Changes

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 ''udakodara''38.

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 gastroenteritis, 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 nabhi'' 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 ''ajatodaka, piccha'' and ''jatodaka'' 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 ''ajatodakavastha'' 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 ''picchavastha'' 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 =====

Type Medicine Dose Time Anupana

Type Medicine Dose Time Anupana