Changes

*All types of udara (enlargement of abdomen) are mostly due to tri discordance of dosha, hence treatment that alleviates all three dosha should be adapted in all types of udara.

*All types of udara (enlargement of abdomen) are mostly due to tri discordance of dosha, hence treatment that alleviates all three dosha should be adapted in all types of udara.

=== Vidhi Vimarsha ===

=== ''Vidhi Vimarsha'' ===

 

 

Malina ahāra meaning unhealthy food refers to all food articles that cause morbidity of dosha in the body when consumed3. Malina ahāra also includes unclean vegetable and other food articles4.

Malina ahāra meaning unhealthy food refers to all food articles that cause morbidity of dosha in the body when consumed3. Malina ahāra also includes unclean vegetable and other food articles4.

Excessive dryness of the body in the absence of counteracting the same by proper measures leads to the udara roga5. The disease ama causing udara  refers to the chronic perpetuation ama leads to udara roga5.  

Excessive dryness of the body in the absence of counteracting the same by proper measures leads to the udara roga5. The disease ama causing udara  refers to the chronic perpetuation ama leads to udara roga5.  

Āma as a cause of udara also refers to the consumption of uncooked foods6.  

Āma as a cause of udara also refers to the consumption of uncooked foods6.  

Severe suffering of diseases like pliha here refers to the suffering due to non availability of proper treatment predisposes to udara roga7.  

Severe suffering of diseases like pliha here refers to the suffering due to non availability of proper treatment predisposes to udara roga7.  

Morbidity of srotas refers to the mutravaha and purishavaha srotas and others that lead to the manifestation of udara roga7.

Morbidity of srotas refers to the mutravaha and purishavaha srotas and others that lead to the manifestation of udara roga7.

Travelling and other physical activities immediately after the meals are referred as irritation after the meals and are the cause of udara roga6.

Travelling and other physical activities immediately after the meals are referred as irritation after the meals and are the cause of udara roga6.

Listing of sinful acts as etiology indicates the serious unrighteousness as the potent etiology of udara roga5 [12-13].

Listing of sinful acts as etiology indicates the serious unrighteousness as the potent etiology of udara roga5 [12-13].

All the foods that are greasy, heavy for digestion or light for digestion and dry causes vidāha (burning sensation in the abdomen during the digestion of foods) or else the patient develops vidaghdājirna8 (intermediate state of digestion that caused burning)[12-15] .

All the foods that are greasy, heavy for digestion or light for digestion and dry causes vidāha (burning sensation in the abdomen during the digestion of foods) or else the patient develops vidaghdājirna8 (intermediate state of digestion that caused burning)[12-15] .

The pathogenesis mentioned earlier in the text is of all types of udara roga. The pathogenesis described here is that of the four types of udara caused by morbid dosha viz vātodara, pittodara, kaphodara and sannipātodara9 [20].

The pathogenesis mentioned earlier in the text is of all types of udara roga. The pathogenesis described here is that of the four types of udara caused by morbid dosha viz vātodara, pittodara, kaphodara and sannipātodara9 [20].

Two tier impairment of jatharāgni is mentioned as the cause of udara roga. In a patient with impaired jatharagni (digestive juices), consumption of unhealthy foods further impairs the functioning of jatharāgni. This indicates extreme impairment of jatharagni is involved in the pathogenesis of udara roga.

Two tier impairment of jatharāgni is mentioned as the cause of udara roga. In a patient with impaired jatharagni (digestive juices), consumption of unhealthy foods further impairs the functioning of jatharāgni. This indicates extreme impairment of jatharagni is involved in the pathogenesis of udara roga.

Impairment of agni is the initial state that causes indigestion and morbidity of dosha. Morbid dosha in turn further impairs the functioning of agni thus forming a vicious cycle.

Impairment of agni is the initial state that causes indigestion and morbidity of dosha. Morbid dosha in turn further impairs the functioning of agni thus forming a vicious cycle.

Morbid dosha formed by the indigestion afflicts the srotas. Constriction and dilatation are the two varieties of pathology of srotas. Dilatation leads to excessive circulation and constriction leads to decreased circulation. In the pathology of udara, srotas are obliterated due to morbid dosha. This obliteration at swedavaha srotas leads to impairment of sweating. The fluid within the sweda-vaha-srotas is deviated to udaka-vaha-srotas thereby adding to the body fluids 10-11.

Morbid dosha formed by the indigestion afflicts the srotas. Constriction and dilatation are the two varieties of pathology of srotas. Dilatation leads to excessive circulation and constriction leads to decreased circulation. In the pathology of udara, srotas are obliterated due to morbid dosha. This obliteration at swedavaha srotas leads to impairment of sweating. The fluid within the sweda-vaha-srotas is deviated to udaka-vaha-srotas thereby adding to the body fluids 10-11.

Udakavaha srotas that are coursing upwards and downwards are also being obliterated by the morbid dosha. The body fluid increased in the srotas is then deviated to the abdomen between the tvacha [skin] and māmsa [visceral tissues] causing udara roga 12.   

Udakavaha srotas that are coursing upwards and downwards are also being obliterated by the morbid dosha. The body fluid increased in the srotas is then deviated to the abdomen between the tvacha [skin] and māmsa [visceral tissues] causing udara roga 12.   

The divergence of fluids is not restricted to sweda-vaha-srotas and udaka-vaha srotas, rather rasa-vaha srotas is also obstructed. Rasa dhātu is another source of fluid in the body. This fluid is also deviated to the space between the kalā (mucus membrane) and visceral tissues in the abdomen. Thus, the fluid from the udaka-vaha srotas, sweda-vaha-srotas, rasa-vaha srotas and annavaha srotas deviates into the abdominal cavity 13.

The divergence of fluids is not restricted to sweda-vaha-srotas and udaka-vaha srotas, rather rasa-vaha srotas is also obstructed. Rasa dhātu is another source of fluid in the body. This fluid is also deviated to the space between the kalā (mucus membrane) and visceral tissues in the abdomen. Thus, the fluid from the udaka-vaha srotas, sweda-vaha-srotas, rasa-vaha srotas and annavaha srotas deviates into the abdominal cavity 13.

Fluid is diverged from the koshtha into the space between the kalā (mucus membrane) and visceral tissues in the abdomen. In the present context, the word koshtha refers to the intestines wherein digestion as well as separation of nutrient from the waste and assimilation of nutrients takes place. To be clearer the chyle formed in the intestines is diverted to the abdominal space between the kalā (mucus membrane) and visceral tissue. The accumulation of the fluid in the abdominal space is due to the diversion of fluids from the intestines, rasa, udaka(fluid) as well as sweda (sweat)13.

Fluid is diverged from the koshtha into the space between the kalā (mucus membrane) and visceral tissues in the abdomen. In the present context, the word koshtha refers to the intestines wherein digestion as well as separation of nutrient from the waste and assimilation of nutrients takes place. To be clearer the chyle formed in the intestines is diverted to the abdominal space between the kalā (mucus membrane) and visceral tissue. The accumulation of the fluid in the abdominal space is due to the diversion of fluids from the intestines, rasa, udaka(fluid) as well as sweda (sweat)13.

Diversion of fluids from the sweda-vaha, udaka-vaha, and rasa-vaha srotas is mobilized by the morbid vāta. In this pathology, the prāna vāta acts in the upper part of the trunk whereas the apāna vāta acts at the lower part of the trunk.

Diversion of fluids from the sweda-vaha, udaka-vaha, and rasa-vaha srotas is mobilized by the morbid vāta. In this pathology, the prāna vāta acts in the upper part of the trunk whereas the apāna vāta acts at the lower part of the trunk.

Since the fluid is diverted, the other body parts exhibit emaciation. Contrary to this the abdomen shows distention as the diverted fluid accumulates in the abdomen13.

Since the fluid is diverted, the other body parts exhibit emaciation. Contrary to this the abdomen shows distention as the diverted fluid accumulates in the abdomen13.

No visible srotas is involved in the diversion of fluids into the abdomen. Rather it is from the minute pores present in the intestine, fluid oozes into the abdominal space between the kalā and visceral tissues. This can be best understood by the allegory of oozing of the water stored in the new earthen pot through the invisible minute pores14. Thus, in udara, the distension of abdomen is due to the accumulation of the fluids within the space between the kalā and visceral tissues in the abdomen15 [9-11].

No visible srotas is involved in the diversion of fluids into the abdomen. Rather it is from the minute pores present in the intestine, fluid oozes into the abdominal space between the kalā and visceral tissues. This can be best understood by the allegory of oozing of the water stored in the new earthen pot through the invisible minute pores14. Thus, in udara, the distension of abdomen is due to the accumulation of the fluids within the space between the kalā and visceral tissues in the abdomen15 [9-11].

Types of udara roga:

 

==== Types of udara roga ====

 

The clinical condition of peritonitis is comparable to the udara roga in general. Clinically this is categorized into primary or secondary, acute or chronic and localized or diffuse. These are comparable to the doshaja udara that includes vataj, pittaja, kaphaja and sannipataja udara roga. Splenomegaly and hepatomegaly refers to plihodara and yakritodara respectively. Intestinal obstruction is said by the baddhagudodara (enlargement of abdomen due to gastrointestinal obstruction) and chhidrodara (abdominal enlargement due to intestinal perforation) refers to the intestinal perforation. [22]

The clinical condition of peritonitis is comparable to the udara roga in general. Clinically this is categorized into primary or secondary, acute or chronic and localized or diffuse. These are comparable to the doshaja udara that includes vataj, pittaja, kaphaja and sannipataja udara roga. Splenomegaly and hepatomegaly refers to plihodara and yakritodara respectively. Intestinal obstruction is said by the baddhagudodara (enlargement of abdomen due to gastrointestinal obstruction) and chhidrodara (abdominal enlargement due to intestinal perforation) refers to the intestinal perforation. [22]

Peritonitis caused without an apparent source of contamination of peritoneal cavity is regarded as primary peritonitis.  The spontaneous peritonitis caused due to hematogenous spread of bacterial infection into the peritoneum causing inflammation. Chronic liver disease is the most common cause of such infection. This can even happen without any underlying disease. 80 % of the patients present with fever.  Acute onset of abdominal pain is characteristic and malaise, fatigue, or encephalopathy is the other co morbidity16. The primary peritonitis caused by gram negative bacteria matches with the symptom of vataj udara. Sub acute manifestation with non pyogenic exudation causing ascites points towards the diagnosis of vātodara. Microbiology study of ascitic fluid will reveal pathogens like Escherichia coli and enterococci16 [25].

Peritonitis caused without an apparent source of contamination of peritoneal cavity is regarded as primary peritonitis.  The spontaneous peritonitis caused due to hematogenous spread of bacterial infection into the peritoneum causing inflammation. Chronic liver disease is the most common cause of such infection. This can even happen without any underlying disease. 80 % of the patients present with fever.  Acute onset of abdominal pain is characteristic and malaise, fatigue, or encephalopathy is the other co morbidity16. The primary peritonitis caused by gram negative bacteria matches with the symptom of vataj udara. Sub acute manifestation with non pyogenic exudation causing ascites points towards the diagnosis of vātodara. Microbiology study of ascitic fluid will reveal pathogens like Escherichia coli and enterococci16 [25].

Again, based on the etiology udara roga is further segregated into nija (endogenous) and agantuja (exogenous) type. Among the different types of udara roga; the types of udara caused due to erroneous food and habits and mediated through morbidity of dosha and dushya is considered as nija type of udara. Plihodara (enlargement of the spleen) and jalodara (enlargement of abdomen due to collection of fluid) are segregated as nija udara in the list of dushya dominant udara. All the four types of dosha dominant udara fall under the category of nija udara (distension of abdomen due to endogenous causes). Contrary to this the baddhodara (enlargement of abdomen due to gastrointestinal obstruction) and chidrodara (abdominal enlargement due to intestinal perforation) caused by injury of intestines due to external factors are regarded as agantu udara (distension of abdomen caused due to exogenous causes) 17 [22].

Again, based on the etiology udara roga is further segregated into nija (endogenous) and agantuja (exogenous) type. Among the different types of udara roga; the types of udara caused due to erroneous food and habits and mediated through morbidity of dosha and dushya is considered as nija type of udara. Plihodara (enlargement of the spleen) and jalodara (enlargement of abdomen due to collection of fluid) are segregated as nija udara in the list of dushya dominant udara. All the four types of dosha dominant udara fall under the category of nija udara (distension of abdomen due to endogenous causes). Contrary to this the baddhodara (enlargement of abdomen due to gastrointestinal obstruction) and chidrodara (abdominal enlargement due to intestinal perforation) caused by injury of intestines due to external factors are regarded as agantu udara (distension of abdomen caused due to exogenous causes) 17 [22].

Vātodara:

 

==== Vātodara ====

 

Initial morbidity of vāta caused by aggravated kapha during the pathogenesis of vātodara indicates that the morbidity of kapha is secondary. Thus, this secondary morbidity of kapha distinguishes the vātodara and kaphodara18 [23-24].

Initial morbidity of vāta caused by aggravated kapha during the pathogenesis of vātodara indicates that the morbidity of kapha is secondary. Thus, this secondary morbidity of kapha distinguishes the vātodara and kaphodara18 [23-24].

Since the lower part of the abdomen is the normal location of vāta, distention of the abdomen initially occur in its lower parts19.

Since the lower part of the abdomen is the normal location of vāta, distention of the abdomen initially occur in its lower parts19.

Blackish and reddish discoloration of nails, conjunctiva, mouth and dermis is pathognomonic of morbid vāta19. [25]

Blackish and reddish discoloration of nails, conjunctiva, mouth and dermis is pathognomonic of morbid vāta19. [25]

Pittodara:

 

==== Pittodara ====

 

In this pathogenesis, the morbidity of pitta is most predominant than that of vāta and kapha. It is worth mentioning here that suppression of the agni in this context implies the suppression of dhātvāgni20 [27].

In this pathogenesis, the morbidity of pitta is most predominant than that of vāta and kapha. It is worth mentioning here that suppression of the agni in this context implies the suppression of dhātvāgni20 [27].

The primary peritonitis caused by pyogenic gram positive bacteria like streptococci, and pneumococci matches with the symptom of pittaja udara. Acute presentation of the illness with rapid progression into prominently exudative ascites justifies the contention of pittodara. Microbiology study of ascitic fluid will reveal pathogens and will clinch the diagnosis21.[28]

The primary peritonitis caused by pyogenic gram positive bacteria like streptococci, and pneumococci matches with the symptom of pittaja udara. Acute presentation of the illness with rapid progression into prominently exudative ascites justifies the contention of pittodara. Microbiology study of ascitic fluid will reveal pathogens and will clinch the diagnosis21.[28]

 

Peritoneal tuberculosis is comparable to kaphodara. Chronic perpetuation of the illness with the co-morbidity of the respiratory illness justifies the same. Infection of peritoneum with Mycobacterium tuberculosis also causes peritonitis. Fever, anorexia, weakness, malaise, and weight loss are the initial constitutional manifestations. Abdominal distention then develops either because of partial intestinal obstruction or ascites.  Doughy abdomen is regarded as most classic sign of tubercular peritonitis. In most of the cases it is possible to detect the primary focus of infection in the lungs. Abdominal tenderness associates the abdominal pain. Analysis of ascitic fluid confirms exudative ascites22.[31]

Peritoneal tuberculosis is comparable to kaphodara. Chronic perpetuation of the illness with the co-morbidity of the respiratory illness justifies the same. Infection of peritoneum with Mycobacterium tuberculosis also causes peritonitis. Fever, anorexia, weakness, malaise, and weight loss are the initial constitutional manifestations. Abdominal distention then develops either because of partial intestinal obstruction or ascites.  Doughy abdomen is regarded as most classic sign of tubercular peritonitis. In most of the cases it is possible to detect the primary focus of infection in the lungs. Abdominal tenderness associates the abdominal pain. Analysis of ascitic fluid confirms exudative ascites22.[31]

Sannipātodara:

 

==== Sannipātodara ====

 

Dushyodara is another name of sannipātodara. This is not the ninth type of udara and the total number of udara remains eight23.

Dushyodara is another name of sannipātodara. This is not the ninth type of udara and the total number of udara remains eight23.

Literally the term dushya refers to the pathology of affliction. Since the illness occurs due to the affliction of rakta; it is termed as dushyodara. Or else, the mutual affliction of dosha is characteristic of sannipātodara hence is termed as dushyodara24.

Literally the term dushya refers to the pathology of affliction. Since the illness occurs due to the affliction of rakta; it is termed as dushyodara. Or else, the mutual affliction of dosha is characteristic of sannipātodara hence is termed as dushyodara24.

Wicked ladies with an intention of subjugating male partners or winning love, likely to offer food mixed with poison treated substances like menstrual blood, body dirt, hair, excreta, urine bone and nails. Person unaware of the mischief of ladies likely to consume the adulterated food offered by them and suffer from sannipātodara. Even enemies may practice adulterating the food with poison treated substances. Unknowingly, consuming such food also leads to the sannipātodara25.

Wicked ladies with an intention of subjugating male partners or winning love, likely to offer food mixed with poison treated substances like menstrual blood, body dirt, hair, excreta, urine bone and nails. Person unaware of the mischief of ladies likely to consume the adulterated food offered by them and suffer from sannipātodara. Even enemies may practice adulterating the food with poison treated substances. Unknowingly, consuming such food also leads to the sannipātodara25.

Probably the slow poisoning is attempted by the enemies. The poisons having reduced potency due to the act of environmental factors is known as dushivisha. The enemies may contaminate the food with such dushivisha. Person consuming such contaminated food suffers from sannipātodara26 [32].

Probably the slow poisoning is attempted by the enemies. The poisons having reduced potency due to the act of environmental factors is known as dushivisha. The enemies may contaminate the food with such dushivisha. Person consuming such contaminated food suffers from sannipātodara26 [32].

Intra abdominal malignancy spreading into the peritoneum causes malignant ascites. Usually it is the endometrial, colonic, gastric and pancreatic carcinoma, which may progress into peritoneal carcinomatosis. Even extra gastro intestinal malignancies like carcinoma of the breast, melanoma and lung carcinoma can cause peritoneal spread. Characteristically ascites happens in this condition in the absence of portal hypertension, tuberculosis, or right heart failure. Diagnostic paracentesis is confirmatory in this condition. More to add, the development of malignant ascites is always indicator of poor prognosis. This peritoneal carcinomatosis presenting with plethora of symptoms that matches with the symptoms pathognomonic of morbid vāta, pitta and kapha dosha, and its prognosis substantiates the consideration of sannipātodara in such cases27 [33-34].

Intra abdominal malignancy spreading into the peritoneum causes malignant ascites. Usually it is the endometrial, colonic, gastric and pancreatic carcinoma, which may progress into peritoneal carcinomatosis. Even extra gastro intestinal malignancies like carcinoma of the breast, melanoma and lung carcinoma can cause peritoneal spread. Characteristically ascites happens in this condition in the absence of portal hypertension, tuberculosis, or right heart failure. Diagnostic paracentesis is confirmatory in this condition. More to add, the development of malignant ascites is always indicator of poor prognosis. This peritoneal carcinomatosis presenting with plethora of symptoms that matches with the symptoms pathognomonic of morbid vāta, pitta and kapha dosha, and its prognosis substantiates the consideration of sannipātodara in such cases27 [33-34].

Plihodara & Yakritodara:

 

==== Plihodara and Yakritodara ====

 

The etiology, pathology and treatment of plihodara and yakritodara are identical. Thus, for the descriptive purposes these two conditions are collectively called as Yakrit-plihodara.

The etiology, pathology and treatment of plihodara and yakritodara are identical. Thus, for the descriptive purposes these two conditions are collectively called as Yakrit-plihodara.

Among the above said list of etiological factors; variety of dietary factors like sweet and greasy foods that cause affliction of rakta dhātu is the cause of achyuta plihavriddhi. All the other etiological factors are of chyuta plihavriddhi28 [35].

Among the above said list of etiological factors; variety of dietary factors like sweet and greasy foods that cause affliction of rakta dhātu is the cause of achyuta plihavriddhi. All the other etiological factors are of chyuta plihavriddhi28 [35].

The Sanskrit term chyuta refers to the act to descend and the vriddhi implies abdominal enlargement. Descent of the spleen is said to happen due to the violent jerk that happens during different physical activities. Descended spleen causes abdominal enlargement. Further this is of four types based on causative morbidity of dosha as vataj, pittaja, kaphaja and sannipataja29.

The Sanskrit term chyuta refers to the act to descend and the vriddhi implies abdominal enlargement. Descent of the spleen is said to happen due to the violent jerk that happens during different physical activities. Descended spleen causes abdominal enlargement. Further this is of four types based on causative morbidity of dosha as vataj, pittaja, kaphaja and sannipataja29.

In Sanskrit the word Achyuta refers to lack of downward displacement. Vriddhi refers to the abdominal enlargement. Put together, the word achyuta plihavriddhi refers to the abdominal enlargement due to splenic causes without its descending. The morbidity of the rakta dhātu causes enlargement of the spleen which in turn is responsible for the abdominal distension. Thus, the chyuta and achyuta type of plihodara together forms five types of plihodara29 [36].

In Sanskrit the word Achyuta refers to lack of downward displacement. Vriddhi refers to the abdominal enlargement. Put together, the word achyuta plihavriddhi refers to the abdominal enlargement due to splenic causes without its descending. The morbidity of the rakta dhātu causes enlargement of the spleen which in turn is responsible for the abdominal distension. Thus, the chyuta and achyuta type of plihodara together forms five types of plihodara29 [36].

Febrile illness of mild degree is the symptom of plihodara. Habitual consumption of food habits that cause burning sensation leads to the morbidity of rakta as well as pitta dosha. Morbid pitta dosha and rakta dhātu cause mild fever. Further loss of appetite is a clinical symptom of plihodara. Habitual consumption of abhishyandi foods causes morbidity of kapha which in turn is responsible for the impairment of agni30 [37-38].

Febrile illness of mild degree is the symptom of plihodara. Habitual consumption of food habits that cause burning sensation leads to the morbidity of rakta as well as pitta dosha. Morbid pitta dosha and rakta dhātu cause mild fever. Further loss of appetite is a clinical symptom of plihodara. Habitual consumption of abhishyandi foods causes morbidity of kapha which in turn is responsible for the impairment of agni30 [37-38].

Baddhagudodara:

 

==== Baddhagudodara ====

 

Acute or chronic intestinal obstruction due to variety of causes is comparable to baddhodara (enlargement of abdomen due to gastrointestinal obstruction). Sudden development of intestinal obstruction in an otherwise healthy person may be due to strangulation, paralytic ileus, and intussusception. Even the simple of malignant stricture of the colon, diverticulitis and pressure by a tumor can cause obstruction. Impaction of masses of roundworms, too much cellulose like orange peel, hair balls and other foreign substances can also cause intestinal obstruction.

Acute or chronic intestinal obstruction due to variety of causes is comparable to baddhodara (enlargement of abdomen due to gastrointestinal obstruction). Sudden development of intestinal obstruction in an otherwise healthy person may be due to strangulation, paralytic ileus, and intussusception. Even the simple of malignant stricture of the colon, diverticulitis and pressure by a tumor can cause obstruction. Impaction of masses of roundworms, too much cellulose like orange peel, hair balls and other foreign substances can also cause intestinal obstruction.

Rare cause of gastro intestinal obstruction is by the bezoars.  The concretions of the foreign materials that are retained in the gastrointestinal tract for long is termed as bezoar. This can happen in all locations from esophagus to anus. The ingestion of fruits and vegetable consisting of indigestible fibers leading concretion of the same in gastro intestinal tract is known as phytobezoar. It is observed that consumption of food articles like apples, grapes, oranges, cherries, raisins, bran, oats, cabbage, potato peels, peanuts, and celery can cause phytobezoar. Also the phytobezoar formed from the excessive consumption of persimmons (Diospyros kaki) is known as diospyrobezoar and is a subtype of phytobezoar. More to add items such as plastic, paper, string, or styrofoam are also known to cause bezoars. The swallowed hair in the gastrointestinal tract can form concretions and is termed as trichobezoar. Medicines getting solidified with the gastrointestinal lumen are known by the name pharmacobezoar. The risk of formation of bezoar is increased with inadequate mastication, missing teeth, or poorly fitting dentures. These remain asymptomatic until they cause obstruction of the gastrointestinal tract.  

Rare cause of gastro intestinal obstruction is by the bezoars.  The concretions of the foreign materials that are retained in the gastrointestinal tract for long is termed as bezoar. This can happen in all locations from esophagus to anus. The ingestion of fruits and vegetable consisting of indigestible fibers leading concretion of the same in gastro intestinal tract is known as phytobezoar. It is observed that consumption of food articles like apples, grapes, oranges, cherries, raisins, bran, oats, cabbage, potato peels, peanuts, and celery can cause phytobezoar. Also the phytobezoar formed from the excessive consumption of persimmons (Diospyros kaki) is known as diospyrobezoar and is a subtype of phytobezoar. More to add items such as plastic, paper, string, or styrofoam are also known to cause bezoars. The swallowed hair in the gastrointestinal tract can form concretions and is termed as trichobezoar. Medicines getting solidified with the gastrointestinal lumen are known by the name pharmacobezoar. The risk of formation of bezoar is increased with inadequate mastication, missing teeth, or poorly fitting dentures. These remain asymptomatic until they cause obstruction of the gastrointestinal tract.  

Clinical presentations include absolute constipation, no passing of the flatus. This is true even after repeated enemata. Abdominal pain initially referred to umbilicus. Eventually the abdominal pain turns into colicky in nature due to strong peristalsis trying to overcome the obstruction. Tenderness is little. Since the beginning the patient will have projectile vomiting. Vomitus consists of food particles initially and then bile follows and finally stercoraceous with fecal odor. Abdominal distention is noticed, more in the flanks in colonic obstruction and will be seen in the central abdomen if, the obstruction is in the intestines. Peristalsis may be visible. Gradually the patient develops the constitutional symptoms like prostration, thready rapid pulse. Urine is diminished. Obstruction located in proximal intestines may cause tetany [39-41].

Clinical presentations include absolute constipation, no passing of the flatus. This is true even after repeated enemata. Abdominal pain initially referred to umbilicus. Eventually the abdominal pain turns into colicky in nature due to strong peristalsis trying to overcome the obstruction. Tenderness is little. Since the beginning the patient will have projectile vomiting. Vomitus consists of food particles initially and then bile follows and finally stercoraceous with fecal odor. Abdominal distention is noticed, more in the flanks in colonic obstruction and will be seen in the central abdomen if, the obstruction is in the intestines. Peristalsis may be visible. Gradually the patient develops the constitutional symptoms like prostration, thready rapid pulse. Urine is diminished. Obstruction located in proximal intestines may cause tetany [39-41].

Kshatodara:

 

==== Kshatodara ====

 

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.