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Constipation and Hemorrhoids

Nonpharmacologic treatment is the mainstay of constipation and hemorrhoids treatment in pregnant patients. Pregnant women should be counseled to eat a high-fiber diet, drink plenty of fluids, exercise regularly, and avoid prolonged time on the toilet. To relieve hemorrhoids, pregnant women may soak in warm sitz baths and apply ice to the area. Bulk-forming laxatives, such as psyllium and calcium polycarbophil are firstline agents (Table 47-8).18 If these methods fail, stimulant laxatives, such as bisaco-dyl and senna, are acceptable second-line agents for short-term or intermittent use.6,18 During lactation, bulk-forming laxatives and the stimulant laxatives are safe for use.19

Acu Pros Hasten to Relieve Constipation

Oriental Medicine categorizes constipation by your individual overall health. For instance, deficient yin symptoms include dry stools, thirst, dry mouth and throat (especially in the evenings), sore back and knees, night sweats, dizziness, and ringing in the ears. Effective treatments are available for this and other forms of constipation. It's not unusual for patients to have overused laxatives in order to move their bowels. I generally begin treatments of acupuncture, lifestyle and nutritional counseling, perhaps herbal medicine to lubricate the bowel, stop intestinal spasms or atrophy and gradually back off the laxatives. Bowel cancer is the second-most frequent cancer among men over 50 (lung cancer is first). You'll notice sudden changes in bowel habits (constipation or diarrhea), blood in the stool, or abdominal pain. Make an appointment with your physician if you have any suspicions.

Constipation Ready Set No Go

What if the urge never comes knocking, is infrequent, or it's painful and difficult to pass the waste material (or stool) That is what commonly is called constipation. The longer your stool sits in the colon, the more water keeps getting pulled out, making it dryer and harder and even more difficult to pass. Constipation is a frequent GI complaint, especially among women, children, and those over age 65. Again, we don't talk about it, but it can lead to various maladies, including bad breath, body odor, depression, headaches, hemorrhoids, indigestion, insomnia, gas, and fatigue. Constipation most often is a result of insufficient fiber and fluids. Some medications, such as painkillers and antidepressants, as well as iron supplements, can cause constipation.

Dealing with Constipation Diarrhea Nausea and Vomiting

Pain is not the only factor that can take its toll on a patient's quality of life. Side effects from radiation, surgery, chemotherapy, and other medications, as well as other ailments resulting from cancer, can cause significant discomfort. Just as the pain of cancer can be well controlled when treated aggressively, most of these symptoms, such as nausea, vomiting, diarrhea, and constipation, can also be effectively managed.

Constipation

Animals are said to be constipated when too slow a passage of faeces through the large bowel causes difficulty in passing hard, dry stools. This may be more common in older dogs and cats partly due to decreased physical activity. Since fibre increases the rate of passage of stools through the large intestine, diets that contain higher levels of fibre have proven beneficial in constipation. Many senior pet foods contain a higher level of insoluble fibre in an attempt to help prevent constipation.

Temozolomide Procarbazine and Dacarbazine

Temozolomide is an imidazotetrazine derivative of dacarbazine (DITC). It has excellent oral bioavailability. Temozolomide itself is inactive, but it is rapidly metabolized in vivo to an active derivative. This acts as an alkylating agent, methylating the O6 position on guanine. Temozolomide has been shown to have activity against both malignant and low-grade gliomas as an adjuvant therapy and at recurrence.14,17 Major toxicities include fatigue, headache, constipation, nausea and vomiting, and myelosuppression. However, temozolomide is relatively well tolerated as compared with many other cytotoxic chemo-therapeutic agents. Its relative efficacy combined with a favorable side-effect profile have resulted in temozolomide's rapidly becoming the first line chemotherapeutic agent of choice for many patients with gliomas.

How to Tell the Patient

One statement is never appropriate There is nothing more that we can do. Such statements tell patients they are being abandoned and increase their feelings of isolation and vulnerability. There is always something the family physician can do to provide compassionate, comforting care to the patient and family, even if it is only sitting at the bedside so the patient does not feel abandoned. Distress can take many forms physical, emotional, and spiritual, as well as anticipating symptoms that may arise, such as pain, constipation, anxiety, depression, and nausea. Family physicians also can help by stopping or avoiding treatments and diagnostic procedures that hold little promise of improving the patient's quality of life, such as taking vital signs or turning patients in bed when they are trying to sleep. If a test will not lead to a change in treatment, the test is not indicated.

Side Effects and Drug Interactions

PCV is not, however, an innocuous therapy, and for a disease in which cure is desired by all but not expected except by the patient, less toxic therapies are necessary. Lomustine (CCNU) is a potent marrow toxin with a delayed nadir. Effects on marrow worsened with repeat dosing. One must avoid cumulative doses of more than 1100 mg m2 because of possible pulmonary fibrosis and secondary leukemias.91 Procarbazine is a mild monoamine oxidase inhibitor. There are potential interactions with medications and tyramine-containing foods.94 Vin-cristine causes a neuropathy, with numbness in the extremities and constipation. This effect may be compounded in patients with preexisting neuropathies.94

General Medical Therapy

Seizures are prevalent in patients with glioma, particularly in slowly growing, low-grade gliomas, and require adequate management. Clinicians should recognize the possibility that seizures could be caused by hyponatremia, hypoglycemia, and hypocalcemia, as well as by mass effect. Seizures are generally managed with standard anticonvulsants, including phenytoin, phenobarbital, primidone, gabapentin, lamotrigine, carba-mazepine, valproic acid, and clonazepam. Anticonvulsants, which are generally dose dependent, can interact with drugs that are commonly given to patients with brain tumors to produce adverse effects, some of which are drowsiness, dizziness, ataxia, nausea, vomiting, confusion, constipation, tremor, hypersalivation, and blurred vision.

Abdominal and Intestinal Disorders

A disease called Dakodara was clearly ascites. The abdomen enlarged with fluid that could be palpated, the umbilicus was flattened out or everted, and there were enlarged blue veins in the thin abdominal wall. Another abdominal distension arose from obstruction of the large bowel, and was manifested by progressive constipation, gaseous swelling of the abdomen, and crampy pains, all of which provides a picture of left colonic cancer or, less commonly, progressive anal stenosis. The latter was ascribed to sharp pieces of food perforating the gut and causing continuous thin and liquid anal discharge associated with vomiting, anorexia, abdominal distension, and pain. The condition could well have been acute gastroenteritis, which was, and is still, a common disease in the Indian subcontinent.

Acute Adrenal Insufficiency Related to Bilateral Adrenal Hemorrhage

Veins Fragile Adrenal

The clinical scenario described by Amador remains unchanged today.23 The sudden onset of steady pain in the upper abdomen, flanks, and lower back, accompanied by mild tenderness, heralds the development of rapidly progressive deterioration. Initially, abdominal distention and obstipation are present. Listlessness and fatigue progress to lethargy and disorientation. Tachycardia and hypotension are late signs. Fever, cyanosis, and severe hypotension are terminal events.23 Rao and colleagues observed that significant premonitory hypotension did not occur before catastrophic hypotension and shock.30 Only approximately half of the patients had a systolic blood pressure less than 100 mm Hg before shock.30 In the group of patients receiving anticoagulants, the clinical manifestations usually occurred within 10 days of instituting therapy.23 Individuals at risk were usually already severely ill. Elderly patients with preexisting heart disease, thromboembolic disease, or coagulopathy had a...

Patient Encounter 2

The increase in HMG-CoA reductase activity can be blocked with a statin, resulting in enhanced reductions in serum lipids (see section on combination therapy). Resins reduce LDL cholesterol from 15 to 30 , with a modest increase in HDL cholesterol (3 -5 ) (Table 12-8). Resins are most often used as adjuncts to statins in patients who require additional lowering of LDL cholesterol. Because these drugs are not absorbed, adverse effects are limited to the GI tract (Table 12-9). About 20 of patients taking cholestyramine or colestipol report constipation and symptoms such as flatulence and bloating. A large number of patients stop therapy because of this. Resins should be started at the lowest dose and escalated slowly over weeks to months as tolerated until the desired response is obtained. Patients should be instructed to prepare the powder formulations in 6 to 8 ounces (approximately 180-240 mL) of noncarbonated fluids, usually juice (enhances palatability) or water. Fluid...

Rationale for Parathyroidectomy

There is good evidence that in about 80 of patients the clinical manifestations improve after successful parathyroidectomy.8'9,10'46'47 Thus, fatigue, exhaustion and weakness, polydipsia, polyuria and nocturia, bone and joint pain, constipation, nausea, and depression improve in some patients.8 I0'46'47 This is also true for associated conditions. In these patients, new kidney stones usually stop forming, osteoporosis stabilizes or improves, peptic ulcer disease often resolves, and pancreatitis becomes less likely.4647 Thus, both neuropsychiatry and somatic problems improve in most, but not all, patients (Figs. 40-1 to 40-4).10-48 Increased fracture risk and weakness also improve after successful parathyroidectomy in most, but certainly not all, patients.1948 Objective increase in muscular strength has also been documented after successful parathyroidectomy.49 Patients can also resume a regular diet with or without calcium supplementation and hypercalcemia is not a concern when...

Understanding And Management Of Back Pain

Edwin Smith 3500 Monografia

Inflammation of the white fibrous tissue of the body unaccompanied by fever but aggravated by motion. The inflammation was attributed to cold and damp. Through the 19th century, treatment of back pain was by general measures against rheumatism such as relief of constipation, counterirritants, blistering, and cupping. The theory was to remove the rheumatic exudi from the affected area, and surgeons removed septic foci in the teeth, toenails, and bowel.

Mecanism Of Centripetal Lipid Accumulation Supraclavicular Fat And Face

Hypothyroidism is considered primary when increased TSH levels accompany low T3 and T4 levels, suggesting thyroid pathology. In secondary or central hypothyroidism, low T3 and T4 are associated with low TSH and suggest pituitary insufficiency. Thyroid hormone deficiency causes mental retardation in infants, growth delay in children, and myxedema in adults. Symptoms of thyroid hormone insufficiency include cold intolerance, weight gain, memory loss, dry skin, hair loss, brittle nails, constipation, increased sleep demand, and fatigue. Severe, untreated hypothyroidism can lead to coma and even death. Hypothyroidism from TSH or TRH deficiency can result from hypothalamic or pituitary destruction (neoplastic, inflammatory, granulomatous, vascular, traumatic, autoimmune, or from radiation necrosis). In the presence of an expanding pituitary mass (i.e., pituitary adenoma), loss of TSH secretion is typically associated with other hormonal abnormalities because there is a step-wise loss of...

Urinary Incontinence The Solutions

Holistics Antiandrogen

Recommended an example is pseudoephedrine (Sudafed). Imipra-mine (Tofranil), a commonly used antidepressant, may help the muscle tone of the sphincter. Oral anticholinergic drugs are widely used to improve continence in elderly persons and are worth trying the most frequently prescribed are tolterodine (Detrol) and oxy-butynin (Ditropan, Oxytrol). Dry mouth, blurred vision, constipation, and sleepiness are common side effects of anticholinergics. Men should always check with their urologist before starting on any of these drugs and ascertain that the new medication does not interact with those being taken for other conditions.

Clinical Features of Hypercalcemic Crisis

The renal symptoms of hypercalcemic crisis are polyuria and polydipsia. The neurologic symptoms are less characteristic and include depression, anxiety, and psychosis. Gastrointestinal symptoms are nausea, vomiting, constipation, peptic ulcer, and pancreatitis. Gastric acid secretion and pancreatic enzyme secretion are increased.10 Cardiac symptoms also are nonspecific. A shortened QT interval and tachycardias may be observed. The mechanism of hypertension attributable to PHPT is unclear.10 Hypercalcemic crisis is a constellation of the preceding signs and symptoms, including psychological disturbances (ranging from drowsiness to stupor to coma), renal insufficiency, and cardiac dysrhythmias (bradyarrhythmias, bundle branch blocks, complete heart blocks, and cardiac arrest).9 (The preceding signs and symptoms are mild and usual, but the signs with italic letters are severe and not common.) Hypercalcemia of malignancy must be considered in cases with a history of, for example, breast...

Accreditation Commission for Acupuncture and Oriental Medicine AGAOM

Massage, constipation, 188-189 needles, 27 Academy for Five Element immune systems, 151 nausea, 149-150 pain, 150-151 carpal tunnel syndrome, 75-77 CFIDS, 221 childbirth, 160-162 constipation, 188-189 coughing, 126 cupping, 43 dental pain, 62-64 depression, 208-209 dianhea, 190 151-153 chemotherapy, 149-150 herbal medicines, 153-154 immune systems, 151 pain, 150-151 CFIDS, 221 childbirth, 160-162 choosing, 243-244 constipation, 187-189 cystitis, 181-184 dental pain, 62-64 depression, 208-209 diagnosis acupressure, 4, 9-10, 19, 21-24, 27-29, 74, 86, 128-131, 239-241 acu-points, 5-7, 63-64, 238 allergies, 116-117 anxiety 210-211 arthritis, 78-79 asthma, 118-120 back pain, 82-85 bladder infections, 182-184 bronchitis, 121 bursitis, shoulders, 70-71 cancer, 151-153 carpal tunnel syndrome, 76-77 colds, 124-125 constipation, 188-189 dental pain, 62-64 diarrhea, 190 dysmenorrhea, 169-170 eczema, 196-197 elbow pressure, 30-31 electrical currents, 8 endometriosis, 177-179 facelifts, 199-200...

Basic Principles of Geriatric Medicine

A third principle is the underreporting of illness. When an interviewer asks a geriatric patient about various symptoms, the patient may fail to report blindness caused by a cataract, deafness caused by otosclerosis, pain in the legs at night, urinary incontinence, constipation, confusion, and so forth. The geriatric patient may believe that these symptoms are normal for a 75- or 80-year-old person. Abdominal pain and other gastrointestinal complaints such as increased gas are commonly mistaken by geriatric patients as a normal part of aging. Sometimes a patient may say, ''Nothing can be done about it, so I don't want to bother anyone by mentioning it.''

PCS Organic or functional

The whiplash shake syndrome that occurs in abused children is considered to be a prototypical demonstration of the phenomena associated with head trauma and an illustration of the fact that central nervous system injury can occur even in the absence of direct head injury (Carter & McCormick, 1983). In most cases of this syndrome, there is a history of a minor accident or shaking of the child. The syndrome is characterised by respiratory depression secondary to the trauma. Physical findings include gastrointestinal symptoms including reduction in appetite, vomiting, and constipation as well as bulging of the fontanelle, a head circumference that exceeds the 90 percentile, and retinal haemorrhage. Subdural or lumbar puncture often reveals blood in the cerebral spinal fluid (CSF), and CT can show subarachnoid haemorrhage and cerebral contusion. The median age of children suffering from the syndrome is 5.8 months, mortality is 15 , and morbidity 50 (Mandel, 1989).

The Intake Interviews The General Intake

Date of birth, school or occupation, and names of the people with whom you live. You will also be asked about your previous medical history the names of prior doctors or therapists, if you are currently taking any medication (what kinds, what dosages), if you've ever been hospitalized, and if you have, why You can expect questions about your menstrual cycle (if you're female), sexual history, use or abuse of tobacco, drugs, laxatives, diet pills, or alcohol, and physically self-injurious thoughts and behaviors.

Physical and Emotional Hazards of Bulimia

Repeated laxative abuse is a dangerous and misguided practice. It can destroy your bowel function and leave you with perpetual diarrhea and rectal bleeding. It can also deplete the sodium and potassium levels in your system (as do diuretics), which can then cause your heart to beat irregularly. In extreme cases, it can lead to heart failure, which can kill you. Ironically, laxatives don't really cause weight loss because they act on the lower portion of the gut, and calories are absorbed higher up. Also, laxatives produce watery stools, and any resulting weight loss is due to a loss of water.

Use of Medications During Pregnancy and Lactation

The most popular medications are vitamins and minerals, analgesics, antacids, antibiotics, antiemetics, laxatives, asthma medication, cold and flu medications, and medications for topical administration (e.g., antifungals, antibiotics, corticosteroids).1,2 One study from the Netherlands indicated that 65.9 of breast-feeding women took at least one medication (53 after exclusion of vitamins and minerals) over a 6-month period. The most popular medications were vitamins, analgesics, iron, antimicrobials, homeopathic remedies, oral contraceptives, cold and flu medications, and laxatives.4

Over time you may lose the ability to tell when your body is hungry or full and will have to relearn this after you

As an alternative or adjunct to vomiting, many bulimics take laxatives, diet pills, or emetics immediately after a binge since the fantasy is that this will cause weight loss. However, as the bulimia continues, you will have to take bigger doses to get the results you initially had water loss, diminished hunger, the sense that you've cleaned out your system. This escalation of abuse is exactly what happens if you're addicted to alcohol or drugs.

Anorexia Nervosa and Bulimia Nervosa

An individual with anorexia nervosa refuses to maintain a minimally normal body weight, is fearful of gaining weight, and exhibits a distorted body self-image. If she is postmenarchal, she is amenorrheic. The long-term mortality rate for anorexia nervosa is 6 to 20 , the highest rate for any psychiatric disorder (Roerig et al., 2002), often as an acute suicidal act rather than slow bodily destruction alone (Pompili et al., 2006). Bulimia nervosa is characterized by binge eating and inappropriate compensation attempts to avoid weight gain, such as self-induced vomiting, misuse of laxatives or diuretics, fasting, or excessive exercise. The prevalence of bulimia nervosa is 1 to 3 in adolescent and young adult women, more common but less often fatal than anorexia nervosa (DSM-IV).

Treatment of H pyloriAssociated Ulcers

Nsaids Ulcers

Bismuth-based four-drug regimens have clinical cure rates similar to three-drug, PPI-based regimens. Bismuth-based regimens usually include tetracycline, met-ronidazole, and an antisecretory agent (e.g., PPI or histamine2-receptor antagonist H2RA ). Bismuth salts promote ulcer healing through antibacterial and mucosal protective effects. While cheaper than most other regimens, drawbacks of bismuth-based regimens include the frequency of administration (four times a day), risk for salicylate toxicity in patients with renal impairment, and propensity for bothersome side effects (e.g., stool and tongue discoloration, constipation, nausea, and vomiting). Adverse effects of sucralfate include constipation, nausea, metallic taste, and the possibility for aluminum toxicity in patients with renal failure. While sucralfate may be used for the treatment of an NSAID-related ulcer when NSAID therapy is being stopped, it is not recommended for use as prophylaxis against NSAID-induced ulcers.

Rasmus P Clausen and Harald S Hansen

Tetrahydrocannabinol Mechanism Action

Morphine has the ability to both excite and inhibit single neurons. Opioid inhibition of neuronal excitability occurs largely by the ability of opioid receptors to activate various potassium channels. Another well-established mechanism of action is the inhibition of neurotransmitter release. The observation in 1917 that morphine inhibited the peristaltic reflex in the guinea-pig ileum (giving rise to constipation, one of the side effects of morphine) was 40 years later shown to result from the inhibition of acetylcholine release. Also glutamate, GABA, and glycine release throughout the central nervous system (CNS) can be inhibited by opioid receptor activation. In general, the CNS effects of opioids are inhibitory, but certain CNS effects (such as euphoria) result from excitatory effects (Table 19.1).

Pharmacologic Interventions Statins

Knee Plica Exercises

There are currently three different BASAs available cho-lestyramine (Questran 4-24 g in 2-3 divided doses daily), colestipol (Colestid 5-30 g in 2-3 divided doses daily), and colesevelam (Welchol 1250 mg 2-3 times daily). The development of constipation, flatulence, and bloating is relatively frequent, although colesevelam has the most favorable side-effect profile of the three available BASAs. Increasing water and soluble-fiber ingestion ameliorates some of the difficulty with constipation. The BASA bind negatively charged molecules in a nonspecific manner. Consequently, they can decrease the absorption of warfarin, phenobarbital, thiazide diuretics, digitalis, p-blockers, thyroxine, statins, fibrates, and ezetimibe. These medications should be taken 1 hour before or 4 hours after the ingestion of BASA. The BASA can reduce the absorption of fat-soluble vitamins. Colesevelam also has an indication to reduce serum glycated hemoglobin levels in patients with diabetes mellitus.

Levocarnitinein Libido

In constipation, 373, 374, 375 dosage of, 830t administration of, 1040 adverse effects of, 1041 dosage of, 1038t in glaucoma, 1038t, 1040-1041 mechanism of action of, 10381, 1040 ocular changes with, 1077t Latent autoimmune diabetes in adults, 736 Latex allergy, 1100, 1100t Laxatives. See also specific types abuse, 372t, 376 in constipation, 373-374, 374t contraindications to, 375 diarrhea with, 376t hyperphosphatemia with, 491 LDL. See Low-density lipoprotein(s) Lead, in calcium products, 972 Lead poisoning, 5011, 1114a Leflunomide, 953, 988 in allergic rhinitis, 1049-1050 in cirrhosis, 394 in constipation, 373 in erectile dysfunction, 885 in GERD, 317, 319, 320t in hyperlipidemia, 234, 236t, 240, 958 in hypertension, 58-59, 59t, 957-958 in ischemic heart disease, 117-118 in musculoskeletal disorders, 1027-1028 in osteoarthritis, 1000 in Parkinson's disease, 557 in urinary incontinence, 914 Lifting, in enuresis, 9231 Lifting techniques, 1028 Ligament, 1020, 1020 adverse effects of,...

Autism and Aspergers Disorder

Anorexia Nervosa and Bulimia Nervosa are in this category. Anorexia, is the refusal to maintain body weight at a minimally normal level necessary for health and growth combined with an overwhelming fear of weight gain and a significant misperception about one's weight and shape. The Binge-Eating Purging Type is a history of vomiting or inappropriate use of laxatives, diuretics, or enemas in the current episode. Bulimia, recurrent binge eating of inordinate amounts of food with a sense of loss of control and preoccupation with weight and shape, includes self-induced vomiting and the misuse of laxatives, enemas, diuretics, exercise, and fasting. The Nonpurging Type involves excessive exercise or fasting.

Clinical Practice Guidelines

A 58-year-old woman with no significant past medical history presented to an outside hospital with progressive bilateral lower extremity weakness, right greater than left, and decreased sensation below the nipple line. In addition, she reported 5 out of 10 pain in the midthoracic area, urinary retention, mild constipation, and an inability to bear weight. Emergency department records indicated that she had twisted her back one week prior to admission and complained of subsequent onset of these progressive symptoms. Of note, several months prior to presentation, the patient noted irritation and a possible mass in the upper outer quadrant of her right breast. Radiographs obtained at an outside hospital demonstrated a pathologic fracture of her sixth thoracic vertebrae. She was transferred to our facility for evaluation and for further radiologic and immunopathic workup for presumed meta-static breast cancer to the thoracic spine. The patient underwent a T3 to T6 laminectomy for...

Acupuncture Yoga and Homeopathic Remedies

Therapeutics Approaches include prevention, detoxification, reestablishment of one's unique constitutional balance. Foods, emotions, and behaviors are used to adjust dosha levels. Panchakarma is used to remove aggravated doshas and toxins. Components of panchakarma include therapeutic vomiting, use of purgatives or laxatives, nasal administration of medications, blood purification (traditionally by blood-letting, now more often with teas), and therapeutic enemas.

Gilbert Y Wong Carlos B Mantilla Jack L Wilson David C Mackey Tim J Lamer

Pain management with systemic analgesic medications can be acceptable for many patients but may cause intolerable side effects with increasing doses. In a study evaluating the WHO analgesic ladder in cancer patients, the most frequent opioid-related side effects were dry mouth (reported on 39 of follow-up days), drowsiness (38 ), constipation (35 ), and nausea and vomiting (22 ). Lack of any significant side effects was noted on only 24 of the days of follow-up.12 In addition, there is increasing evidence that chronic high doses of opioids may inhibit immune function, including activity of natural killer cells and other immune cells, which may be involved in the scavenging of tumor cells and suppression of tumor growth. 12 Theoretically, this immunosuppression may be important in cancer patients, especially those who require increasingly large doses of opioids to manage their pain.

Tricyclic Antidepressants

Side-effects of tricyclic therapy include sedation and anticholinergic symptoms (dry mouth, blurred vision, delayed gastric emptying, constipation, urinary retention). Centrally acting anticholinergic drugs (atropine, hyoscine) should be avoided in premedication because the additive effect may precipitate confusion, especially in the elderly.

Change in Bowel Movements

''Do you have periods of diarrhea alternating with constipation '' Are the stools watery loose floating malodorous '' Have you noticed blood in the stools mucus undigested food '' ''What is the color of the stools '' How many bowel movements do you have a day '' Does the diarrhea occur after eating '' What happens when you fast Do you still have diarrhea '' Diarrhea and constipation frequently alternate in patients with colon cancer or diverticulitis. Loose bowel movements are common in diseases of the left colon, whereas watery movements are seen in severe inflammatory bowel disease and protein-losing enteropathies. Floating stools may result from malabsorption syndromes. Patients with ulcerative colitis commonly have stool mixed with blood and mucus. Any inflammatory process of the small bowel or colon can manifest with blood mixed with stool or undigested food. Irritable bowel syndrome classically produces more diarrhea in the morning. Patients complaining of constipation should be...

The Agentic Self and Personality Changes in Parkinson s Disease

MMPI was administered early in life many decades earlier (with subjects aged 20-39 years old). Thus, the personality profile that best predicted PD onset some five decades later was an anxious and neurotic profile that was obtained when these people were young adults. Several case-control or cohort studies (reviewed in Savica, Rocca, & Ahlskog, 2010) have suggested that anxiety may be one of the earliest manifestations of PD even when analyses are restricted to 20 or more years before PD onset. In summary, anxiety and neuroticism may predate motor symptoms of PD by more than 20 years. This personality profile may, therefore, be one of the earliest biomarkers for the disease currently known. REM sleep behavior disorder (RBD) can precede PD onset, but typically, it does not appear until 5 or 10 years before onset. The same is true with other potential clinical biomarkers such as constipation. Thus, the premorbid personality of PD may be the earliest clinical biomarker for risk of the...

Orthostatic Hypotension

Management of orthostatic hypotension requires patient education to avoid factors that precipitate a fall in blood pressure. Patients should be made aware of the hypotensive effects of certain drugs, large meals, environmental temperature increases, and physical activities. Other instructions include institution of a high-fiber diet to lessen straining resulting from constipation and the use of physical maneuvers that help to increase postural tolerance. These maneuvers include crossing the legs, lowering the head in a stooped position, bending forward, and placing a foot on

Impaired Potassium Homeostasis

Patients with CKD should avoid abrupt increases in dietary intake of potassium because the kidney is unable to increase potassium excretion with an acute potassium load, particularly in latter stages of the disease. Hyperkalemia resulting from an acute increase in potassium intake can be more severe and prolonged. Patients who develop hyperkalemia should restrict dietary intake of potassium to 50 to 80 mEq (50-80 mmol) per day. Potassium concentrations can also be altered in the dialysate for patients receiving hemodialysis and peritoneal dialysis to manage hyperkalemia. Because GI excretion of potassium plays a large role in potassium homeostasis in patients with stage 5 CKD, a good bowel regimen is essential to minimize constipation, which can occur in 40 of patients receiving hemodialysis.40 Severe hyperkalemia is most effectively managed by hemodialysis.

Effects Of Child Sexual Abuse Across The Life Span

Children and adolescents exposed to sexual abuse are at great risk for physical, social, and psychological challenges. Sexual abuse has been linked to a variety of negative consequences including disordered eating,52 suicidal behaviors,52,17 and sexual risk behaviors.53 Ackard and Neumark-Sztainer52 found that for girls and boys, experiencing a single form or more than one form of sexual abuse was associated with significantly higher rates of vomiting, taking diet pills, binge eating, skipping meals, and taking laxatives than for peers who were not sexually abused. In addition, they found that those reporting multiple forms of sexual abuse reported the highest rates of suicide attempts (52.9 girls 58.5 boys). Similarly, Martin et al.17 found that sexually abused adolescents were much more likely to report thoughts about killing themselves, to have made plans, to have made threats, to have deliberately hurt themselves, and to claim attempt(s) to kill...

Refeeding and Nutrition

Malnutrition can cause delayed gastrointestinal transit, leading patients to experience abdominal pain, bloating, and constipation during the refeed-ing process. A warm pack to the abdomen can be helpful, as can relaxation techniques such as deep breathing, guided imagery, biofeedback, or hypnosis. If necessary, stool softeners, promotility agents, and or mild laxatives can also be used (American Psychiatric Association 2006).

End Stage Renal Disease

Chronic kidney disease is progressive and leads to renal failure. In end-stage renal disease (ESRD) the only life-sustaining treatments are dialysis or renal transplant. Without treatment, kidney failure causes uremia, oliguria, hyperkalemia and other electrolyte disorders, fluid overload and hypertension unresponsive to treatment, anemia, hepatorenal syndrome, and uremic pericarditis. Symptoms associated with chronic kidney disease (stage 5) include fatigue, pruritus, nausea, vomiting, constipation, dysgeusia, muscle pain, and bleeding abnormalities. Palliative care in these patients includes the minimization of listed symptoms however, because many options for drug therapy will be cleared through the kidneys, agents should be chosen cautiously to avoid other complications (see Chap. 26).

Parkinsonism Plus Syndromes

Clinical Features and Associated Disorders. MSA encompasses three neurodegenerative syndromes, which in the past were considered clinically distinct striatonigral degeneration (SND), olivopontocerebellar atrophy (OPCA), and Shy-Drager syndrome (SDS). All these conditions share similarities with one another and with PD. The hallmark features of MSA are parkinsonism that is poorly responsive to levodopa therapy and varying degrees of autonomic, cerebellar, and pyramidal dysfunction. SDS is diagnosed clinically when dysautonomia far outweighs the other signs, SND is designated when anterocollis and pyramidal dysfunction are prominent, and OPCA is used to characterize the patient with prominent cerebellar features of ataxia, limb dyssynergia, and kinetic tremor. For all MSA patients, autonomic insufficiencies include orthostatic hypotension, postprandial hypotension, anhidrosis with thermoregulatory disturbances, poor lacrimation and salivation, constipation, and impotence. Disturbances...

Edging Out Endo Acu Points Plus

When I first met Anne, she was 37 years of age and had already undergone laser surgery for infertility due to endometriosis. She had still not been able to conceive, had adopted two little girls, and found her old endo symptoms returning. With two small children to care for, her downtime from abdominal pain, constipation, and nausea was more than she could bear. We began with acupuncture and herbs, such as Dang Gui, Mu Dan Pi, and Chi Shao that significantly reduced her symptoms after one month of treatment. After three cycles, she felt greatly improved, acupuncture treatments were reduced to the times just before and after ovulation, and she uses herbs, biomagnets, acupressure, and nutrition to stay feeling good. It takes time, but positive results can be on the way.

Clinical manifestations

Foodborne botulism begins with gastrointestinal symptoms of nausea, vomiting and diarrhea in about one-third of cases. These symptoms are thought to result from metabolic byproducts of growth of C. botulinum or from the presence of other toxic contaminants in the food, as gastrointestinal distress is not seen in wound botulism. However, constipation is common in foodborne botulism once flaccid paralysis become evident. Illness usually begins 18-36 h after ingestion of the contaminated food, but can range from as little as 2 h to as long as 8 days. The incubation period in wound botulism is 4-14 days. Fever may be present in wound botulism but is absent in foodborne botulism unless a secondary infection (e.g., pneumonia) is present. All three forms of botulism display a wide spectrum in their clinical severity, from the very mild with minimal ptosis, flattened facial expression, minor dysphagia and dysphonia to the fulminant, with rapid onset of extensive paralysis, respiratory...

Clinical Manifestations and Pathology

In anorexia nervosa, normal dieting escalates into a preoccupation with being thin, profound changes in eating patterns, and a weight loss of at least 25 percent of the original body weight. Weight loss is usually accomplished by a severe restriction of caloric intake, with patients subsisting on fewer than 600 calories per day. Contemporary anorectics may couple fasting with self-induced vomiting, use of laxatives and diuretics, and strenuous exercise. By the time the anorectic is profoundly underweight, other physical complications due to severe malnutrition begin to appear. These include bradycardia (slowing of the heartbeat), hypotension (loss of normal blood pressure), lethargy, hypothermia, constipation, the appearance of lanugo or fine silky hair covering the body, and a variety of other metabolic and systemic changes.

Endocrine and Metabolic Factors

Although rarely found in children, hypothyroidism is associated with slow statural growth and developmental delay. More common among adults and more often seen in women, hypothyroidism is a relatively rare cause of obesity. If undiagnosed, it is typically accompanied by other symptoms of thyroid deficiency, such as cold intolerance, decreased energy, obstipation, and increased thinning of the scalp.

Pharmacologic Treatment

The major problem with existing agents is their lack of selectivity to bladder mus-carinic receptors, thus leading to dose-limiting side effects outside ofthe urinary tract. These include dry mouth, constipation, blurred vision, confusion, cognitive dysfunction, and tachycardia. With oxybutynin, orthostasis due to a-receptor blockade and sedation and weight gain due to histamine-1 receptor blockade may also occur. Dry mouth is the most problematic of the anticholinergic side effects and is frequently dose limiting. In the systematic review and meta-analysis cited previously, in terms of

What is a lipomyelomeningocele

A lipomyelomeningocele is a common congenital spinal anomaly in which herniation of a lipoma into the conus medullaris or the dorsal spinal cord occurs through an osseous defect and communicates with an adjacent subcutaneous fatty mass. It is a common cause of tethered cord syndrome. Symptoms may include constipation, urinary urgency, dyspareunia, lumbar pain, or cephalgia (headache) with defecation. The term lipomyelomeningocele is actually a misnomer, because abnormal neural tissue does not extend outside of the spinal canal. Surgical treatment of this anomaly is extremely challenging and should be referred to a regional center with extensive treatment of these lesions.

Nonpharmacologic Therapy

Dietary modifications improve constipation, nausea, erratic drug absorption, and minimize the risk of aspiration and weight loss. Nutritionists help with meal selection, products to boost calories, and suggestions for arranging the proper protein content of meals to maximize medication absorption. Speech therapy may improve swallowing, articulation, and the force of speech.

Epidemiology And Etiology

Noninfectious causes of acute diarrhea include drugs and toxins (Table 21-3), laxative abuse, food intolerance, IBS, inflammatory bowel disease, ischemic bowel disease, lactase deficiency, Whipple's disease, pernicious anemia, diabetes mellitus, malabsorption, fecal impaction, diverticulosis, and celiac sprue.

Clinical Presentation

The differential diagnosis between severe benign HPT and parathyroid carcinoma is difficult. Therefore, every case involving the rapid onset of symptoms of HPT should be considered suspect for carcinoma. The target organs for HPT-induced hypercalcemia are the skeleton (40 to 70 ), the kidneys (30 to 60 ), and to a lesser extent the digestive system (i.e., pancreas and stomach-duodenum) (15 ). In addition, general symptoms such as nausea, anorexia, constipation, polydipsia and polyuria, muscle weakness, fatigue, and depression are common findings. A palpable cervical mass is encountered in approximately 5 .10151720 Marked hypercalcemia, low serum phosphorus if renal function is not impaired, and a substantial elevation of serum parathyroid hormone (PTH) are common findings. With today's assays, which measure intact PTH, the diagnosis of PHPT is quickly established, and hypercalcemia caused by other malignancies can be ruled out. Moreover, there is no evidence that PTH-related peptide...

Gastrointestinal Disease

Medications with anticholinergic side effects can slow gastrointestinal motility, affecting absorption and causing constipation. By contrast, selective serotonin reuptake inhibitors (SSRIs) increase gastric motility and may cause diarrhea (Trindade et al. 1998). SSRIs have the potential to increase the risk of gastrointestinal bleeding, especially when coad-ministered with NSAIDs (de Abajo et al. 2006 Loke et al. 2008). Using extended- or controlled-release preparations of medications may reduce gastrointestinal side effects, particularly where gastric distress is related to rapid increases in plasma drug concentrations.

Clinical and Pathologic Characteristics

Although found most frequently in the gastrointestinal tract, the neuromas of MEN 2B may be present in any organ possessing a submucosa, including the bronchi and urinary bladder. These neuromas have been described as hamar-tomatous proliferations of Schwann cells, nerve fibers, and, less frequently, ganglion cells.21 When present in the gut, they predispose the patient to significant gastrointestinal symptoms, especially constipation or diarrhea, which may constitute the presenting complaint.

Selection of Medication

Hypertension, sweating, nausea, constipation, dizziness, sexual dysfunction Dry mouth, constipation, blurry vision, orthostatic hypotension, weight gain, somnolence, headache, sweating, sexual dysfunction Insomnia, dry mouth, tremor, headache, nausea, constipation, dizziness

Outcome evaluation

Precaution should be used in removal of ascites because of the potential complications associated with rapid fluid shifts. Liberal use of opioids to control pain is appropriate as ovarian cancer patients cope with PD and approaching end of life. Appropriate bowel regimens with laxatives and stool softeners should be used to prevent constipation. However, when a patient with a well-controlled bowel regimen presents with new onset of constipation, additional workup is required prior to altering bowel regimen. In ovarian cancer patients, small bowel obstruction is a common com plication of progressive disease. In general, laxatives should not be used in patients with SBOs. Prior to treating constipation, patients should have a physical examination and abdominal x-ray to rule out SBO. Often, palliative surgery is required to correct SBO and alleviate patient pain. Patients should not eat any solid or liquids until resolution of SBO. If inoperable SBO exists, then parenteral nutrition can...

Turn On Your Acu Points Shut Off the Ringer

The two most common oriental diagnoses of tinnitus that I see are rising liver and gallbladder fire, and kidney deficiency. Rising liver and gallbladder fire is characterized by sudden onset of a loud noise, emotional stress, headache, irritability, a bitter taste in the mouth, constipation, dizziness, reddish face, and thirst. Deficient kidney tinnitus comes on gradually with low, intermittent sounds, poor memory, blurred vision, sore back and knees, and reduced sexual desire or performance.

Rule 2 Make sure there really is a problem

I noticed scars on my girlfriend's knuckles soon after we started dating and I knew she'd been going to the dentist a lot lately, so I made the assumption that she was a bulimic. That's when I found out a little knowledge could be a dangerous thing. Instead of asking her point-blank, I kept sneaking in references to bingeing and purging and how bad it was for you. I even looked through her bathroom cabinets for laxatives. I thought I could help her since she liked me so much and we got on so great. But she caught me snooping. She let me have it Her scars were from an old riding accident and she was going to the dentist to have a crown on her molar repaired. We'll never go out again she was that mad at me.

The uUh0h Better Get Drano Feeling

Most pregnant women experience the constipation blues at one time or another during the nine-month haul. Why does food tend to stop dead in its tracks before reaching its Sometimes, the increased iron can cause constipation, diarrhea, dark-colored stools, and abdominal discomfort. Don't be alarmed it's just par for the course. Be sure to increase your fiber and fluids and move around as much as possible.

Miscellaneous disgustrelated disorders

In relation to eating disorders, rates of major depression have been identified in underweight patients with anorexia of between 40 and 60 (Patton, 1988). High rates of affective disorders have also been observed in the relatives of individuals with anorexia. In the case of bulimia, the rates of depression have been estimated at between 24 and 79 (Patton, 1988). Two disgust-based reactions provide defining features of anorexia (Mitchell & McCarthy, 2000). First, there is a disgust-based avoidance of foods that are considered to be fattening. Second, there is a disgust-based reaction towards the body or certain parts of the body which are either perceived to be fat or prone to becoming fat. Preliminary evidence that some aspects of disgust sensitivity may correlate with the drive for thinness comes from a study of eating disorder cases by Troop, Murphy, Bramon, and Treasure (2000). Our emphasis on disgust and disgust-based avoidance contrasts with the normal fear-based definitions,...

What is amyotrophic lateral sclerosis ALS

Clinical presentation typically includes atrophic weakness of hands and forearms, slight spasticity of the legs, and generalized hyperreflexia. Other findings may include hand and finger stiffness, cramping, fasciculations, and atrophy and weakness of tongue, pharyngeal, and laryngeal muscles. There is no sensory loss. The disease is characterized by middle life presentation and death is usually within 2 to 6 years. Diagnosis is made on the basis of history and neurologic examination and electromyography (EMG) nerve conduction studies. Riluzole is a medication to treat ALS and may improve the neurologic function and survival. Its mechanism is not well understood. Physical therapy, occupational therapy, and speech therapy are necessary treatments. Symptomatic treatment for depression, secretion control, pain, fatigue, muscle spasms, and constipation are supportive measures. The disease is also called Lou Gehrig's disease, named for the New York Yankee's baseball player who died from...

Drugs affecting intestinal motility

Drugs increasing motility of the stomach are used in the treatment of gastric reflux and disorders of gastric emptying, and drugs increasing intestinal motility are used as laxatives to cure constipation. Domperidone is used to increase gastric motility. It is thought to do this by blocking the effects of the tonic inhibitory activity of the sympathetic nerves. Although the drug is a dopamine receptor antagonist, it also blocks the adrenoceptors that mediate inhibition at the level of the ganglia and non-sphincteric smooth muscle. Another drug increasing gastric motility is metoclopramide this may also be a dopamine antagonist, although its precise mechanism of action is unclear. It causes marked acceleration of gastric emptying without increasing acid secretion. Both of these drugs are also powerful anti-emetics. Purgative laxatives increase intestinal motility by their stimulatory effects on the mucosa of the colon and rectum. This triggers local peristaltic reflexes and can...

Medical Interventions

A 31-year-old woman slipped and fell down a flight of stairs, landed on her back, and was unable to move her legs. She recovered the ability to walk but had mild residual leg weakness, a drop foot, and dyses-thesias of the feet. At age 42, she suddenly felt pain in the upper back and urinary incontinence while cheering at a basketball game. Upper thoracic, cervical, and right arm pain recurred with sneezing. At age 44, her left hand became dry and walking and urinary urgency and constipation worsened. The MRI scan shows a wide sy-ringomyelia from T-12 to C-2 in the (A) sagittal and (B) axial planes. She had kyphotic angulation of the spine at T-12 L-1 and an L-1 fracture. A staged decompression of the subarachnoid space was carried out with an anterior spinal decompression and partial extradural vertebrec-tomy of L-1, followed by a T-12 and L-1 laminectomy with intradural lysis of adhesions and placement of a dural graft. The (C) sagittal and (D) axial scans a few months...

Describe the presentation of an anterior sacral meningocele

An anterior sacral meningocele is a rare congenital spinal anomaly in which herniation of dura mater and or neural elements through a defect in the ventral spine is identified. The anomaly contains CSF and may contain neural elements. Unlike the myelomeningocele, this anomaly is not associated with hydrocephalus or Chiari malformation. Associated findings include the triad of sacral bony anomalies, a presacral mass, and anorectal anomalies (Currarino syndrome). Symptoms may include constipation, urinary urgency, dyspareunia, lumbar pain, or cephalgia (headache) with defecation. Examination findings include a smooth pelvic mass, palpable on pelvic or rectal examination. This entity is most commonly found at the sacral level and is more common in females.

Cincinnati filter device

Referral criteria will include suspected intussusception, chronic constipation (suspected Hirschprung's disease), possible swallowed foreign body, and suspected necrotizing enterocolitis. More specific referral criteria of abdominal radiographs are given by Cook et al. (1998).

Relevant pharmacology

Gastrointestinal tract disorders are common, and many drugs are targeted at the autonomic nervous system and its effectors to control over-activity or under-activity in the smooth muscles and glands. Perhaps the most important are those controlling gastric acid secretion, those inhibiting or inducing vomiting, and those affecting intestinal motility (i.e. drugs used for the treatment of constipation and diarrhoea).

Human TCell Lymphotrophic Virus Type

Clinical Features and Associated Findings. HTLV- 1-associated myelopathy-tropical spastic paraparesis is a slowly progressive spastic paraparesis marked by hyperreflexia, bladder dysfunction, constipation, and impotence in males. Sensory abnormalities due to demyelination of the posterior columns occur less frequently than motor abnormalities and present primarily as paresthesias of the lower extremities. yi

Acu Points to Slow the Flow

Locate SP-15 (Big Horizontal), which is three-finger width on either side of your navel. Rest your palms on your belly bend your fingers, and press deeply into the abdomen for one to two minutes. Close your eyes and breathe deeply. Relax. This point helps diarrhea or constipation.

Lead Poisoning Clinical Summary

Lead poisoning affects multiple organ systems. Neurotoxicity may range from subtle personality changes to encephalopathy and cerebral edema. At the societal level, even small lead burdens are associated with statistically significant decreases in intelligence quotient. Motor neuropathy such as foot drop and wrist drop may be seen in adult patients, especially after occupational exposure. Microcytic anemia may occur and basophilic stippling of the red cells may be seen. Hypertension and an acute nephropathy may occur. Abdominal pain may be described by patients but unlike other heavy metal poisonings, constipation is more likely than diarrhea. Radiographic lead lines, bands of increased density on long bones metaphyses, may be seen in young children. These densities are not due to deposition of lead but rather increased calcium deposition.

Irritable Bowel Syndrome

Although not completely understood, irritable bowel syndrome (IBS) seems to be more common these days than the sniffles. With symptoms ranging from excessive gas, cramping, bloating, and intermittent bouts of constipation and diarrhea, IBS (also called a spastic colon) usually has nothing to do with food allergies or intolerances. It's more likely a functional problem with the muscular movement of your intestines. In fact, it's generally diagnosed when the serious gastrointestinal ailments are ruled out. Some doctors say that people can even bring it on with anxiety or nerves.

Irritable Bowel Syndrome A Moving Experience

Irritable bowel syndrome, or IBS, is the most common digestive condition in the United States, affecting one in five adults. Twice as many are women than men. The condition occurs when the normal rhythm of your colon becomes irregular, typically leaving you experiencing diarrhea, cramping abdominal pain, bloating, constipation, or nausea. Pockets of trapped intestinal gas can cause pain, especially after eating, and are often temporarily relieved by bowel movements. Victims may dread mealtime due to the anticipated discomfort afterward.

Confusion and Delirium

Delirium and confusion can stem from many causes, including infection, stopping a medication suddenly, or the side effects of certain drugs, such as diuretics. Confusion may also occur from too much insulin, especially if a patient has suffered great weight loss and persistently shows a lack of appetite. Many medications, including benzodiazepines, narcotics, steroids, and anticholinergic drugs, and even nonprescription drugs such as aspirin or antihistamine, if taken often, can trigger confusion. Other causes include poor pain control, lack of sleep, fecal impaction, urinary retention, and brain tumors. In most cases, the cause is a result of the disease and not a form of any kind of mental illness. Families should be prepared, however, for episodes of confusion or delirium, because they occur is some 85 percent of terminally ill cancer patients. Almost all patients will experience some degree of confusion or delirium at least intermittently in the last few days of life.

Multiple choice questions

B The majority of intestinal transit time is determined by the colonic transit. c Exercise cures functional constipation. d Running is frequently associated with diarrhea or increased urgency of bowel movements. e Medications are of minimal value in managing symptoms caused by changes in intestinal transit during exercise.

Critique of Selected Clinical Trials

A scientifically unacceptable study of the effect of aromatherapy on endometriosis, reported only at an aromatherapy conference (Worwood, 1996), involved 22 aromatherapists who treated a total of 17 women in two groups over 24 weeks. One group was initially given massage with essential oils and then not touched for the second period, while the second group had the two treatments reversed. Among the many parameters measured were constipation, vaginal discharge, fluid retention, abdominal and pelvic pain, degree of feeling well, renewed vigor, depression, and tiredness. The data were presented as means (or averages, possibly, as this was not stated) but without standard errors of mean (SEM) and lacked any statistical analyses. Unfortunately, the study has been accepted by many aromatherapists as being a conclusive proof of the value in treating endometriosis using aromatherapy.

Patient Encounter 1 Part

The patient is diagnosed with IDA and is started on ferrous sulfate 325 mg orally three times daily to be taken on an empty stomach. Follow-up CBC 1 month later reveals a Hgb of 10 g dL (100 g L or 6.2 mmol L), previously 9.3 g dL (93 g L or 5.77 mmol L). The patient complains of shortness of breath on exertion and constipation. She also admits to taking only one tablet a day because of nausea.

Prevalence of eating disorders among athletes

B Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting misuse of laxatives,diuretics or other medications fasting or excessive exercise vomiting or the misuse of laxatives, diuretics or enemas Non-purging type The person uses other inappropriate compensatory behaviors, such as fasting or excessive exercise, but does not regularly engage in self-induced vomiting or the misuse of laxatives, diuretics or enemas

Psychopharmacological Treatments

Although clomipramine, imipramine, and desipramine have shown efficacy in comparison with placebo (Lydiard, 1987 Uhlenhuth et al., 1989 Mavissakalian and Perel, 1995 Lecrubier et al., 1997 Fallon and Klein, 1997), they all have significant side effects, high rates of intolerance, and safety concerns (Noyes et al., 1989 Papp et al., 1997). These include anticholinergic side effects (dry mouth, constipation, difficulty urinating, blurred vision), sedation, orthostatic hypotension, weight gain, and sexual dysfunction. These agents can prolong cardiac conduction and in overdose or in patients with preexisting cardiac conduction defects, a fatal arrhythmia may occur. Clinical experience suggests that although monoamine oxidase inhibitors (MAOIs) are effective in treating panic, the dietary restrictions and the risks of serious side effects (potential

Diagnosis of Primary Hyperparathyroidism

The symptoms and signs of mild primary hyperparathyroidism can be more subtle and less specific, such as fatigue, weakness, lethargy, depression, memory loss, personality changes, constipation, and decreased bone density. It is controversial whether to operate on patients with few or no symptoms or metabolic problems and minimal hypercalcemia. A prospective study of patients with primary hyperparathyroidism showed, however, that truly asymptomatic patients are uncommon less than 5 of patients.14 Many patients with these nonspecific symptoms improved after a successful parathyroid operation compared with a control group of patients who underwent thyroidectomy. Ninety-five percent had improvement of one or more symptoms after parathyroidectomy, and 55 felt better overall (compared with 30 after thyroidectomy).15 The severity of hypercalcemia did not correlate with the presence of these symptoms before parathyroidectomy neither did it correlate with the improvement in symptoms after...

Serotonin 5HT Antagonists

Cyproheptadine is safe and effective in the pediatric population and may be used in adults as well for migraine prevention. It can be safely used during pregnancy, but is not safe during lactation. Dosing is up to 4-8 mg tid. Adverse effects include drowsiness, dry mouth, constipation, and weight gain.

Patient Care and Monitoring UI

Educate the patient on lifestyle modifications that may improve symptoms, including but not limited to, smoking cessation (for patients with cough-induced SUI), weight reduction for those patients with SUI and UUI, prevention of constipation in patients at risk, caffeine reduction, and modification of diet and fluid intake (e.g., timing and quantity of fluid intake and avoidance of foods or beverages that worsen UI).

Adjunctive Medication

Anticholinergic agents effectively treat the EPS associated with first-generation 'conventional' neuroleptics. The justification for the use of anticholiner-gics with atypical antipsychotics is more limited. As noted previously, anticholinergics may contribute to cognitive deficits, as well as to peripheral side effects such as constipation, dry mouth, urinary retention, and blurred vision. Indications for use of anticholinergics with atypical antipsychotics include akathisia, rare EPS, and excessive salivation with clozapine.

Understanding How Adjuvant Drugs Relieve Pain and Suffering

In addition to the basic pain relievers, other medications are often prescribed to enhance patient comfort. Called adjuvant drugs or co-analgesics, these drugs are auxiliary medications, most of which were developed for conditions other than pain, but can play an important role in the relief of pain. Adjuvant simply means helper these drugs may help counteract side effects of the primary pain reliever(s) or help relieve other distressing symptoms, such as nausea, constipation, or breathlessness. Adjuvant analgesics, however, actually relieve pain in their own right in specific circumstances. Unlike the opioids and anti-inflammatories (NSAIDs), which are all-purpose analgesics that relieve any type of pain to some extent, the adjuvants are mechanism-specific, meaning that they may help relieve a particular type of pain but aren't effective for other types. May cause manageable problems with constipation, drowsiness, nausea and vomiting, itchiness, and urinary problems at first, may...

How to Set Up Preventive Treatment Active Tips

Worsening of headache may occur with the very drugs we use to treat headache. Consider patients' comorbidities and the adverse effects of the medications. Amitriptyline is efficacious but may not be your first choice in an obese patient because of increased appetite and weight gain associated with the drug. It may be a great choice for a patient who suffers from insomnia or chronic diarrhea, as it may cause sedation or constipation. Only a few preventive medications cause weight loss or are weight neutral topiramate, zonisamide, and duloxetine, and the latter two, although used in prophylaxis, have no randomized controlled evidence for efficacy.

What Practitioners Say It Does

Proponents indicate that qigong lowers heart rate and blood pressure, and improves relaxation potential. Specific qigong exercises aimed at directing the flow of qi to certain areas of the body are used to help prevent tension headaches, constipation, and insomnia. Practitioners describe reports of qigong curing disease, reducing farsightedness and nearsightedness and treating sinus allergies, hemorrhoids, and problems of the prostate (all highly unlikely). Other reports indicate that qigong can lessen the pain of arthritis and migraine headaches and alleviate depression, reduce anxiety, and promote sounder sleep (very probable).

Relative Contraindications

GI complaints are seen often with oral contraceptives. Estrogen can induce nausea and vomiting via the CNS, whereas progesterone slows peristalsis, causing constipation and feelings of bloating and distention.1 Most women will adjust to the symptoms, and the symptoms often will resolve within 1 to 3 months. Taking the pill at bedtime or with food may be a good strategy to help cope with nausea. If women are unable to tolerate the GI side effects, then either a decrease in ethinyl estradiol to a low-dose 20 mcg formulation may minimize nausea or a decrease in progestin may minimize bloating and constipation. Progestin-only products may be considered if even low-dose ethinyl estradiol causes nausea.

Call Your Doctor

Possible causes Local soreness or severe constipation are possible causes. In some cases, a urinary infection (opposite) may be causing pain on passing urine, and your child may be reluctant to try to pass urine again. A child who feels a strong urge to pass urine but is unable to do so needs urgent medical help.

Feeding and Elimination Habits

After the first 48 hours, the normal infant has 6 to 8 wet diapers and 1 to 2 stools per day. The infant may appear to be uncomfortable as he or she has a bowel movement, possibly straining or turning red in the face. If the stool remains soft, parents should be reassured that the baby is not constipated (Thureen et al., 2005). Normal infant stools are soft, loose, and yellow or yellow-green, and they may be confused with diarrhea. Diarrheal stools are more watery and often leave a water ring in the diaper surrounding the more solid parts of the stool. Parents should be instructed to contact the family physician for true constipation (firm, small, pelletlike stools), diarrhea lasting more than 1 day, and blood or mucus in the stool.

Gastrointestinal Dysmotility

The principles of management of any gastrointestinal motility disorder include restoration of hydration and nutrition by the oral, enteral, or parenteral route, suppression of bacterial overgrowth, use of prokinetic agents or stimulating laxatives, and resection of localized disease. Bowel Hypomotility. The first line of treatment of bowel hypomotility is to increase dietary fiber as well as water intake and exercise. Psyllium or methylcellulose with a concomitant increase in fluid intake may be used to further increase stool bulk. Some caution is required in diabetic patients, in whom high fiber may pose a risk of distention, cramping, and potential bezoar formation in the presence of gastroparesis. If these measures are ineffective, stool softeners (e.g., docusate sodium) or lubricants (e.g., mineral oil) together with an osmotic agent (e.g., milk of magnesia or lactulose) may be used. Glycerine suppositories or sodium phosphate enemas promote fluid retention in the rectum and thus...

Blueprint for Positives

The rules of those relationships if you plan to stay friends with them. In practical terms, this means that you might need to tell them things like, I'm not doing any binges with you from now on and don't try to change my mind, or I don't want to talk about the latest laxatives and diet drinks or pills anymore, or I'm not going to compare our weights each morning with you. Then tell them why.

Patient Encounter 1 Part 1

HT, a 34-year-old woman, comes to the clinic complaining of fatigue, lethargy, and having a fuzzy head for the past 6 months. She thought it was because she was working too hard, but the symptoms have not improved despite a better work schedule. She has noticed a 2.3-kg (5-lb) weight gain over the past 6 months, her menses have become heavier, she feels cold all the time, and her skin is drier. She takes no medications other than occasional acetaminophen for headache and milk of magnesia for constipation. Her vital signs and physical examination, including pelvic examination are normal.

Clinical Manifestations Diagnosis Treatment and Control

Argentine Hemorrhagic Fever (Junin) The disease occurs in the heavily agricultural moist pampas provinces to the west of Buenos Aires. It is seen in the rural regions, mostly in farm workers, including migrant workers. Several hundred cases are seen annually, occurring mainly in the harvest season between April and July. Infection in humans results from contact with field rodents. The incubation period is from 10 to 14 days, with an insidious onset beginning with malaise, fever, chills, head and back pains, nausea, vomiting, and diarrhea or constipation.

Neurobiological Factors

Delayed gastric emptying, constipation, superior mesenteric artery syndrome, pancreatitis and elevated hepatic enzymes with refeeding Parotid and salivary gland enlargement, delayed gastric emptying, esophagi tis, Mallory-Weiss tear, esophageal rupture, constipation, laxative dependence, gastric dilatation or rupture due to bingeing

Bulimia Nervosa and Binge Eating Disorder

Common bulimia nervosa medical complications are described in Table 10-3 (Fisher et al. 1995 Mitchell et al. 1991 Rome and Ammerman 2003 Rome et al. 2003). Although body weight is generally in the normal range, obesity is the main health risk factor associated with bulimia nervosa. Other less common consequences of bulimia nervosa include constipation, electrolyte abnormalities (particularly low potassium), and esophageal tears (Rome and Ammerman 2003).

NSAIDs nonsteroidal antiinflammatory drugs SNRIs serotonlnnorepinephrine reuptake inhibitors SSRls selective serotonin

AX, a 27-year-old African American woman, presents to your clinic with GI complaints (e.g., constipation, bloating, and cramping) and fatigue. She is a single mother of three (ages 2, 3, and 6 years) and is a full-time college student. She states that she worries about everything her grades, finances, the 6-year-old riding the school bus, etc. She states that even if it's not important, I still worry. She has difficulty sleeping and says that she often feels like she might jump out of her skin. On one occasion she felt like she might be having a heart attack or something.

Side Effects of Antidepressants

Antimuscarinic cholinergic properties cause dry mouth, dental caries (due to dry mouth), blurred vision, constipation, sinus tachycardia, urinary retention, and memory loss and confusion. The most serious of these effects is the possibility of an anticholin-ergic delirium (atropine psychosis). This is usually associated with elevated plasma levels of TCA drugs but can be seen at therapeutic blood levels. Typical symptoms include impaired short-term memory, confusion, and peripheral signs of anticholiner-gic activity such as dry mouth, enlarged pupils, and dry skin. Older patients seem to

Prolapsed Rectum Clinical Summary

Involving only the mucosa (prolapse is < 2 cm), or complete, involving in full thickness extrusion of the rectal wall. Prolapse may result from laxity of the pelvic floor, weak anal sphincters, and or lack of mesorectal fixation. Patients complain of bleeding, mucous discharge, rectal pressure, or a mass. Problems with fecal incontinence, constipation, and rectal ulceration are common as well. Prolapse may be associated with an increased familial incidence, chronic cough, dysentery, or parasitic infection. Other diagnoses to consider include foreign body, tumor, perianal or perirectal abscess, rectal polyp, or engorged external hemorrhoids.

Internalexternal Hemorrhoids Clinical Summary

External hemorrhoids result from the dilatation of the venules of the inferior hemorrhoidal plexus below the dentate line. They have a covering of skin, or anoderm, versus internal hemorrhoids, which have a mucosal covering. Hemorrhoids commonly present with an episode of rectal bleeding of bright red blood after defecation. This results from the passage of the fecal mass over the thin-walled venules, causing abrasions and bleeding. Symptoms from external hemorrhoids include swelling, burning, pruritus, and wetness of the anal area. Contributing factors include constipation, family history, pregnancy, portal hypertension, and increased intra-abdominal pressure. Hemorrhoids are commonly found at three anatomic locations right anterior, right posterior, and left lateral positions. A thrombosed external hemorrhoid contains intravascular clots and causes exquisite pain the first 48 hours.

Anal Fissure Clinical Summary

An anal fissure is a longitudinal tear of the skin of the anal canal and extends from the dentate line to the anal verge. Fissures are thought to be caused by the passage of hard or large stools with constipation, but may also be seen with diarrhea. The fissures are typically a few millimeters wide and occur in the posterior midline, but may occur elsewhere. An anal fissure that is off the midline may have a secondary cause, such as inflammatory bowel disease or sexually transmitted infection. Although often seen in infants, this condition is found mostly in young and middle-aged adults. Patients present with intense sharp, burning pain during and after bowel movements. They may see bright red blood at the time or shortly after the passage of stool. Gentle examination with separation of the buttocks usually provides good visualization. The diagnosis of inflammatory bowel disease, ulcerative colitis, or Crohn disease should be considered in the differential, particularly if the fissure...

Gastrointestinal tract

Less common intestinal side-effects are leakage of fluid through the ileum and the formation of tight mucosal folds which may be intermittent or persistent and may cause intestinal obstruction (pseudodiaphragmatic disease). Nausea and vomiting, diarrhoea or constipation may also occur.

Medicines Management in Hospitals Existing Business Processes

These are medicines that are given only when required to treat acute symptoms, and are generally medicines such as analgesics, antiemetics and laxatives. They are not given at set administration times, but the time and date of each dose is recorded on the chart. An example of a PRN medicine would be Paracetamol 500 mg tablets - one or two to be taken every four to six hours as required for pain.

Autonomic and Other Problems

Drooling may be accompanied by speech problems and dysphagia. Anticholinergics, botulinum toxin injections, and sublingual atropine can decrease drooling. Speech therapists perform swallowing studies to assess the risk of aspiration, and nutritionists optimize diet. Patients at high risk of aspiration or poor nutrition may require placement of a percutaneous endoscopic gastrostomy tube. Nausea improves if patients take their PD medications with meals or pharmacologic therapy (domperidone in Canada or trimethobenzamide). Sexual dysfunction or urinary problems may require a urolo-gic evaluation. Adjustment of PD therapy to increase on time, removal of drugs that decrease sexual response, and pharmacologic therapy (sildenafil or yohimbine) may help treat sexual dysfunction. Patients with urinary frequency may find a bedside urinal along with a decrease in evening fluids helpful. Improvement in PD symptom control can improve urinary frequency, but worsening symptoms may require...

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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