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Spleen
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For other uses, see Spleen (disambiguation).
This article uses anatomical terminology; for an overview, see Anatomical terminology.
It has been suggested that Red pulp be merged into this article. (Discuss) Proposed since March 2018.
Spleen
Human spleen removed from a cadaver
Spleen
Details
Precursor
Mesenchyme of dorsal mesogastrium
System
Immune system (lymphatic system and mononuclear phagocyte system)
Artery
Splenic artery
Vein
Splenic vein
Nerve
Splenic plexus
Identifiers
Latin
Lien
Greek
splḗn–σπλήν[1]
MeSH
D013154
TA
A13.2.01.001
FMA
7196
Anatomical terminology
[edit on Wikidata]
The spleen is an organ found in virtually all vertebrates. Similar in structure to a large lymph node, it acts primarily as a blood filter. The word spleen comes from Ancient Greek σπλήν (splḗn).[1]
The spleen plays important roles in regard to red blood cells (also referred to as erythrocytes) and the immune system.[2] It removes old red blood cells and holds a reserve of blood, which can be valuable in case of hemorrhagic shock, and also recycles iron. As a part of the mononuclear phagocyte system, it metabolizes hemoglobin removed from senescent red blood cells (erythrocytes). The globin portion of hemoglobin is degraded to its constitutive amino acids, and the heme portion is metabolized to bilirubin, which is removed in the liver.[3]
The spleen synthesizes antibodies in its white pulp and removes antibody-coated bacteria and antibody-coated blood cells by way of blood and lymph node circulation. A study published in 2009 using mice found that the red pulp of the spleen forms a reservoir that contains over half of the body's monocytes.[4] These monocytes, upon moving to injured tissue (such as the heart after myocardial infarction), turn into dendritic cells and macrophages while promoting tissue healing.[4][5][6] The spleen is a center of activity of the mononuclear phagocyte system and can be considered analogous to a large lymph node, as its absence causes a predisposition to certain infections.[7]
In humans the spleen is purple in color and is located in the left upper quadrant of the abdomen.[3][8]
Contents
[hide]
1 Structure
1.1 Blood supply
1.2 Development
2 Function
2.1 Red pulp
2.2 White pulp
2.3 Other
3 Clinical significance
3.1 Enlarged spleen
3.2 Spleen deflation
3.3 Decreased function
3.4 Accessory spleen
4 Society and culture
5 Other animals
6 Gallery
7 See also
8 References
9 External links
Structure[edit]
The spleen, in healthy adult humans, is approximately 7 centimetres (2.8 in) to 14 centimetres (5.5 in) in length. It usually weighs between 150 grams (5.3 oz)[9] and 200 grams (7.1 oz).[10] An easy way to remember the anatomy of the spleen is the 1×3×5×7×9×11 rule. The spleen is 1 by 3 by 5 inches (3 by 8 by 13 cm), weighs approximately 7 oz (200 g), and lies between the 9th and 11th ribs on the left hand side.
Visceral surface of the spleen
The spleen is underneath the left diaphragm, and has a smooth, convex surface that faces the diaphragm. It is underneath the ninth, tenth, and eleventh ribs. The other side of the spleen is divided by a ridge into two regions: an anterior gastric portion, and a posterior renal portion. The gastric surface is directed forward, upward, and toward the middle, is broad and concave, and is in contact with the posterior wall of the stomach. Below this it is in contact with the tail of the pancreas. The renal surface is directed medialward and downward. It is somewhat flattened, considerably narrower than the gastric surface, and is in relation with the upper part of the anterior surface of the left kidney and occasionally with the left adrenal gland.
Blood supply[edit]
Near the middle of the spleen is a long fissure, the hilum, which is the point of attachment for the gastrosplenic ligament, and the point of insertion for the splenic artery and splenic vein. There are other openings present for lymphatic vessels and nerves.
Like the thymus, the spleen possesses only efferent lymphatic vessels. The spleen is part of the lymphatic system. Both the short gastric arteries and the splenic artery supply it with blood.[11]
The germinal centers are supplied by arterioles called penicilliary radicles.[12]
Development[edit]
The spleen is unique in respect to its development within the gut. While most of the gut organs are endodermally derived (with the exception of the neural-crest derived adrenal gland), the spleen is derived from mesenchymal tissue.[13] Specifically, the spleen forms within, and from, the dorsal mesentery. However, it still shares the same blood supply—the celiac trunk—as the foregut organs.
Function[edit]
Red pulp[edit]
Micrograph of splenic tissue showing the red pulp (red), white pulp (blue) and a thickened inflamed capusule (mostly pink - top of image). H&E stain.
The spleen contains two different tissues, white pulp (A) and red pulp (B). The white pulp functions in producing and growing immune and blood cells. The red pulp functions in filtering blood of antigens, microorganisms, and defective or worn-out red blood cells.
Area
Function
Composition
red pulp Mechanical filtration of red blood cells. In mice: Reserve of monocytes[4]
"sinuses" (or "sinusoids"), which are filled with blood
"splenic cords" of reticular fibers
"marginal zone" bordering on white pulp
white pulp Active immune response through humoral and cell-mediated pathways. Composed of nodules, called Malpighian corpuscles. These are composed of:
"lymphoid follicles" (or "follicles"), rich in B-lymphocytes
"periarteriolar lymphoid sheaths" (PALS), rich in T-lymphocytes
White pulp[edit]
This section is empty. You can help by adding to it. (April 2018)
Other[edit]
Other functions of the spleen are less prominent, especially in the healthy adult:
Production of opsonins, properdin, and tuftsin.
Creation of red blood cells. While the bone marrow is the primary site of hematopoiesis in the adult, the spleen has important hematopoietic functions up until the fifth month of gestation. After birth, erythropoietic functions cease, except in some hematologic disorders. As a major lymphoid organ and a central player in the reticuloendothelial system, the spleen retains the ability to produce lymphocytes and, as such, remains a hematopoietic organ.
Storage of red blood cells, lymphocytes and other formed elements. In horses, roughly 30% of the red blood cells are stored there. The red blood cells can be released when needed.[14] In humans, up to a cup (240 ml) of red blood cells can be held in the spleen and released in cases of hypovolemia[15] and hypoxia.[16] It can store platelets in case of an emergency and also clears old platelets from the circulation. Up to a quarter of lymphocytes can be stored in the spleen at any one time.
Clinical significance[edit]
Main article: Splenic disease
Enlarged spleen[edit]
Main article: Splenomegaly
Disorders include splenomegaly, where the spleen is enlarged for various reasons, such as cancer, specifically blood-based leukemias, and asplenia, where the spleen is not present or functions abnormally.
Traumas, such as a road traffic collision, can cause rupture of the spleen, which is a situation requiring immediate medical attention.
Spleen deflation[edit]
Human spleens have been noted to decrease in volume up to 40% when subjected to stimuli from strenuous exercise or hypoxic gas inhalation.[17]
Decreased function[edit]
Asplenia refers to a non-functioning spleen, which may be congenital, damaged by trauma, or caused by disease such as sickle cell anaemia. Hyposplenia refers to a partially functioning spleen. These conditions may cause[5] a modest increase in circulating white blood cells and platelets, a diminished response to some vaccines, and an increased susceptibility to infection. In particular, there is an increased risk of sepsis from polysaccharide encapsulated bacteria. Encapsulated bacteria inhibit binding of complement or prevent complement assembled on the capsule from interacting with macrophage receptors. Phagocytosis needs natural antibodies, which are immunoglobulins that facilitate phagocytosis either directly or by complement deposition on the capsule. They are produced by IgM memory B cells (a subtype of B cells) in the marginal zone of the spleen.[18][19]
A splenectomy (removal of the spleen) also causes asplenia and results in a greatly diminished frequency of memory B cells.[20] A 28-year follow-up of 740 World War II veterans whose spleens were removed on the battlefield showed a significant increase in the usual death rate from pneumonia (6 rather than the expected 1.3) and an increase in the death rate from ischemic heart disease (41 rather than the expected 30), but not from other conditions.[21]
Accessory spleen[edit]
An accessory spleen is a small splenic nodule extra to the spleen usually formed in early embryogenesis. Accessory spleens are found in approximately 10 percent of the population[22] and are typically around 1 centimeter in diameter. Splenosis is a condition where displaced pieces of splenic tissue (often following trauma or splenectomy) autotransplant in the abdominal cavity as accessory spleens.[23]
Polysplenia is a congenital disease manifested by multiple small accessory spleens,[24] rather than a single, full-sized, normal spleen. Polysplenia sometimes occurs alone, but it is often accompanied by other developmental abnormalities such as intestinal malrotation or biliary atresia, or cardiac abnormalities, such as dextrocardia. These accessory spleens are non-functional.
Society and culture[edit]
The word spleen comes from the Ancient Greek σπλήν (splḗn), and is the idiomatic equivalent of the heart in English, i.e. to be good-spleened (εὔσπλαγχνος, eúsplankhnos) means to be good-hearted or compassionate.[25]
In English the word spleen was customary during the period of the 18th century. Authors like Richard Blackmore or George Cheyne employed it to characterise the hypochondriacal and hysterical affections.[26][27] William Shakespeare, in Julius Caesar uses the spleen to describe Cassius' irritable nature.
Must I observe you? must I stand and crouch
Under your testy humour? By the gods
You shall digest the venom of your spleen,
Though it do split you; for, from this day forth,
I'll use you for my mirth, yea, for my laughter,
When you are waspish.[28]
In French, "splénétique" refers to a state of pensive sadness or melancholy. It has been popularized by the poet Charles Baudelaire (1821–1867) but was already used before in particular to the Romantic literature (19th century). The French word for the organ is "rate".
The connection between spleen (the organ) and melancholy (the temperament) comes from the humoral medicine of the ancient Greeks. One of the humours (body fluid) was the black bile, secreted by the spleen organ and associated with melancholy. In contrast, the Talmud (tractate Berachoth 61b) refers to the spleen as the organ of laughter while possibly suggesting a link with the humoral view of the organ. In eighteenth- and nineteenth-century England, women in bad humor were said to be afflicted by the spleen, or the vapours of the spleen. In modern English, "to vent one's spleen" means to vent one's anger, e.g. by shouting, and can be applied to both males and females. Similarly, the English term "splenetic" is used to describe a person in a foul mood.
The spleen also plays an important role in Traditional Chinese Medicine and is the Yin part of the Earth element paired with its Yang counterpart the Stomach.
Other animals[edit]
Laparoscopic view of a horse's spleen (the purple and grey mottled organ)
In cartilaginous and ray-finned fish, it consists primarily of red pulp and is normally somewhat elongated, as it lies inside the serosal lining of the intestine. In many amphibians, especially frogs, it has the more rounded form and there is often a greater quantity of white pulp.[29]
In reptiles, birds, and mammals, white pulp is always relatively plentiful, and in birds and mammals the spleen is typically rounded, but it adjusts its shape somewhat to the arrangement of the surrounding organs. In most vertebrates, the spleen continues to produce red blood cells throughout life; only in mammals this function is lost in adults. Many mammals have tiny spleen-like structures known as haemal nodes throughout the body that are presumed to have the same function as the spleen.[29] The spleens of aquatic mammals differ in some ways from those of fully land-dwelling mammals; in general they are bluish in colour. In cetaceans and manatees they tend to be quite small, but in deep diving pinnipeds, they can be quite massive, due to their function of storing red blood cells.
The only vertebrates lacking a spleen are the lampreys and hagfishes (the Cyclostomata). Even in these animals, there is a diffuse layer of haematopoeitic tissue within the gut wall, which has a similar structure to red pulp and is presumed to be homologous with the spleen of higher vertebrates.[29]
In mice the spleen stores half the body's monocytes so that upon injury, they can migrate to the injured tissue and transform into dendritic cells and macrophages and so assist wound healing.[4]
Gallery[edit]
Transverse section of the spleen, showing the trabecular tissue and the splenic vein and its tributaries.
Back of lumbar region, showing surface markings for kidneys, ureters, and spleen.
Side of thorax, showing surface markings for bones, lungs (purple), pleura (blue), and spleen (green).
Spleen
See also[edit]
Marginal zone
Asplenia with cardiovascular anomalies
References[edit]
^ Jump up to: a b σπλήν, Henry George Liddell, Robert Scott, A Greek-English Lexicon, on Perseus Digital Library
Jump up ^ Darling, David. "spleen". www.daviddarling.info.
^ Jump up to: a b Mebius, RE; Kraal, G (2005). "Structure and function of the spleen". Nature Reviews. Immunology. 5 (8): 606–16. doi:10.1038/nri1669. PMID 16056254.
^ Jump up to: a b c d Swirski, FK; Nahrendorf, M; Etzrodt, M; Wildgruber, M; Cortez-Retamozo, V; Panizzi, P; Figueiredo, JL; Kohler, RH; Chudnovskiy, A; Waterman, P; Aikawa, E; Mempel, TR; Libby, P; Weissleder, R; Pittet, MJ (2009). "Identification of splenic reservoir monocytes and their deployment to inflammatory sites". Science. 325 (5940): 612–6. doi:10.1126/science.1175202. PMC 2803111  . PMID 19644120.
^ Jump up to: a b Jia, T; Pamer, EG (2009). "Immunology. Dispensable but not irrelevant". Science. 325 (5940): 549–50. doi:10.1126/science.1178329. PMC 2917045  . PMID 19644100.
Jump up ^ Finally, the Spleen Gets Some Respect By NATALIE ANGIER, The New York Times, August 3, 2009
Jump up ^ Brender, Erin (2005-11-23). Richard M. Glass, ed. Illustrated by Allison Burke. "Spleen Patient Page" (PDF). Journal of the American Medical Association. American Medical Association. 294 (20): 2660. doi:10.1001/jama.294.20.2660. PMID 16304080. Retrieved 2008-03-20.
Jump up ^ Loscalzo, Joseph; Fauci, Anthony S.; Braunwald, Eugene; Dennis L. Kasper; Hauser, Stephen L; Longo, Dan L. (2008). Harrison's principles of internal medicine. McGraw-Hill Medical. ISBN 978-0-07-146633-2.
Jump up ^ eMedicine > Splenomegaly Author: David J Draper. Coauthor(s): Ronald A Sacher, Emmanuel N Dessypris, Lewis J Kaplan. Updated: Oct 4, 2009
Jump up ^ Spielmann, Audrey L.; David M. DeLong; Mark A. Kliewer (1 January 2005). "Sonographic Evaluation of Spleen Size in Tall Healthy Athletes". American Journal of Roentgenology. American Roentgen Ray Society. 184: 45–49. doi:10.2214/ajr.184.1.01840045. PMID 15615949. Retrieved 2008-09-09.
Jump up ^ Blackbourne, Lorne H (2008-04-01). Surgical recall. Lippincott Williams & Wilkins. p. 259. ISBN 978-0-7817-7076-7.
Jump up ^ "Penicilliary radicles". Medical-dictionary.thefreedictionary.com. Retrieved 2011-04-03.
Jump up ^ Vellguth, Swantje; Brita von Gaudecker; Hans-Konrad Müller-Hermelink (1985). "The development of the human spleen". Cell and Tissue Research. Springer Berlin / Heidelberg. 242 (3): 579–592. doi:10.1007/BF00225424. Retrieved 2009-02-14.
Jump up ^ Carey, Bjorn (May 5, 2006). "Horse science: What makes a Derby winner - Spleen acts as a 'natural blood doper,' scientist says". MSNBC.com. Retrieved 2006-05-09.
Jump up ^ "Spleen: Information, Surgery and Functions". Childrens Hospital of Pittsburgh - Chp.edu. 2010-11-17. Retrieved 2011-04-03.
Jump up ^ Lodin-Sundström, Angelica; Schagatay, Erika (June 2010). "Spleen contraction during 20 min normobaric hypoxia and 2 min apnea in humans". Aviation, Space, and Environmental Medicine. 8 (6): 545–549. doi:10.3357/ASEM.2682.2010. Retrieved 20 April 2018.
Jump up ^ "Web of Science - Starting New Session..." apps.webofknowledge.com.
Jump up ^ Di Sabatino, A; Carsetti, R; Corazza, GR (Jul 2, 2011). "Post-splenectomy and hyposplenic states". Lancet. 378 (9785): 86–97. doi:10.1016/S0140-6736(10)61493-6. PMID 21474172.
Jump up ^ Carsetti, R; Rosado, MM; Wardmann, H (February 2004). "Peripheral development of B cells in mouse and man". Immunological reviews. 197: 179–91. doi:10.1111/j.0105-2896.2004.0109.x. PMID 14962195.
Jump up ^ Kruetzmann, S; Rosado, MM; Weber, H; Germing, U; Tournilhac, O; Peter, HH; Berner, R; Peters, A; Boehm, T; Plebani, A; Quinti, I; Carsetti, R (Apr 7, 2003). "Human immunoglobulin M memory B cells controlling Streptococcus pneumoniae infections are generated in the spleen". The Journal of Experimental Medicine. 197 (7): 939–45. doi:10.1084/jem.20022020. PMC 2193885  . PMID 12682112.
Jump up ^ Dennis Robinette, C.; Fraumeni, Josephf. (1977). "Splenectomy and Subsequent Mortality in Veterans of the 1939-45 War". The Lancet. 310 (8029): 127–9. doi:10.1016/S0140-6736(77)90132-5. PMID 69206.
Jump up ^ Moore, Keith L. (1992). Clinically Oriented Anatomy (3rd ed.). Baltimore: Williams & Wilkins. p. 187. ISBN 0-683-06133-X.
Jump up ^ Abu Hilal M; Harb A; Zeidan B; Steadman B; Primrose JN; Pearce NW (January 5, 2009). "Hepatic splenosis mimicking HCC in a patient with hepatitis C liver cirrhosis and mildly raised alpha feto protein; the important role of explorative laparoscopy". World Journal of Surgical Oncology. England: BioMed Central. 7 (1): 1. doi:10.1186/1477-7819-7-1. PMC 2630926  . PMID 19123935.
Jump up ^ "polysplenia" at Dorland's Medical Dictionary
Jump up ^ Robertson's Word Pictures of the New Testament, commentary on 1 Peter 3:8
Jump up ^ Cheyne, George: The English Malady; or, A Treatise of Nervous Diseases of All Kinds, as Spleen, Vapours, Lowness of Spirits, Hypochondriacal and Hysterical Distempers with the Author's own Case at large, Dublin, 1733. Facsimile ed., ed. Eric T. Carlson, M.D., 1976, Scholars' Facsimiles & Reprints, ISBN 978-0-8201-1281-7;
Jump up ^ Blackmore, Richard: Treatise of the spleen and vapors. London, 1725
Jump up ^ Julius Caesar by William Shakespeare Act 4:1
^ Jump up to: a b c Romer, Alfred Sherwood; Parsons, Thomas S. (1977). The Vertebrate Body. Philadelphia: Holt-Saunders International. pp. 410–411. ISBN 0-03-910284-X.
External links[edit]
Look up spleen in Wiktionary, the free dictionary.
Wikimedia Commons has media related to Spleen.
Anatomy figure: 38:03-01 at Human Anatomy Online, SUNY Downstate Medical Center—"The visceral surface of the spleen."
Anatomy image:7881 at the SUNY Downstate Medical Center
"spleen" from Encyclopædia Britannica Online
Spleen and Lymphatic System, Kidshealth.org (American Academy of Family Physicians)
Spleen Diseases from MedlinePlus
"Finally, the Spleen Gets Some Respect" New York Times piece on the spleen
Normal range of spleen size for a given age in children
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Spleen
Structure
Hilum
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Marginal zone
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GND: 4039388-4
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text:
Flatulence
From Wikipedia, the free encyclopedia
Jump to: navigation, search
"Breaking wind" redirects here. For the 2012 comedy film, see Breaking Wind.
"Fart" redirects here. For other uses, see Fart (disambiguation).
Flatulence
German peasants greet the fire and brimstone from a papal bull of Pope Paul III in Martin Luther's 1545 Depictions of the Papacy
Classification and external resources
Specialty
Gastroenterology
ICD-10
R14.2
ICD-9-CM
787.3
MeSH
D005414
[edit on Wikidata]
Flatulence is defined in the medical literature as "flatus expelled through the anus" or the "quality or state of being flatulent",[1] which is defined in turn as "marked by or affected with gases generated in the intestine or stomach; likely to cause digestive flatulence".[2] The root of these words is from the Latin flatus – "a blowing, a breaking wind".[3] Flatus is also the medical word for gas generated in the stomach or bowels.[4] Despite these standard definitions, a proportion of intestinal gas may be swallowed environmental air, and hence flatus is not totally generated in the stomach or bowels. The scientific study of this area of medicine is termed flatology.[5]
It is normal for humans to pass flatus through the rectum, although the volume and frequency may vary greatly between individuals. It is also normal for intestinal gas passed through the rectum to have a characteristic feculent smell, although this too may vary in concentration. Flatus is brought to the rectum by specialised contractions of the muscles in the intestines and colon. The noises commonly associated with flatulence ("blowing a raspberry") are caused by the vibration of anal sphincters, and occasionally by the closed buttocks. Both the noise and smell associated with flatus leaving the anus can be sources of embarrassment or comedy in many cultures.
There are five general symptoms related to intestinal gas: pain, bloating and abdominal distension, excessive flatus volume, excessive flatus smell and gas incontinence. Furthermore, eructation ("an act or instance of belching", colloquially known as "burping") is sometimes included under the topic of flatulence.[6]
Contents
[hide]
1 Terminology
2 Signs and symptoms
2.1 Bloating and pain
2.2 Excessive volume
2.3 Smell
2.4 Incontinence of flatus
3 Cause
4 Mechanism
4.1 Production, composition, and smell
4.2 Volume and intestinal gas dynamics
5 Management
5.1 Pain and bloating
5.2 Volume
5.3 Smell
5.4 Incontinence
6 Society and culture
6.1 Environmental impact
6.2 Entertainment
6.3 Religion
7 See also
8 References
9 External links
Terminology
A human flatulence
Non-medical definitions of the term include "the uncomfortable condition of having gas in the stomach and bowels", or "a state of excessive gas in the alimentary canal". These definitions highlight that many people consider "bloating", abdominal distension or increased volume of intestinal gas to be synonymous with the term flatulence (although this is technically inaccurate). Colloquially, flatulence may be referred to as "farting", "trumping", "tooting", "passing gas", "breaking wind" or simply (in American English) "gas" or (British English) "wind". Derived terms include vaginal flatulence, otherwise known as a queef.
Signs and symptoms
Generally speaking, there are four different types of complaints that relate to intestinal gas, which may present individually or in combination.
Bloating and pain
Patients may complain of bloating as abdominal distension, discomfort and pain from "trapped wind". In the past, functional bowel disorders such as irritable bowel syndrome (IBS) that produced symptoms of bloating were attributed to increased production of intestinal gas. However, three significant pieces of evidence refute this theory. First, in normal subjects, even very high rates of gas infusion into the small intestine (30 ml/min) are tolerated without complaints of pain or bloating and harmlessly passed as flatus per rectum.[7] Secondly, studies aiming to quantify the total volume of gas produced by IBS patients (some including gas emitted from the mouth by eructation) have consistently failed to demonstrate increased volumes compared to healthy subjects. The proportion of hydrogen produced may be increased in a subset of IBS patients, but this does not affect the total volume.[8] Thirdly, it is known that the total volume of flatus produced by IBS patients who complain of pain and abdominal distension would be tolerated in normal subjects without any complaints of pain.
Patients who complain of bloating frequently can be shown to have objective increases in abdominal girth, often increased throughout the day and then resolving during sleep. The increase in girth combined with the fact that the total volume of flatus is not increased led to studies aiming to image the distribution of intestinal gas in patients with bloating. They found that gas was not distributed normally in these patients: there was segmental gas pooling and focal distension.[7] In conclusion, abdominal distension, pain and bloating symptoms are the result of abnormal intestinal gas dynamics rather than increased flatus production.
Excessive volume
As mentioned above, the normal range of volumes of flatus in normal individuals varies hugely (476–1,491 ml/24 h).[5] All intestinal gas is either swallowed environmental air, present intrinsically in foods and beverages or the result of gut fermentation. Swallowing small amounts of air occurs while eating and drinking. This is emitted from the mouth by eructation (burping) and is normal. Excessive swallowing of environmental air is called aerophagia, and has been shown in a few case reports to be responsible for increased flatus volume. This is however considered a rare cause of increased flatus volume. Gases contained in food and beverages is likewise emitted largely through eructation, e.g., carbonated beverages. Endogenously produced intestinal gases make up 74 percent of flatus in normal subjects. The volume of gas produced is partially dependent upon the composition of the intestinal microbiota, which is normally very resistant to change, but is also very different in different individuals. Some patients are predisposed to increased endogenous gas production by virtue of their gut microbiota composition.[7] The greatest concentration of gut bacteria is in the colon, while the small intestine is normally near sterile. Fermentation occurs when unabsorbed food residues may arrive in the colon. Therefore, even more than the composition of the microbiota, diet is the primary factor that dictates the volume of flatus produced.[7] Diets that aim to reduce the amount of undigested fermentable food residues arriving in the colon have been shown to significantly reduce the volume of flatus produced. Again, it is emphasised that increased volume of intestinal gas will not cause bloating and pain in normal subjects. Abnormal intestinal gas dynamics will create pain, distension, and bloating, regardless of whether there is high or low total flatus volume.
Smell
Although flatus possesses physiological smell, this may be abnormally increased in some patients and cause social distress to the patient. Increased smell of flatus presents a distinct clinical issue from other complaints related to intestinal gas.[9] Some patients may exhibit over-sensitivity to bad flatus smell, and in extreme forms, olfactory reference syndrome may be diagnosed.
Incontinence of flatus
"Gas incontinence" could be defined as loss of voluntary control over the passage of flatus. It is a recognised subtype of faecal incontinence, and is usually related to minor disruptions of the continence mechanisms. Some consider gas incontinence to be the first, sometimes only, symptom of faecal incontinence.[10]
Cause
Intestinal gas is composed of varying quantities of exogenous sources and endogenous sources.[11] The exogenous gases are swallowed (aerophagia) when eating or drinking or increased swallowing during times of excessive salivation (as might occur when nauseated or as the result of gastroesophageal reflux disease). The endogenous gases are produced either as a by-product of digesting certain types of food, or of incomplete digestion, as is the case during steatorrhea. Anything that causes food to be incompletely digested by the stomach or small intestine may cause flatulence when the material arrives in the large intestine, due to fermentation by yeast or prokaryotes normally or abnormally present in the gastrointestinal tract.
Flatulence-producing foods are typically high in certain polysaccharides, especially oligosaccharides such as inulin. Those foods include beans, lentils, dairy products, onions, garlic, spring onions, leeks, turnips, swedes, radishes, sweet potatoes, potatoes, cashews, Jerusalem artichokes, oats, wheat, and yeast in breads. Cauliflower, broccoli, cabbage, Brussels sprouts and other cruciferous vegetables that belong to the genus Brassica are commonly reputed to not only increase flatulence, but to increase the pungency of the flatus.[citation needed]
In beans, endogenous gases seem to arise from complex oligosaccharides (carbohydrates) that are particularly resistant to digestion by mammals, but are readily digestible by gut flora – microorganisms (methane-producing archaea; Methanobrevibacter smithii) that inhabit the digestive tract. These oligosaccharides pass through the upper intestine largely unchanged, and when they reach the lower intestine, bacteria feed on them, producing copious amounts of flatus.[12]
In the case of people who have lactose intolerance, intestinal bacteria feeding on lactose can give rise to excessive gas production when milk or lactose-containing substances have been consumed.
Interest in the causes of flatulence was spurred by high-altitude flight and manned spaceflight; the low atmospheric pressure, confined conditions, and stresses peculiar to those endeavours were cause for concern.[12] In the field of mountaineering, the phenomenon of high altitude flatus expulsion was first recorded over two hundred years ago.
Some infections, such as giardiasis, are also associated with flatulence.[13]
Mechanism
Production, composition, and smell
Flatus (intestinal gas) is mostly produced as a byproduct of bacterial fermentation in the gastrointestinal (GI) tract, especially the colon.[14] There are reports of aerophagia (excessive air swallowing) causing excessive intestinal gas, but this is considered rare.[15] Over 99% of the volume of flatus is composed of non-smelly gases.[5] These include oxygen, nitrogen, carbon dioxide, hydrogen and methane. Nitrogen is not produced in the gut, but a component of environmental air. Patients who have excessive intestinal gas that is mostly composed of nitrogen have aerophagia.[16] Hydrogen, carbon dioxide and methane are all produced in the gut and contribute 74% of the volume of flatus in normal subjects.[17] Methane and hydrogen are flammable, and so flatus containing adequate amounts of these can be ignited.[18] Not all humans produce flatus that contains methane. For example, in one study of the faeces of nine adults, only five of the samples contained archaea capable of producing methane.[19] The prevalence of methane over hydrogen in human farts may correlate with obesity, constipation and irritable bowel syndrome, as archaea that oxidise hydrogen into methane promote the metabolism's ability to absorb fatty acids from food.[20]
The remaining trace (<1% volume) compounds give flatus its smell. Historically, compounds such as indole, skatole, ammonia and short chain fatty acids were thought to cause the smell of flatus. More recent evidence proves that the major contribution to the smell of flatus comes from a combination of volatile sulfur compounds (VSC).[5][21] It is known that hydrogen sulfide (H2S), methyl mercaptan (MM, also known as methanethiol, MT), dimethyl sulfide (DMS), dimethyl disulfide (DMDS) and dimethyl trisulfide (DMTS) are present in flatus. The benzopyrrole volatiles indole and skatole have a mothball smell, and therefore probably do not contribute greatly to the characteristic smell of flatus.
In one study, H2S concentration was shown to correlate convincingly with perceived bad smell of flatus, followed by MM and DMS.[16] This is supported by the fact that H2S may be the most abundant VSC present. These results were generated from subjects who were eating a diet high in pinto beans to stimulate flatus production. Others report that MM was the greatest contributor to the smell of flatus in patients not under any specific dietary alterations.[5] It has now been demonstrated that MM, DMS and H2S (described as decomposing vegetables, unpleasantly sweet/wild radish and rotten eggs respectively) are all present in human flatus in concentrations above their smell perception thresholds.[5] It is known that increased dietary sulfur-containing amino acids significantly increases the smell of flatus. It is therefore likely that the smell of flatus is created by a combination of VSC, with minimal contribution from non-sulfur volatiles.[16] Such smell can also be caused by the presence of large numbers of microflora bacteria or the presence of faeces in the rectum. Diets high in protein, especially sulfur-containing amino acids, have been demonstrated to significantly increase the smell of flatus.
Volume and intestinal gas dynamics
Normal flatus volume range is around 476 to 1,491 ml per 24 hours.[5][14] This variability between individuals is greatly dependent upon diet. Similarly the number of flatus episodes per day is variable, the normal range is given as 8–20 per day.[16] The volume of flatus associated with each flatulence event again varies (5–375 ml).[5][14][17] The volume of the first flatulence upon waking in the morning is significantly larger than those during the day.[5] This may be due to buildup of intestinal gas in the colon during sleep, the peak in peristaltic activity in the first few hours after waking or the strong prokinetic effect of rectal distension on the rate of transit of intestinal gas.[7] It is now known that gas is moved along the gut independently of solids and liquids, and this transit is more efficient in the erect position compared to when supine.[7] It is thought that large volumes of intestinal gas present low resistance, and can be propelled by subtle changes in gut tone, capacitance and proximal contraction and distal relaxation. This process is thought not to affect solid and liquid intra-lumenal contents.[7]
Researchers investigating the role of sensory nerve endings in the anal canal did not find them to be essential for retaining fluids in the anus, and instead speculate that their role may be to distinguish between flatus and faeces, thereby helping detect a need to defecate or to signal the end of defecation.[22]
The sound varies depending on the tightness of the sphincter muscle and velocity of the gas being propelled, as well as other factors, such as water and body fat. The auditory pitch (sound) of the flatulence outburst can also be affected by the anal embouchure. Among humans, flatulence occasionally happens accidentally, such as incidentally to coughing or sneezing or during orgasm; on other occasions, flatulence can be voluntarily elicited by tensing the rectum or "bearing down" on stomach or bowel muscles and subsequently relaxing the anal sphincter, resulting in the expulsion of flatus.
Management
Since problems involving intestinal gas present as different (but sometimes combined) complaints, the management is cause related.
Pain and bloating
Main articles: Abdominal distension and Bloating
While not affecting the production of the gases themselves, surfactants (agents that lower surface tension) can reduce the disagreeable sensations associated with flatulence, by aiding the dissolution of the gases into liquid and solid faecal matter.[23] Preparations containing simethicone reportedly operate by promoting the coalescence of smaller bubbles into larger ones more easily passed from the body, either by burping or flatulence. Such preparations do not decrease the total amount of gas generated in or passed from the colon, but make the bubbles larger and thereby allowing them to be passed more easily.[23]
Other drugs including prokinetics, lubiprostone, antibiotics and probiotics are also used to treat bloating in patients with functional bowel disorders such as IBS, and there is some evidence that these measures may reduce symptoms.[24]
A flexible tube, inserted into the rectum, can be used to collect intestinal gas in a flatus bag. This method is occasionally needed in a hospital setting, when the patient is unable to pass gas normally.[25]
Volume
Main articles: Antiflatulent and Carminative
One method of reducing the volume of flatus produced is dietary modification, reducing the amount of fermentable carbohydrates. This is the theory behind diets such as the low FODMAP diet (low fermentable oligosaccharide, dissacharide, monosaccharide and polyols).[26]
Certain spices have been reported to counteract the production of intestinal gas, most notably the closely related cumin, coriander, caraway, fennel and others such as ajwain, turmeric, asafoetida (hing), epazote, and kombu kelp (a Japanese seaweed).[citation needed] Most starches, including potatoes, corn, noodles, and wheat, produce gas as they are broken down in the large intestine.[11] Intestinal gas can be reduced by fermenting the beans, and making them less gas-inducing, or by cooking them in the liquor from a previous batch. Some legumes also stand up to prolonged cooking, which can help break down the oligosaccharides into simple sugars. On the other hand, fermented bean products such as miso are less likely to produce as much intestinal gas. Fermentative lactic acid bacteria such as Lactobacillus casei and Lactobacillus plantarum reduce flatulence in human intestinal tract.[27]
Probiotics (live yogurt, kefir, etc.) are reputed to reduce flatulence when used to restore balance to the normal intestinal flora.[28] Live (bioactive) yogurt contains, among other lactic bacteria, Lactobacillus acidophilus, which may be useful in reducing flatulence. L. acidophilus may make the intestinal environment more acidic, supporting a natural balance of the fermentative processes. L. acidophilus is available in supplements. Prebiotics, which generally are non-digestible oligosaccharides, such as fructooligosaccharide, generally increase flatulence in a similar way as described for lactose intolerance.
Digestive enzyme supplements may significantly reduce the amount of flatulence caused by some components of foods not being digested by the body and thereby promoting the action of microbes in the small and large intestines. It has been suggested that alpha-galactosidase enzymes, which can digest certain complex sugars, are effective in reducing the volume and frequency of flatus.[29] The enzymes alpha-galactosidase, lactase, amylase, lipase, protease, cellulase, glucoamylase, invertase, malt diastase, pectinase, and bromelain are available, either individually or in combination blends, in commercial products.
The antibiotic rifaximin, often used to treat diarrhoea caused by the microorganism E. coli, may reduce both the production of intestinal gas and the frequency of flatus events.[30]
Smell
Bismuth
Smell from flatulence is commonly treated with bismuth subgallate, available over-the-counter in the US as Devrom. Bismuth subgallate is commonly used by individuals who have had ostomy surgery, bariatric surgery, faecal incontinence and irritable bowel syndrome.[31][32] Bismuth subsalicylate is a compound that binds H2S, and one study reported a dose of 524 mg four times a day for 3–7 days bismuth subsalicylate yielded a >95% reduction in faecal H2S release in both humans and rats.[33] Another bismuth compound, bismuth subnitrate was also shown to bind with H2S.[34] Another study showed that bismuth acted synergistically with various antibiotics to inhibit sulfate-reducing gut bacteria and sulfide production.[35] Some authors proposed a theory that H2S was involved in the development of ulcerative colitis and that bismuth might be helpful in the management of this condition.[36] However, bismuth administration in rats did not prevent them from developing ulcerative colitis despite reduced H2S production.[36] Also, new evidence suggests that colonic H2S is largely present in bound forms, probably sulfides of iron and other metals.[5] Rarely, serious bismuth toxicity may occur with higher doses.[37]
Activated charcoal
Despite being an ancient treatment for various digestive complaints, activated charcoal did not produce reduction in both the total flatus volume nor the release of sulfur-containing gasses, and there was no reduction in abdominal symptoms (after 0.52 g activated charcoal four times a day for 1 week).[38] The authors suggested that saturation of charcoal binding sites during its passage through the gut was the reason for this. A further study concluded that activated charcoal (4 g) does not influence gas formation in vitro or in vivo.[39] Other authors reported that activated charcoal was effective. A study in 8 dogs concluded activated charcoal (unknown oral dose) reduced H2S by 71%. In combination with yucca schidigera, and zinc acetate, this was increased to an 86% H2S reduction, although total flatus volume and number of flatus events was unchanged.[40] An early study reported activated charcoal (unknown oral dose) prevented a large increase in the number of flatus events and increased breath hydrogen concentrations that normally occur following a gas-producing meal.[41]
Garments & external devices
In 1998, Chester "Buck" Weimer of Pueblo, Colorado, received a patent for the first undergarment that contained a replaceable charcoal filter. The undergarments are air-tight and provide a pocketed escape hole in which a charcoal filter can be inserted.[42] In 2001 Mr Weimer received the Ig Nobel Prize for Biology for his invention.[43]
A similar product was released in 2002, but rather than an entire undergarment, consumers are able to purchase an insert similar to a pantiliner that contains activated charcoal.[44] The inventors, Myra and Brian Conant of Mililani, Hawaii, still claim on their website to have discovered the undergarment product in 2002 (four years after Chester Weimer filed for a patent for his product), but state that their tests "concluded" that they should release an insert instead.[45]
Incontinence
Main article: Faecal incontinence
Flatus incontinence where there is involuntary passage of gas, is a type of faecal incontinence, and is managed similarly.
Society and culture
In many cultures, flatulence in public is regarded as embarrassing, but, depending on context, can also be considered humorous. People will often strain to hold in the passing of gas when in polite company, or position themselves to conceal the noise and scent. In other cultures,[examples needed] it may be no more embarrassing than coughing.
While the act of passing flatus in said cultures is generally considered to be an unfortunate occurrence in public settings, flatulence may, in casual circumstances and especially among children, be used as either a humorous supplement to a joke ("pull my finger"), or as a comic activity in and of itself. The social acceptability of flatulence-based humour in entertainment and the mass media varies over the course of time and between cultures. Enough entertainers performed with their flatus that the term flatulist was coined. The whoopee cushion is a joking device invented in the early 20th century for simulating a fart. In 2008, a farting application for the iPhone earned nearly $10,000 in one day.[46]
A farting game named Touch Wood was documented by John Gregory Bourke in the 1890s.[47] It existed under the name of Safety in the 20th century in the U.S., and has been found being played in 2011.[47]
In January 2011, the Malawi Minister of Justice, George Chaponda, said that Air Fouling Legislation would make public farting illegal in his country. When reporting the story, the media satirised Chaponda's statement with punning headlines. Later, the minister withdrew his statement.[48]
Environmental impact
The flatulence of cows is only a small portion of cows' methane release. Cows also burp methane, due to the physiology of their digestive systems.
Flatulence is often blamed as a significant source of greenhouse gases, owing to the erroneous belief that the methane released by livestock is in the flatus.[49] While livestock account for around 20% of global methane emissions,[50] 90–95% of that is released by exhaling or burping.[51]
Since New Zealand produces large amounts of agricultural products, it is in the unique position of having high methane emissions from livestock compared to other greenhouse gas sources. The New Zealand government is a signatory to the Kyoto Protocol and therefore attempts are being made to reduce greenhouse emissions. To achieve this, an agricultural emissions research levy was proposed, which promptly became known as a "fart tax" or "flatulence tax". It encountered opposition from farmers, farming lobby groups and opposition politicians.
Entertainment
Main article: Flatulist
Historical comment on the ability to fart at will is observed as early as Saint Augustine's The City of God (5th century AD). Augustine mentions men who "have such command of their bowels, that they can break wind continuously at will, so as to produce the effect of singing".[52] Intentional passing of gas and its use as entertainment for others appear to have been somewhat well known in pre-modern Europe, according to mentions of it in medieval and later literature, including Rabelais.
Le Pétomane ("the Fartomaniac") was a famous French performer in the 19th century who, as well as many professional farters before him, did flatulence impressions and held shows. The performer Mr. Methane carries on le Pétomane's tradition today. Also, a 2002 film Thunderpants revolves around a boy named Patrick Smash who has an ongoing flatulence problem from the time of his birth. He eventually overcomes his problems and fulfills his dreams, including one of becoming an astronaut.
In literature, farting features prominently in the novel The Catcher in the Rye.[citation needed] Since the 1970s, farting has increasingly featured in film, especially lowbrow comedies such as Blazing Saddles.
Religion
In Islam, flatulence invalidates wudu (ritual purity).[53]
See also
Biology portal
Tympanites
Antiflatulent
Flatulence humor
Borborygmus
Vaginal flatulence
The Gas We Pass
Fart lighting
Le Pétomane
Eproctophilia
Belching, the action of wind going out of the mouth.
Ralph L. Obendorf, The importance of flatulence-causing oligosaccharides to the seed that contains them.
References
Notes
Jump up ^ "Flatulence". Merriam-Webster. Retrieved August 24, 2015.
Jump up ^ "Medical Dictionary: Flatulent". Merriam-Webster. Retrieved August 24, 2015.
Jump up ^ "Flatulent". Online Etymological Dictionary. Retrieved August 24, 2015.
Jump up ^ "Medical Dictionary: Flatus". Merriam-Webster. Retrieved August 24, 2015.
^ Jump up to: a b c d e f g h i j Tangerman, Albert (October 1, 2009). "Measurement and biological significance of the volatile sulfur compounds hydrogen sulfide, methanethiol and dimethyl sulfide in various biological matrices". Journal of Chromatography B. 877 (28): 3366–3377. doi:10.1016/j.jchromb.2009.05.026. PMID 19505855.
Jump up ^ Parveen Kumar; Michael L. Clark, eds. (2005). Kumar & Clark Clinical Medicine (6th ed.). Edinburgh: Saunders. p. 266. ISBN 0702027634.
^ Jump up to: a b c d e f g Azpiroz, F (July 1, 2005). "Intestinal gas dynamics: mechanisms and clinical relevance". Gut. 54 (7): 893–895. doi:10.1136/gut.2004.048868.
Jump up ^ King, TS; Elia, M; Hunter, JO (October 10, 1998). "Abnormal colonic fermentation in irritable bowel syndrome". The Lancet. 352 (9135): 1187–9. doi:10.1016/S0140-6736(98)02146-1. PMID 9777836.
Jump up ^ Bailey, J; Carter, NJ; Neher, JO (June 15, 2009). "FPIN's Clinical Inquiries: Effective management of flatulence". American Family Physician. 79 (12): 1098–100. PMID 19530642.
Jump up ^ Bruce G. Wolff; James W. Fleshman; David E. Beck; John H. Pemberton; Steven D. Wexner, eds. (2007), The ASCRS textbook of colon and rectal surgery, New York: Springer Publishing, ISBN 0-387-24846-3
^ Jump up to: a b "Gas in the Digestive Tract". National Institute of Diabetes and Digestive and Kidney Diseases. Retrieved August 24, 2015.
^ Jump up to: a b McGee, Harold (1984). On Food and Cooking. Scribner. pp. 257–8. ISBN 0-684-84328-5.
Jump up ^ Flanagan PA (August 1992). "Giardia—diagnosis, clinical course and epidemiology: A review". Epidemiology and Infection. 109 (1): 1–22. PMC 2272232  . PMID 1499664.
^ Jump up to: a b c Tomlin, J; Lowis, C; Read, NW (June 1991). "Investigation of normal flatus production in healthy volunteers". Gut. 32 (6): 665–669. doi:10.1136/gut.32.6.665. PMC 1378885  . PMID 1648028.
Jump up ^ Hemmink, GJ; Weusten, BL; Bredenoord, AJ; Timmer, R; Smout, AJ (October 2009). "Aerophagia: excessive air swallowing demonstrated by esophageal impedance monitoring". Clinical Gastroenterology and Hepatology. 7 (10): 1127–9. doi:10.1016/j.cgh.2009.06.029. PMID 19602452.
^ Jump up to: a b c d Levitt, MD; Furne, J; Aeolus, MR; Suarez, FL (November 1998). "Evaluation of an extremely flatulent patient: case report and proposed diagnostic and therapeutic approach". The American Journal of Gastroenterology. 93 (11): 2276–2281. doi:10.1111/j.1572-0241.1998.00635.x. PMID 9820415.
^ Jump up to: a b Suarez, F; Furne, J; Springfield, J; Levitt, M (May 1997). "Insights into human colonic physiology obtained from the study of flatus composition". American Journal of Physiology. 272 (5 Pt 1): G1028–33. PMID 9176210.
Jump up ^ Mercer, Bobby (2009-04-18). How Do You Light a Fart?: And 150 Other Essential Things Every Guy Should Know about Science. Adams Media. p. 71. ISBN 9781440519871. Retrieved October 2, 2014.
Jump up ^ Miller TL; Wolin MJ; de Macario EC; Macario AJ (1982). "Isolation of Methanobrevibacter smithii from human faeces". Applied and Environmental Microbiology. 43 (1): 227–32. PMC 241804  . PMID 6798932.
Jump up ^ Pimentel, Mark; Robert P Gunsalus; Satish SC Rao; Husen Zhang (2012). "Methanogens in Human Health and Disease". The American Journal of Gastroenterology Supplements. 1 (1): 28–33. doi:10.1038/ajgsup.2012.6. ISSN 1948-9498.
Jump up ^ Suarez, FL; Springfield, J; Levitt, MD (July 1998). "Identification of gases responsible for the odour of human flatus and evaluation of a device purported to reduce this odour". Gut. 43 (1): 100–4. doi:10.1136/gut.43.1.100. PMC 1727181  . PMID 9771412.
Jump up ^ Read, M. G.; Read, N. W. (1982). "Role of anorectal sensation in preserving continence". Gut. 23 (4): 345–347. doi:10.1136/gut.23.4.345. PMC 1419736  . PMID 7076012.
^ Jump up to: a b Brecević L, Bosan-Kilibarda I, Strajnar F (1994). "Mechanism of antifoaming action of simethicone". Journal of Applied Toxicology. 14 (3): 207–11. doi:10.1002/jat.2550140311. PMID 8083482.
Jump up ^ Schmulson, M; Chang, L (May 2011). "Review article: the treatment of functional abdominal bloating and distension". Alimentary Pharmacology & Therapeutics. 33 (10): 1071–86. doi:10.1111/j.1365-2036.2011.04637.x. PMID 21488913.
Jump up ^ "Flatus tube". Gastro Training. Retrieved 3 April 2016.
Jump up ^ Staudacher, HM; Whelan, K; Irving, PM; Lomer, MC (October 2011). "Comparison of symptom response following advice for a diet low in fermentable carbohydrates (FODMAPs) versus standard dietary advice in patients with irritable bowel syndrome". Journal of Human Nutrition and Dietetics. 24 (5): 487–95. doi:10.1111/j.1365-277X.2011.01162.x. PMID 21615553.
Jump up ^ "Study shows secret to gas-free beans". 2006-04-26. Archived from the original on 2006-05-02. Retrieved 2007-09-10.
Jump up ^ Rubin, Jordan S.; Joseph Brasco (2003). Restoring Your Digestive Health. Kensington Books. ISBN 978-0758202826. [page needed]
Jump up ^ Ganiats TG; Norcross WA; Halverson AL; Burford PA; Palinkas LA (1994). "Does Beano prevent gas? A double-blind crossover study of oral alpha-galactosidase to treat dietary oligosaccharide intolerance". The Journal of Family Practice. 39 (5): 441–5. PMID 7964541.
Jump up ^ Di Stefano M; Strocchi A; Malservisi S; Veneto G; Ferrieri A; Corazza GR (2000). "Non-absorbable antibiotics for managing intestinal gas production and gas-related symptoms". Alimentary Pharmacology & Therapeutics. 14 (8): 1001–8. doi:10.1046/j.1365-2036.2000.00808.x. PMID 10930893.
Jump up ^ Turnbull G (2005). "The Ostomy Files:The Issue of Oral Medications and a Fecal Ostomy". Ostomy Wound Management. 51: 14–16.
Jump up ^ "Colostomy Guide". 2006-01-04. Retrieved 2007-09-10.
Jump up ^ Suarez, F.L.; Furne, J.K.; Springfield, J.R.; Levitt, M.D. (1998). "Bismuth subsalicylate markedly decreases hydrogen sulfide release in the human colon". Gastroenterology. 114: A420. doi:10.1016/S0016-5085(98)81700-9. ISSN 0016-5085. PMID 9558280.
Jump up ^ Levitt, MD; Springfield, J; Furne, J; Koenig, T; Suarez, FL (April 2002). "Physiology of sulfide in the rat colon: use of bismuth to assess colonic sulfide production". Journal of Applied Physiology. 92 (4): 1655–60. doi:10.1152/japplphysiol.00907.2001. PMID 11896034.
Jump up ^ Ohge, H; Furne, JK; Springfield, J; Sueda, T; Madoff, RD; Levitt, MD (November 7, 2003). "The effect of antibiotics and bismuth on fecal hydrogen sulfide and sulfate-reducing bacteria in the rat". FEMS Microbiology Letters. 228 (1): 137–4 2. doi:10.1016/s0378-1097(03)00748-1. PMID 14612249.
^ Jump up to: a b Furne, JK; Suarez, FL; Ewing, SL; Springfield, J; Levitt, MD (July 2000). "Binding of hydrogen sulfide by bismuth does not prevent dextran sulfate-induced colitis in rats". Digestive Diseases and Sciences. 45 (7): 1439–43. PMID 10961726.
Jump up ^ Gordon, MF; Abrams, RI; Rubin, DB; Barr, WB; Correa, DD (March 1995). "Bismuth subsalicylate toxicity as a cause of prolonged encephalopathy with myoclonus". Movement Disorders. 10 (2): 220–2. doi:10.1002/mds.870100215. PMID 7753066.
Jump up ^ Suarez, FL; Furne, J; Springfield, J; Levitt, MD (January 1999). "Failure of activated charcoal to reduce the release of gases produced by the colonic flora". The American Journal of Gastroenterology. 94 (1): 208–12. doi:10.1111/j.1572-0241.1999.00798.x. PMID 9934757.
Jump up ^ Potter, T; Ellis, C; Levitt, M (March 1985). "Activated charcoal: in vivo and in vitro studies of effect on gas formation". Gastroenterology. 88 (3): 620–4. doi:10.1016/0016-5085(85)90129-5. PMID 3917957.
Jump up ^ Giffard, CJ; Collins, SB; Stoodley, NC; Butterwick, RF; Batt, RM (March 15, 2001). "Administration of charcoal, Yucca schidigera, and zinc acetate to reduce malodorous flatulence in dogs". Journal of the American Veterinary Medical Association. 218 (6): 892–6. doi:10.2460/javma.2001.218.892. PMID 11294313.
Jump up ^ Hall RG, Jr; Thompson, H; Strother, A (March 1981). "Effects of orally administered activated charcoal on intestinal gas". The American Journal of Gastroenterology. 75 (3): 192–6. PMID 7015846.
Jump up ^ Weimer, Chester (1997-01-14). "Protective underwear with malodorous flatus filter". Retrieved 2007-07-27.
Jump up ^ "The 2001 Ig Nobel Prize Winners". Archived from the original on February 25, 2011. Retrieved June 22, 2010.
Jump up ^ Conant, Brian J.; Myra M. Conant (2001-11-06). "Flatulence deodorizer". Retrieved 2007-09-10.
Jump up ^ "About the Inventor". Flat-D Innovations Inc. Retrieved 2007-09-10.
Jump up ^ Chen, Brian X. (December 24, 2008). "iPhone Fart App Rakes in $10,000 a Day". Wired News.
^ Jump up to: a b Fishlock, Diana (June 8, 2011). "Penn State professor's essay on farting takes the prize". The Patriot-News. Harrisburg, Pennsylvania. Retrieved December 28, 2011. Trevor Blank [...] found Pennsylvania boys playing "Safety," a farting game, the same as Blank had as a kid in Maryland, and the same game John Bourke documented in the 1890s, when it was called "Touch Wood." Basically, a boy who farts must say "Safety" or touch wood before his friends say another key phrase. If not, they're allowed to punch him. (It usually is boys who make farting a game or a weapon.)
Jump up ^ Joe Chibewa (February 4, 2011). "Chaponda: Oops I goofed, you can fart!". Marevi Post. Archived from the original on July 14, 2011. Retrieved March 2, 2011.
Jump up ^ ABC Southern Queensland: "Could skippy stop cows farting and end global warming?" February 3, 2006. Example of error. Although the article doesn't specify whether the methane is released by flatulence or eructation, it appears the headline-writer assumes it's through flatulence. Archived October 14, 2007, at the Wayback Machine.
Jump up ^ Nowak, Rachel (September 24, 2004). "Burp vaccine cuts greenhouse gas". New Scientist.
Jump up ^ "Bovine belching called udderly serious gas problem—Global warming concerns spur effort to cut methane." Archived August 13, 2004, at the Wayback Machine. By Gary Polakovic. Los Angeles Times, July 13, 2003.
Jump up ^ The City of God Against the Pagans. Philip Levine, editor and translator. Cambridge, Mass.: Harvard University Press,. 1966. , XIV.24.
Jump up ^ http://www.sunniforum.com/forum/showthread.php?77168-Wudu-and-Passing-Wind Archived May 15, 2015, at the Wayback Machine.[better source needed]
Bibliography
Allen, V. (2007) On Farting: Language and Laughter in the Middle Ages. Palgrave MacMillan. ISBN 978-0-312-23493-5.
Bolin, T. D. & Stanton, R. (1997). Wind Breaks. Allen & Unwin. ISBN 978-1-86448-321-5.
Dawson, Jim (1999). Who Cut the Cheese?: A Cultural History of the Fart. Ten Speed Press. ISBN 1-58008-011-1.
Dawson, Jim (2006). Blame it on the Dog: A Modern History of the Fart. Ten Speed Press. ISBN 1-58008-751-5.
Franklin, Benjamin (2003). Japikse, Carl, ed. Fart Proudly ((Reprint) ed.). Frog Ltd/Blue Snake. ISBN 1-58394-079-0.
Persels, J., & Ganim, R. (2004) Fecal Matters in Early Modern Literature and Art: Studies in Scatology. (Chap. 1: The Honorable Art of Farting in Continental Renaissance). ISBN 0-7546-4116-3.
von Schmausen, D. (2002). Official Rules, New World Odor International Freestyle Farting Championship. LULU. ISBN 1435709195.
External links
Look up flatus or flatulence in Wiktionary, the free dictionary.
Wikimedia Commons has media related to Flatulence.
Wikisource has original text related to this article:
A cure for flatulence from 1872
The Merck Manual of Diagnosis and Therapy, Gas
Dictionary of Fart Slang
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