 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 accumulation of the chyle within the abdomen that does not diffuse into the rectum causes jalodara. This jalodara of chidrodara 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 chidrodara and is due to the leakage of fluids form the perforated intestines35.

The accumulation of the chyle within the abdomen that does not diffuse into the rectum causes jalodara. This jalodara of chidrodara 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 chidrodara 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.

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.

The etiopathogenesis of chidrodara 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 & 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 etiopathogenesis of chidrodara 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 & 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.

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 cause37 [43-44]

Jalodara:

 

==== Jalodara ====

 

Udaka in Sanskrit translates as fluid and udara refers to the distension of the abdomen, put together the term udakodara means distension of the abdomen due to accumulation of the fluid. According to Sanskrit literature, the word dakodara is formed by the removal of initial letter u from the word udakodara. Thus, formed word dakodara also give the same meaning of udakodara38.

Udaka in Sanskrit translates as fluid and udara refers to the distension of the abdomen, put together the term udakodara means distension of the abdomen due to accumulation of the fluid. According to Sanskrit literature, the word dakodara is formed by the removal of initial letter u from the word udakodara. Thus, formed word dakodara also give the same meaning of udakodara38.

Image 02: Sira janma in udara

Image 02: Sira janma in udara

Water intoxication and edema are the two distinct clinical implications of over hydration. Excessive intake of plain water without adequate solutes causes abnormal increase in extracellular fluid with deficient sodium. This in turn causes movement of fluid into the cell to maintain the salt balance. Thus, resulting in cellular edema which in turn causes the clinical manifestation of water intoxication and it is a fatal condition. Contrary to this over hydration with adequate intake of sodium leads to increase in the fluid within the interstitial compartment due to excess of isotonic volume excess. The water does not diffuse into the cells as the solutes hold the water in the interstitial fluid compartment. Thus this will result in the edema. This edema is due to over hydration and is comparable to jalodara.  

Water intoxication and edema are the two distinct clinical implications of over hydration. Excessive intake of plain water without adequate solutes causes abnormal increase in extracellular fluid with deficient sodium. This in turn causes movement of fluid into the cell to maintain the salt balance. Thus, resulting in cellular edema which in turn causes the clinical manifestation of water intoxication and it is a fatal condition. Contrary to this over hydration with adequate intake of sodium leads to increase in the fluid within the interstitial compartment due to excess of isotonic volume excess. The water does not diffuse into the cells as the solutes hold the water in the interstitial fluid compartment. Thus this will result in the edema. This edema is due to over hydration and is comparable to jalodara.

Over hydration is observed in different clinical situations. As fluid supplementation is recommended in patients suffering from gastro enteritis, an excess of fluid intake may lead to over hydration. Identical to this, excessive fluid intake after any of the purification procedure may have similar sequel.  Psychogenic polydipsia characterized by compulsive water drinking may sometimes lead to over hydration. This is also true in mentally challenged children. Individuals are likely to take large amount of fluids following long bouts of intensive exercise and will have the similar consequences of over hydration. Marathon runners are susceptible to excessive fluid intake while running and may prove incriminatory. Any physical activity leading to profuse sweating like working in extreme heat or humidity; may be followed by intake of excessive fluid to replace the loss. These situations with excessive fluid supplementation with adequate addition of salt and other solutes lead to edema39.

Over hydration is observed in different clinical situations. As fluid supplementation is recommended in patients suffering from gastro enteritis, an excess of fluid intake may lead to over hydration. Identical to this, excessive fluid intake after any of the purification procedure may have similar sequel.  Psychogenic polydipsia characterized by compulsive water drinking may sometimes lead to over hydration. This is also true in mentally challenged children. Individuals are likely to take large amount of fluids following long bouts of intensive exercise and will have the similar consequences of over hydration. Marathon runners are susceptible to excessive fluid intake while running and may prove incriminatory. Any physical activity leading to profuse sweating like working in extreme heat or humidity; may be followed by intake of excessive fluid to replace the loss. These situations with excessive fluid supplementation with adequate addition of salt and other solutes lead to edema39.

Edema due to isotonic volume excess is characterized by weight gain, dependent edema, pitting edema, engorged neck vein, ascites, pericardial effusion, pleural effusion, increased blood pressure and congestive cardiac failure. [47]

Edema due to isotonic volume excess is characterized by weight gain, dependent edema, pitting edema, engorged neck vein, ascites, pericardial effusion, pleural effusion, increased blood pressure and congestive cardiac failure. [47]

   

   

Image03: Raji janma in udara

Image03: Raji janma in udara

   

   

Image 04: Parivritta nābhi in udara  

Image 04: Parivritta nābhi in udara  

   

   

Image 05: Kutilopastha in udara   

Image 05: Kutilopastha in udara   

All types of udara are characterized by distension of the abdomen. Accumulation of the fluid in the abdomen is the common pathology in these conditions. But in the initial phases the collection of the fluid in the abdomen is due to the diffusion of chyle. This chyle is little as the impairment of agni is less severe. Also the little accumulation of the fluid is not detected clinically. In this state, in the absence of immediate effective treatment; morbid dosha tend to obliterate the external body channels that maintain the homeostasis of fluid in the body. The chyle is more liquefied. And more and more fluid is poured into the abdomen causing huge accumulation of the fluid in the abdomen. At this stage, accumulation of the fluid is clinically detected.  Accordingly, the udara roga is distinguished into three stages. Identification of these stages is important and immediate energetic treatment should be planned lest all udara finally land in jalodara. Condition of ajātodaka, picchā and jātodaka are the three stages of udara .

All types of udara are characterized by distension of the abdomen. Accumulation of the fluid in the abdomen is the common pathology in these conditions. But in the initial phases the collection of the fluid in the abdomen is due to the diffusion of chyle. This chyle is little as the impairment of agni is less severe. Also the little accumulation of the fluid is not detected clinically. In this state, in the absence of immediate effective treatment; morbid dosha tend to obliterate the external body channels that maintain the homeostasis of fluid in the body. The chyle is more liquefied. And more and more fluid is poured into the abdomen causing huge accumulation of the fluid in the abdomen. At this stage, accumulation of the fluid is clinically detected.  Accordingly, the udara roga is distinguished into three stages. Identification of these stages is important and immediate energetic treatment should be planned lest all udara finally land in jalodara. Condition of ajātodaka, picchā and jātodaka are the three stages of udara .

The course of primary as well as secondary peritonitis exhibits a typical progression. Initially the peritoneum gets inflamed and is characterized by abdominal pain and associated symptoms.  This inflammation of the peritoneum is supervened by paralytic ileus. This paralytic ileus is responsible for the diminishing bowel sounds, gaseous distention of the abdomen and tympanic percussion note. This stage of peritonitis is the ajātodakavasthā of udara.

The course of primary as well as secondary peritonitis exhibits a typical progression. Initially the peritoneum gets inflamed and is characterized by abdominal pain and associated symptoms.  This inflammation of the peritoneum is supervened by paralytic ileus. This paralytic ileus is responsible for the diminishing bowel sounds, gaseous distention of the abdomen and tympanic percussion note. This stage of peritonitis is the ajātodakavasthā of udara.

As the inflammation continues gradually the fluid starts accumulating. The features of gaseous distension are going to be masked by the fluid accumulation. This phase of peritonitis is indicative of picchāvasthā of udara.  

As the inflammation continues gradually the fluid starts accumulating. The features of gaseous distension are going to be masked by the fluid accumulation. This phase of peritonitis is indicative of picchāvasthā of udara.  

Further as the fluid accumulates, the patient develops the complete symptoms of ascites that include horse shoe dullness, shifting dullness and fluid thrill. This stage of peritonitis is considered as jātodakāvasthā of udara40 [48-49].

Further as the fluid accumulates, the patient develops the complete symptoms of ascites that include horse shoe dullness, shifting dullness and fluid thrill. This stage of peritonitis is considered as jātodakāvasthā of udara40 [48-49].

Current management:

Current management: