Curing Flatulence Forever
That most eminent of Victorian dyspeptics, Thomas Carlyle, likened his torment to a rat gnawing at the pit of the stomach. Dyspepsia's victims still complain of gastric pain, along with fullness or heaviness in the stomach, nausea and vomiting, belching, flatulence, and or acid eructations. Finally, dyspeptics may suffer heartburn, a caustic pain behind the sternum that sometimes climbs into the throat, resulting from esophageal reflux. Heartburn is the special affliction of those with sliding hiatus hernia when they bend or lie down.
Radiograph typically shows abnormally distended bowel loops containing excessive gas. Not infrequently the typical signs are absent, especially if the bowel contains predominantly fluid an erect image may then show fluid levels that confirm the diagnosis (in the appropriate clinical setting). Air fluid levels also occur in a range of conditions, including those not requiring surgery, such as gastroenteritis and jejunal diverticulosis.
If you can't stomach milk and you experience bloating, nausea, cramping, excessive gas, or a bad case of the runs after eating a dairy food, you are not alone. In fact, an estimated 30 to 50 million Americans suffer from some degree of lactose intolerance, which is the inability to digest the milk sugar lactose. In fact, I once had a client tell me he visited so many restrooms while touring through Europe he was ready to write The Complete Idiot's Guide to European Bathrooms.
A final case involved a collapse at 36 weeks, with abdominal distension and extreme pain and tenderness. The fetal heart tones were still present, and the presumed diagnosis was pla-cental abruption. The patient was immediately taken to theater for Cesarean section. On opening the peritoneum, a massive hemoperitoneum gushed forth, but the uterus was perfectly soft and normal in color. A Cesarean section was carried out and a healthy baby delivered. It was assumed that the source of bleeding could be a splenic artery aneurysm accident, and a four-quarter exploration of the abdomen carried out. The upper abdomen revealed no bleeding whatsoever, and eventually an arteriovenous malformation at the brim of the pelvis was found to be bleeding. A vascular surgeon was called in to check that hemostasis was satisfactory. After an 8-unit blood transfusion, the patient and baby did well.
Stern, there appear to be several important diagnoses. Inflammatory bowel disease (IBD), irritable bowel syndrome, traveler's diarrhea, pseudomembranous colitis, celiac disease, and giardiasis are certainly in the differential diagnosis. The history of iritis and low back pain makes the diagnosis of IBD a strong possibility. IBD, consisting of Crohn's disease and ulcerative colitis, is very common, with an annual incidence in the United States of approximately 3 to 10 new cases per 100,000 people. Extraintestinal inflammatory manifestations are common. Ocular manifestations occur in 5 of patients with IBD, and ankylosing spondylitis, in 5 to 10 . The most common extraintestinal manifestation is a peripheral, large-joint, asymmetric, nondeforming arthritis this occurs in 20 of patients with IBD. Mr. Stern does not have a history of this type of arthritis. Genetic disorders seem unlikely, inasmuch as the appearance of this patient's problem started at age 27 or 28....
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.
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...
A 67-year-old female with history of coronary artery disease, diabetes, and GI reflux presents to your clinic complaining of persistent flatulence, bloating, and feels she is getting fat. After discussing the symptoms with her, you learn that her reflux symptoms are recent onset and her proton pump inhibitor is working. However, for the past 3 or 4 months, she also has irregular bleeding and occasional cramping, which has been frustrating for her because she thought that ended years ago when she went through menopause. She reports her menses began when she was 9 and lasted all way until she was 61. She has two sisters in good health and a brother with diabetes. She has been married for 25 years with no children. The physician orders a CA-125 and CT scan that both come back positive and suggestive of ovarian cancer.
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.
Correct Veress needle placement should be confirmed before proceeding with insufflation of the abdomen (Table 1). Bowel insufflation through a Veress needle may produce asymmetrical abdominal distension, insufflation of only a small amount of CO2 (less than 2 L) before high intra-abdominal pressures are reached, and passage of flatus during insufflation. If these signs are identified, insufflation should be immediately terminated. A pneumoperitoneum may then be established using a second Veress needle or an open Hasson technique at a different site.
Rectal injury during radical prostatectomy converts the case from a clean contaminated to a contaminated procedure and may increase the risk of septic complications, such as wound infection, pelvic abscess, peritonitis, rectourethral fistula, and death. The reported incidence of rectal injury during open radical prostatectomy ranges from 0 to 9 . The average incidence of rectal injuries reported in the larger series of laparoscopic radical prostatectomies is 1.7 (28 1647 procedures) (42). Guillonneau et al. reported 13 rectal injuries (1.3 ) in their first 1000 laparoscopic transperitoneal radical prostatectomies (42). None of these patients had previous prostatic surgery, or had received preoperative radiotherapy or hormonal therapy. Of the 13 rectal injuries, 11 were diagnosed intraoperatively and primarily repaired. Of the 11 intraoperative rectal repairs, nine healed primarily without colostomy. Two patients who had intraoperative rectal repair by a single-layer closure developed...
In the approach to the patient with symptomatic gallstones, clinicians should effectively rule out other potential causes of RUQ and epigastric abdominal pain, distinguishing biliary from nonbiliary etiologies as the primary source of disease (see Table 38-1). A gallstone blocking the cystic duct or common bile duct (CBD choledocholithiasis) results in acute biliary colic, which can evolve into acute suppu-rative cholecystitis or cholangitis. The onset of pain from biliary colic is rarely related to meals or the type of food consumed, contrary to popular opinion. Many patients with postprandial abdominal pain believe that they have gallbladder disease, but many of them suffer from dyspepsia or GERD. One meta-analysis found that heartburn, flatulence, regurgitation, and fatty food intolerance were not associated with gallstones, but that epigastric pain, nausea, and vomiting were associated with a higher odds ratio of having gallstones (Kragg et al., 1995).
In all these situations, the tricuspid valve itself is anatomically normal and the regurgitation is caused by right ventricular dilatation. The latter will stretch the tricuspid annulus and cause tricuspid regurgitation. The latter occurs in late stages when right ventricular hypertrophy is no longer able to compensate for the pressure load. The high-pressure tricuspid regurgitation is often less well tolerated by the right ventricle. The right ventricular hypertrophy would usually precede the development of the tricuspid regurgitation, and the right ventricular diastolic pressures, in particular the pre-a wave pressure, would be elevated. This will lead to significant elevation of the right atrial and jugular venous pressures. The raised venous pressure would cause systemic venous congestion, resulting in abdominal distension, hepatomegaly, pulsatile liver, and peripheral edema. The jugular venous contour will be abnormal, reflecting the tricuspid regurgitation showing...
Berde used daily single-shot injections of caudal morphine in a 5-month-old infant with neuroblastoma and massive abdominal distension.1 The team had feared that systemic opioids would precipitate respiratory failure. They did not place a neuraxial catheter because of the child's profound neutropenia and short expected lifespan (days). Outcomes included the following
Impairment of oxygenation in the postoperative period is related to a reduction in FRC. After induction of anaesthesia, there is an abrupt decrease in FRC. The magnitude of the decrease is similar for anaesthetic techniques in which the patient breathes spontaneously and those in which IPPV is employed. Postoperatively, this decrease is maintained by wound pain, which causes spasm of the expiratory muscles, and abdominal distension, which leads to diaphragmatic splinting. This is also influenced by the site of surgical incision the greatest reduction follows thoracic or upper abdominal surgery. The supine position also reduces FRC.
The oral-gastric decompression tube is removed before extubation. The suction drain is removed when the drainage is less than 25 mL or fluid chemistries suggest peritoneal fluid. The patient can be discharged when they are afebrile and able to complete three consecutive meals without abdominal distension, the first meal is usually started on the first postoperative day. Patients are discharged with the indwelling urethral catheter used for bladder drainage and three times daily bladder irrigation with 100 mL of sterile saline. Low-dose prophylactic antibiotics are continued during the first three postoperative weeks. At that time, the urinary catheter is removed and intermittent catheterization is initiated. For patients who have an indwelling catheter via the umbilical stoma, the catheter is usually capped at the time of hospital discharge, but may be used to flush the augmented bladder at the time of bladder irrigations.
Initial reports found that up to half of all marathon runners have occasional loose stools or three or more bowel movements per day. Furthermore, the urge to defecate, abdominal cramping and increased flatulence are common lower GI symptoms of runners. A small percentage of marathoners report bloody bowel movements with running. Upper GI symptoms such as heartburn are not infrequent, particularly during running. Other upper tract symptoms include increased eructations, abdominal pain, nausea and vom-
Abdominal radiography of the acute abdomen in children is normally performed in conjunction with abdominal ultrasound. It is not routine in cases of non-specific abdominal pain, as a radiographic abnormality is unlikely to be demonstrated in the absence of any one of the following loin pain, haematuria, diarrhoea, palpable mass, abdominal distension, or suspected inflammatory bowel disease.
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, 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.
Maldigestion due to pancreatic enzyme insufficiency is present in about 85 to 90 of CF patients.5 Thick pancreatic secretions and cellular debris obstruct the pancreatic ducts and lead to fibrosis. Volume and concentration of pancreatic enzymes and bicarbonate are reduced, leading to maldigestion of fat and protein and subsequent malabsorption of fat-soluble vitamins (A, D, E, and K). Maldigestion is characterized by abdominal distention, steatorrhea, flatulence, and malnourish-ment despite voracious intake. Maldigestion is progressive and may develop later in a previously pancreatic sufficient patient. Other complications may include gastroesophageal reflux, dysmotility, salivary dysfunction, intussusception, volvulus, atresia, rectal prolapse, and complications related to corrective surgery for meconium ileus.6
Side-effects include headache, abdominal cramps, nausea and flatulence, chills, shivering, and fever, all of which are dose-dependent. It is interesting to note that, before its use in pregnant women, chills, shivering and fever were not commonly reported side-effects, suggesting that these are dose-dependent.
There has been considerable dispute about the clinical importance of Giardia infection. Although many cases are asymptomatic, it is now clear that the flagellates damage the intestinal wall and heavy infestations can cause nutritionally significant malabsorption of food. Symptoms include diarrhea, flatulence, abdominal discomfort, and light-colored, fatty stools. Repeated examinations and use of serologic techniques developed in the 1980s yield more reliable diagnoses for either individual patients or an entire population. Most infections are self-limiting, and treatment is effective, but reinfestation must be avoided. Some evidence indicates that mothers' milk helps protect infants against infection.
Gaseous distention related to eating is intermittent and is relieved by the passage of flatus or belching. A patient with ascites has the insidious development of increased abdominal girth, noted through a progressive increase in belt size. Loss of appetite is often associated with cirrhosis and malignancy, although end-stage congestive heart failure may produce this symptom as well. Shortness of breath and ascites may be symptoms of congestive heart failure, but the shortness of breath may be the result of a decrease in pulmonary capacity owing to ascites from another cause. Questions related to alcoholic abuse are most appropriate and are outlined in Chapter 1, The Interviewer's Questions.
Dosage For therapeutic purposes, chew one fresh clove daily. (For breath purposes, you might want to follow it up with an Altoid, one of those curiously strong mints ) There are also enteric-coated garlic-powder supplements, but note that the supplement should provide at least 5,000 mg of allicin daily. Consumption of large quantities (five or more cloves daily) can result in heartburn, flatulence, and related gastrointestinal problems.
Flatulence, abdominal discomfort, The a-glucosidase inhibitors have been the least utilized of the oral medications available in the United States because of their side effects, not because of their lack of efficacy. The agents interfere with intestinal digestion of complex carbohydrates, slowing the absorption of glucose and limiting the beta-cell insulin response, thus lowering insulin levels. Their disadvantage is that they require administration with meals and often cause postprandial abdominal discomfort and flatulence. Patients who can tolerate these agents can experience HbA1c reductions comparable to other oral agents. However, most patients eventually request a change in medication. These drugs may be better tolerated at the onset of diabetes and prediabetic phase of diagnosis.
These agents are either naturally derived (psyllium), semisynthetic (polycarbophil), or synthetic (methylcellulose). They act by swelling in intestinal fluid, forming a gel that aids in fecal elimination and promoting peristalsis. They may cause flatulence (which is less common with methylcellulose) and abdominal cramping. Bulk-forming laxatives must be taken with sufficient water (8 oz or 240 mL dose) to avoid becoming lodged in the esophagus and producing obstruction or worsening constipation. Hyper- These products cause water to enter the lumen of the colon. Lactulose, sorbitol, and glycerin are osmolar sugars. Polyethylene glycol 3350 with electrolytes is most useful for acute complete bowel evacuation prior to GI examination. Polyethylene glycol 3350 without electrolytes is useful in patients who are experiencing acute constipation or who have had inadequate response to other agents.8 Lactulose causes acidification of the contents of the colon, increases water content of the gut,...
For example fu man, or abdominal fullness, was an important sign. This could mean edema (.chung). The Nei Ching actually says that fluid passing into the skin and tissues by overflow from above and below the diaphragm forms oedema. It could also mean ascites occurring in liver cirrhosis, heart failure, and especially schistosomiasis, undoubtedly so common in ancient China. Fu man was also accompanied by the excretion of watery feces with undigested food (shih i) found in gastroenteritis, cholera, and the like. Fu man was also called fu chang and tien. This latter word is a good example of a word that can be pronounced in two ways pronounced tien, it meant abdominal distension but pronounced chen, it meant various forms of madness and, in the binome chen hsien, epilepsy. It is clear from the clinical description that from Han times onward the terms lao feng and lao chung referred to tuberculosis. The term feng by itself always had the connotation of...
One study evaluated the longer-term effect of orlistat in adolescents. In a group of 12-to 16-year-old individuals, orlistat (120 mg three times daily) in combination with diet, exercise, and behavior modification resulted in a significant reduction in BMI and waist circumference when compared to placebo. In addition, orlistat-treated subjects exhibited minimal weight increase after 1 year (0.53 kg) compared with placebo-treated patients (3.14 kg). Common adverse reactions observed were fatty or oily stools, oily spotting, oily evacuation, or abdominal pain and or flatulence with bowel movements. Soft stools, nausea, increased defecation, and fecal incontinence also were noted.44 The safety and efficacy of orlistat have not been determined beyond 4 years of use. Minimal systemic effects exist because orlistat acts locally in the GI tract. Thus, common side effects reported include oily spotting, flatus with discharge, fecal ur3g9ency, fatty oily stools, oily evacuation, increased...
Common adverse effects of calcium salts include constipation, bloating, cramps, and flatulence. Changing to a different salt form may alleviate symptoms for some patients. Calcium salts may reduce the absorption of iron and some antibiotics, such as tetracycline and fluoroquinolones.
There has been considerable dispute in the past about the clinical importance of Giardia infection. Although many cases are in fact asymptomatic, it is now clear that the flagellates damage the intestinal wall and that heavy infestations can cause nutritionally significant malabsorption of food. Symptoms include diarrhea, flatulence, abdominal discomfort, and light-colored, fatty stools. The classic method for detecting Giardia infections is to find the trophozoites in the feces with a microscope, but surveys that depend on this technique will generally underestimate prevalence because trophozoites do not appear consistently in the stools. Repeated examinations and use of serologic techniques developed in the 1980s give more accurate results for either an individual patient or an entire population. Most infections are self-limiting and treatment is effective, but reinfestation must be avoided. There is some evidence that mothers' milk helps protect infants against infection.
An exclusive concentration on the institutional history of psychiatry may also obscure the broader social currents that already were greatly expanding the concept of mental illness. Milder forms of insanity, such as hypochondriasis and hysteria, had by Pinel's day gained a status as the period's quintessential medical complaint. These conditions, also known as the vapors, spleen, melancholy, or later nerves, referred to an irksome cluster of psychological and somatic (especially gastric) complaints, ranging from ennui to flatulence. Through such works as Richard Blackmore's Treatise of the Spleen and Vapours (1725) and George Cheyne's The English Malady (1733), the valetudinarian hypochon-driack, known by oppressive moodiness, oversensitive skin, and bad digestion, became enshrined as a stock Enlightenment figure.
Leakage of urine can occur due to poor anastomosis, failure of suture material, distal ureteral obstruction, or unrecognized injury to the ureter distal to the anastomosis. Clinically, this can be identified by excessive and prolonged drain output or abdominal distension from urinary ascites. Confirmation can be achieved biochemically by testing the drain fluid for creatinine and comparing to serum cre-atinine. A drain fluid creatinine that is greater than the serum creatinine indicates the presence of urine.