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Nature's Quick Constipation Cure

The First Step-by-step Plan To Cure Constipation Using A Combination Of Unique All-natural Remedies. This plan uses a strategically organized and ordered combination of the safest and most effective natural remedies for constipation. Everything used in this plan is from natures garden. No use of harmful laxatives. People who have used these swear they work Better than over-the-counter laxatives! Every strategy is carefully researched for safety and effectiveness. Each remedy builds on the last while helping out the next. The plan takes into account human physiology, anatomy, nutrition, metabolic needs and deficiencies while using specific dietary remedies and the almost always neglected but extremely powerful, mechanical remedies. All of these have been carefully planned and refined to provide you the most powerful, synergistic constipation relief plan that will relieve you of even the most stubborn of constipation episodes within as quick as 15 minutes and less than 24 Hours. More here...

Natures Quick Constipation Cure Overview

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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 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.

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 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

Constipation

Constipation can be more easily prevented than treated. When mobility and oral intake decrease and opioid analgesics are required, virtually every patient will require regular doses of laxatives to avoid distressing constipation. The laxative should be given once or twice every day and the amount increased until an effective dose is found. Bulk laxatives are tolerated poorly and rarely are adequate for these patients. If docusate (Colace), 100 to 200 mg twice daily, is not effective, add senna (Senokot), 1 to 4 tablets twice daily. Sorbitol 70 or lactulose should be added in doses of 15 to 45 mL two or three times per day if the tablets are inadequate or cause excessive cramping. If a patient has gone several days without a bowel movement or is having small, frequent, liquid stools, an impaction may require manual removal. Bisac-odyl (Dulcolax) 10-mg suppositories or sodium phosphate (Fleet) enemas may be needed occasionally until an effective oral regimen is found. Impaction may...

Amyotrophic Lateral Sclerosis Lou Gehrigs Disease

Amyotrophic lateral sclerosis (ALS) is a chronic neurodegenerative disorder that is characterized by progressive loss of motor neurons. The median survival is approximately 3 years from the onset of symptoms with less than 15 of patients surviving 10 years. Initially symptoms of ALS present as limb weakness, with other symptoms developing in no particular order including cramps, spasticity, pain, dysarthria, sialorrhea, fatigue, insomnia, depression, fear and anxiety, involuntary emotional expression disorder, constipation, aspiration, and laryngospasm. Many patients do not have cognitive impairment however, one-fourth to one-half of patients with ALS may have associated frontal lobe dementia. Disease progression eventually involves all systems except sphincter control and eye movement. Unless the individual has long-term mechanical ventilation, the cause of death is typically respiratory failure.

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.

Vinca Alkaloids and Epipodophyllotoxins

Vincristine and vinblastine are vinca alkaloids that act on tubulin to inhibit microtubule assembly. They result in S-phase-specific mitotic arrest. Resistance is mediated by the p170 membrane glycoprotein. These agents are water soluble, must be given intravenously, and have poor BBB penetration.8 Toxicities are primarily neurologic, including peripheral neuropathy and (as a result) constipation. Vinblastine is seldom administered to patients with nervous system tumors. Vin-cristine is commonly used in combination with procarbazine and CCNU (PCV chemotherapy) and may have activity against malignant gliomas, PNETs, low-grade gliomas, ependymomas, and primary CNS lymphomas.

Other Sources of Pain Associated with Cancer Other Conditions

Pain may also result from other conditions that occur at the same time as the cancer (comorbid conditions) and which may or may not be directly related, such as arthritis, gastrointestinal disorders, and long-standing back pain these account for pain in about 3 percent of hospitalized cancer patients and 10 percent of those cared for at home. Some physicians also consider problems related to the side effects of cancer therapies as another category of pain, such as discomfort due to muscle spasms, muscle wasting from inactivity, constipation, mouth sores from dehydration, and other causes, such as bedsores (also called decubitus ulcers). These problems are discussed more fully in Chapters 10 and 11.

General Signs and Symptoms

Patients may complain of swelling of their feet and ankles, which can extend up to their calves or thighs. Abdominal congestion may cause a bloated feeling, abdominal pain, early satiety, nausea, anorexia, and constipation. Often patients may have difficulty fitting into their shoes or pants due to edema.

Pharmacologic Therapies

Various medications have been used to treat the different forms of urinary incontinence. However, most current medications are used for urge or mixed incontinence, because there is little evidence that adrenergic agonists help stress incontinence (Alhasso et al., 2005) (Table 4-18). The anti-cholinergic, antimuscarinic medications prescribed for urge incontinence work by blocking cholinergic receptors in the bladder, which in turn diminishes bladder contractility. This class of medications is effective but has adverse side effects (e.g., dry mouth, constipation) related to the cross-reactivity with muscarinic receptors in the salivary glands and colon (Alhasso et al., 2006). Additional side effects include dry eyes, blurry vision, and risk of urinary retention. Anticholin-

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.

Mghr on for 1214 hours off for 101 hours

In clinical trials, ranolazine at a dose of 750 to 1,000 mg twice daily improved angina and increased exercise capacity when added to other antianginal therapy.35,36 Ranolazine has minimal effects on heart rate or blood pressure however, it has the potential to prolong the QT interval and increase the risk for the life-threatening arrhythmia, torsades de pointes. Therefore, ranolazine should be reserved for patients with angina that is refractory to traditional antianginal medications. Contraindications to ranolazine are shown in Table 7-10. Common adverse effects with ranolazine include dizziness, headache, constipation, and nausea. Syncope may occur infrequently. Ranolazine is a substrate for CYP3A4 and both an inhibitor and substrate of p-gly-coprotein. Concomitant use of ranolazine with moderate to potent CYP3A4 inhibitors, including verapamil and diltiazem, is contraindicated. Ranolazine should be used cautiously with p-glycoprotein inhibitors (e.g., cyclosporine) and substrates...

Visceral Pain and Smooth Muscle Spasm

Such as dicyclomine (Bentyl) or oxybutynin (Ditropan). If only small doses are needed, Transderm Scop patches may be useful. For more severe cases, 0.6 to 1.6 mg of glycopyr-rolate (Robinul) subcutaneously may be used (Storey et al., 1990). The physician must be alert for side effects such as dry mouth, constipation, and delirium.

The Bothersome Barometer

Feels hot and can dry you out. Symptoms are fever, headache, rash, constipation, and dry cough, while mucus is dark or yellow, sticky, and foul-smelling. > Dryness (fall). Dries up the moisture of your body (like a dry, crisp fall leaf dry skin, chapped lips, dry hacking cough, and constipation.

Argentine Hemorrhagic Fever Junin

This disease occurs in the heavily agricultural pampas west of Buenos Aires. It is seen in rural regions, mostly in farm workers. Several hundred cases occur annually, mainly in the harvest season between April and July. Infection in humans results from contact with field rodents. The incubation period is 10-14 days, and an insidious onset begins with malaise, fever, chills, head and back pains, nausea, vomiting, and diarrhea or constipation. Hemorrhagic manifestations may proceed to death (in about 10 percent of cases). In some cases, neurological symptoms predominate.

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

Gastrointestinal System

GI involvement may present initially as small bowel obstruction shortly after birth due to abnormally thick meconium that cannot be passed (meconium ileus). Older CF patients may develop distal intestinal obstruction syndrome (DIOS), formerly called meconium ileus equivalent, which occurs due to fecal impaction in the terminal ileum and cecum.

Using NSAIDs with Opioids

No additional pain relief, only increased side effects. Although each NSAID is associated with a usual ceiling dose, there is still some variation among individuals, even for the same drug. As a result, the doctor may recommend a moderate increase in the initial dose of an NSAID, hoping for a corresponding improvement in comfort. Moreover, the side effect profile of the NSAIDs is very different from that of opioids. While opioids commonly cause constipation, nausea, drowsiness, and itchiness, the NSAIDs commonly cause GI problems (a risk that appears reduced though not absent with the newer COX-2 inhibitors), easy bruising, and bleeding.

Reducing Your Risk of Colon Cancer

Can a diet rich in fiber actually lower your chance of developing colon cancer Several studies say yes, and it makes perfect sense. Think about it. Insoluble fiber helps move waste material through your intestines more quickly. Therefore, there is less time for suspicious substances to lurk around and possibly damage your colon and rectal area. In addition, fiber may bind with possibly harmful bacteria, transporting it through the intestines and out of your body. While we're down there, it's a perfect time to point out that softer, more regular bowel movements can also prevent constipation and reduce your chance of getting hemorrhoids.

What are some of the side effects of opioids

Nausea is common, especially at initiation of therapy, and usually responds to treatment with antiemetics. Constipation occurs in most patients, and prophylaxis is important, using dioctyl sodium sulfate (DSS) plus Senokot, two to four tablets at night. For more resistant constipation, polyethylene glycol (MiraLax) is often useful. Other side effects include itching (which is not an allergic reaction), sweating, and dry mouth. There may be sexual dysfunction due to opioid-induced lowered testosterone, which is treated by the use of a testosterone patch or gel.

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.

Upon completion of the chapter the reader will be able to

Identify the causes of constipation. 2. Compare the features of functional constipation with those of irritable bowel syndrome (IBS) with constipation (IBS-C). 3. Recommend general and dietary modifications and therapeutic interventions for the treatment of functional constipation. 9. Contrast IBS with diarrhea (IBS-D) and IBS with constipation (IBS-C). 0 Constipation is defined in many ways, and it is important to know what is meant when the term is used. 01 Functional constipation exists when criteria are fulfilled for at least 3 months with symptom onset at least 6 months before diagnosis. General and dietary modifications should be employed prior to the use of laxatives in most instances of constipation. Oral laxatives are the primary pharmacologic intervention for relief of constipation. IBS symptoms typically cluster around two main types IBS with diarrhea and IBS with constipation. The principal goal of IBS treatment is to reduce or control symptoms. CONSTIPATION O Constipation...

Epidemiology And Etiology

Constipation is a common complaint of patients seeking medical attention, and about one-third of patients with constipation seek medical treatment. Constipation occurs in approximately 20 of the population. Approximately 2.5 million physician visits and 90,000 hospitalizations per year in the United States are due to constipation.4'5 Many medications and some disease states are associated with constipation. Constipation is associated with high socioeconomic costs and has considerable quality-of-life ramifications.6 Elderly patients, non-Caucasians, women, and those of lower educational and socioeconomic levels are more likely to report being constipated. Constipation in children can occur because of a change in the usual diet or fluid intake, a deviation from usual toileting routines such as during vacations, avoidance of bowel movements because of pain associated with having a stool, or due to the use of medications. Children who are diagnosed with severe constipation at a young age...

Genetic Testing for Hereditary MTC

Germiine defects in the RET protooncogene are responsible for MEN 2A, MEN 2B, and FMTC.4143 RET encodes a transmembrane growth neurotrophic receptor with tyrosine kinase activity. In MEN 2A and FMTC, gain-of-function mutations within codons specifying cysteine residues in the extracellular ligand-binding domain of the RET gene product are most commonly found (see Table 15-2). In MEN 2B, a mutation is found in the intracellular tyrosine kinase domain. Changes in protein structure and function that result from these mutations predispose to neoplasia by a dominant oncogenic mechanism.44 Loss-of-function mutations in different regions of the same gene have been found in patients with Hirschsprung's disease. A small percentage of patients with MEN 2A have Hirschsprung's disease.810 All patients with MEN 2B have megacolon and constipation.4'10,11

Clinical Presentation And Diagnosis Diagnosis

A complete history should be obtained so that the patient's symptoms can be evaluated and the diagnosis of functional constipation confirmed. The diagnosis of functional constipation is suggested by the presence of two or more of the following criteria (a) straining, (b) hard or lumpy stools, (c) sensation of incomplete evacuation, (d) sensation of anorectal blockage obstruction, (e) need for manual maneuvers, or (f) fewer than three defecations per week for at least 25 of defecations. The symptoms must have been present for the last 3 months with onset at least 6 months prior to diagnosis. In addition the criteria for meeting the diagnosis of IBS are not met.

Nonpharmacologic Therapy

General and dietary modifications should be employed prior to the use of laxatives in most instances of constipation. Treatment of constipation depends upon the characteristics and severity of symptoms. Intake of dietary fiber increases fecal bulk by promoting movement of water into the feces and bacterial proliferation. Increasing fiber intake to 20 to 35 g day may help improve symptoms. Foods high in fiber include beans, whole grains, bran cereals, fresh fruits, and vegetables such as asparagus, brussels sprouts, cabbage, and carrots. Persons with constipation should avoid excessively processed low-fiber foods such as luncheon meats, hot dogs, certain cheeses, and ice cream. Walking and other aerobic exercises help to tone the muscles of the lower abdominal area, which promotes propulsion in the bowel. Constipation is a frequent complaint of sedentary persons.

Alosetron Lotronex11 5HT4 Raptor Agonist

In IBS With Constipation Stimulation of 5-HT3 receptors triggers hypersensitivity and hyperactivity of the large intestine. Alosetron (Lotronex) is a selective 5-HT3 antagonist that blocks these receptors and is used to treat women with severe IBS-D. Eligible patients should have frequent and severe abdominal pain, frequent bowel urgency or incontinence, and restricted daily activities. Alosetron has been shown to improve overall symptoms and quality of life. Alosetron can cause constipation in some patients.

Urinary Tract Infections in Children

Urinary tract infection is one of the most common infections of childhood. Factors predisposing to UTI include taking broad-spectrum antibiotics (e.g., amoxicillin, cephalexin), which are likely to alter gastrointestinal and periurethral flora incomplete bladder emptying or infrequent voiding voiding dysfunction and constipation. UTI in young children serves as a marker for abnormalities of the urinary tract. Imaging of the urinary tract is recommended in every febrile infant or young child with a first UTI to identify children with abnormalities that predispose to renal damage. Imaging should consist of urinary tract ultrasonography to detect dilation of the renal parenchyma. Voiding cystourethrogra-phy is often ordered but does not appear to improve clinical outcomes in uncomplicated UTIs (Alper and Curry, 2005).

The Endogenous Opioid System

These opioid receptors belong to a superfamily of guanine (G) protein-coupled receptors that constitute 80 of all known receptors, including muscarinic, adrenergic, y-aminobutyric acid, and somatostatin receptors. or morphine-preferring receptors are principally responsible for supraspinal and spinal analgesia. Receptors include a subpopulation of and receptors. The activation of receptors produces analgesia, euphoria, and miosis, whereas the activation of receptors is responsible for hypoventilation, physical dependence, and marked constipation. Exogenous -receptor agonists include morphine, meperidine, fentanyl, sufentanil, alfentanil, and remifentanil. Activation of calcium channel-linked k receptors produces less respiratory depression than -receptor activation. However, dysphoria and diuresis may accompany activation of k receptors. Opioid agonists-antagonists often act principally on k receptors.

Therapeutic Interventions

Review several eating disorder behaviors (e.g., gorging, purging, use of laxatives, excessive exercise) that occurred under stress, and help the client discover what he she could have done to cope more effectively, rather than to use food dysfunctionally in each situation. 6. Review several eating disorder behaviors (e.g., gorging, purging, use of laxatives, excessive exercise) that occurred under stress, and help the client discover what he she could have done to cope more effectively, rather than to dysfunctionally use food or addictive behavior in each situation.

Patient Encounter Part 2

Bowel symptoms in MS patients can include both fecal incontinence and constipation. Fecal incontinence is difficult to treat a regular schedule for emptying the bowel with laxative suppositories or enemas may be helpful. Alternatively, antidiarrheal medications such as loperamide can be used.13

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...

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.

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.

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...

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.

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.

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

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.

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).

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

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.

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 and Pathology

Other symptoms that commonly occur include a full sensation or cramping of the epigastrium, heartburn, constipation, and mental confusion. B. Wood and K. J. Breen (1980) define clinical thiamine deficiency to consist of beriberi heart failure and Wernicke's encephalopathy. The latter is a dysfunction of the brain that is characterized by confusion and by a loss of coordination and independent movement of the eyes that is commonly found in alcoholics. Thiamine reverses most of the symptoms, but many patients are left permanently with an inability to form new memories (Korsakoff's psychosis).

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.

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...

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.

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.

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.

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).

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.

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...

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.

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).

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.

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...

Orthostatic Hypotension

After stroke, a few measures may reduce the risk for additional hypoperfusion-induced ischemic injury during initial attempts at mobilizing the patient soon after transfer for inpatient rehabilitation. The most frequent errors of commission that lead to OH include fluid restriction from initial concern about cerebral edema and, later, from inadequate fluid intake secondary to dysphagia, and medications for hypertension and heart disease, such as beta-blockers and diuretics. Deconditioning from immobility contributes to postural pressure changes. People with diabetes mellitus and a peripheral neuropathy often have baroreceptor denervation, so they cannot raise their blood pressure by increasing their heart rates. Hard stool may force patients to strain and produce Valsalva's maneuver, causing hypotension.

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

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

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.

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.

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.

Clinical Presentation

Diarrhea constipation food, and therefore they lose weight. Patients with CMI typically avoid food and demonstrate significant weight loss. However, patients with ischemic gastropathy may also present with atypical symptoms such as vomiting, diarrhea, constipation, ischemic colitis, and lower gastrointestinal bleeding. Most patients have evidence of atherosclerosis in other vascular beds and may have had prior myocar-dial infarction, stroke, or claudication.

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.

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.

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.

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.

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.

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

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).

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).

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.

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.

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...

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...

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...

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,...

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.

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.

Treatment of Nonmotor Symptoms

Patients with Parkinson's disease frequently develop other comorbid conditions such as depression or dementia. In the case of depression, an SSRI can be used. Up to 40 of patients develop dementia (Aarsland et al., 2003). In these patients the cholinesterase inhibitors can be effective. Parkinson's disease is a progressive illness, so it is important for the family physician to discuss advanced directives, establishment of power of attorney for health care decisions, and the patient's wishes surrounding the use of artificial nutrition. Living wills and other legal documents should be prepared and appropriate discussions documented. Common symptoms such as constipation, sleep disturbance, and orthostatic hypotension should be aggressively treated.

Symptomatic Management

Medications used for symptomatic management depend on the specific symptoms encountered by the patient. MS patients frequently develop spasticity, which can be treated with baclofen, tizanidine, or benzodiazepines. Physical therapy can also help with spasticity. Bladder dysfunction can also occur in patients with MS. New bladder symptoms should be evaluated with a urine culture to rule out infection. A postvoid residual should also be obtained, as well as urodynamic testing to determine whether the problem is overflow incontinence from urinary retention or urge incontinence from detrusor instability. In the presence of urge incontinence, the anticholinergics oxybutynin (Ditropan) and tolterodine (Detrol) may be useful. If the problem is urinary retention and overflow incontinence, patients will usually need to be treated with intermittent self-catheteriza-tion. Patient may also experience depression, constipation, and sexual dysfunction. The usual evaluation and treatment options...

Patient Encounter 2

A 36-year-old female who has been in good health presents to your clinic complaining of constipation and abdominal pain. She explains to you that she has been feeling stressed lately because her 40-year-old sister is undergoing chemotherapy for breast cancer and they just lost their mother to ovarian cancer a few years ago.

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.

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...

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

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.

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 Manifestations

Typhoid fever is an illness characterized by fever and headache. Other early symptoms that may occur are abdominal distension or tenderness, constipation and a few loose bowel movements, cough or bronchitis, and rose spots - a transient rash that usually begins on the abdomen. As the illness progresses, the headache may be more severe and be associated with mental confusion or stupor, the liver and spleen usually become enlarged, and complications such as intestinal hemorrhage, intestinal perforation, and pneumonia may occur.

Laparoscopic Partial Nephrectomy Models

The following patient parameters were recorded during the retrospective chart review (334 patients) age, sex, surgeon, body mass index, American society in anesthasiology grade, hypertension, prior pancreatitis, prior abdominal surgery, prior deep venous thrombus, peripheral vascular disease, smoking, coronary astery disease, gastic erophageal refull disease, anxiety, hyperlipidemia, depression, renal stone disease, constipation, liver cirrhosis, hepatitis C, hematuria (micro or gross), chronic obstructive pulmonary disease, alcohol use, hypothyroidism, diabetes mellitus, chronic renal insufficiency, cerebrovascular accident, gout, congestive heart failure, osteoarthritis, bleeding disorder, Crohn's disease or inflammatory bowel disease, obstructive sleep apnea, polycystic kidney disease, seizures, anemia, von Hippel-Lindau disease, simple or partial nephrectomy, planned retroperitoneal versus transperitoneal approach, tumor size (by computed tomography), solitary kidney, preoperative...

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...

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

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

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).

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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