Natural Irritable Bowel Syndrome Treatment Book
Inflammatory bowel disease constitutes a group of diseases of unknown cause. The symptoms produced depend on the location, extent, and acuteness of the inflammatory lesions. The common presenting features are fever, anorexia, weight loss, abdominal discomfort, Inflammatory bowel disease may lead to long absences from school or work, disruption of family life, malabsorption, malnutrition, and multiple hospitalizations. A patient can have 10 to 30 watery or bloody bowel movements each day. As a consequence, patients with inflammatory bowel disease can have many psychologic problems, particularly when they are young adults. Because of malabsorption, the prevalence of osteopenia in patients with inflammatory bowel disease ranges from 40 to 50 osteoporosis is present in 5 to 30 of all patients. Fractures of the hip, spine, and distal radius occur. One study revealed that the incidence of fractures among persons with inflammatory bowel disease is 40 greater than in the general population....
Tanelian performed a neurolytic celiac plexus block for a 4-year-old boy with rapidly progressive, painful, cryptogenic inflammatory bowel disease.123 The child had undergone many bowel resections. His disease was deemed fatal, but the course of the illness was unpredictable. The child's pain was refractory to high-dose parenteral opioids. A neurolytic celiac plexus block performed under fluoroscopic guidance produced no analgesia. A second celiac plexus block performed under computed tomography guidance yielded the following outcomes
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.
One of the controversies within the medical coping literature focuses on the use of a categorical versus a noncategorical approach to conceptualizing the childhood illness experience (R.J. Thompson and Gustafson 1996). In categorical approaches, illnesses are grouped in terms of specific diseases, such as inflammatory bowel disease or asthma. These approaches consider the different rates and presentations of psychological problems in childhood within each category of illness (e.g., cancer, heart disease). This method has the advantage of being able to identify important differences between conditions and to identify specific targets for intervention. However, as pediatric psychosomatic medicine has evolved, an increasing focus has been placed on the characteristics that pediatric illnesses have in com
AT Antithrombin DVT deep vein thrombosis HIT heparin Induced thrombocytopenia RAI L plasminogen activator inhibitor PC
Tibodies, estrogen use, and pregnancy. The strong link between cancer and thrombosis has been recognized since the late 1800s.9 Tumor cells secrete a number of procoagulant substances that activate the clotting cascade. Furthermore, patients with cancer often have suppressed levels of protein C, protein S, and AT. Antiphospholipid antibodies, commonly found in patients with autoimmune disorders such as systemic lupus erythematosus and inflammatory bowel disease, can cause venous and arterial thrombosis.8 The antiphospholipid antibody syndrome is associated with repeated pregnancy loss. The precise mechanism by which these antibodies provoke thrombosis is unclear, but they activate the coagulation cascade and platelets, as well as inhibit the anticoagulant activity of proteins C and S. Estrogen-containing contraceptives, estrogen replacement therapy, and many of the selective estrogen receptor modulators (SERMs) increase the risk of venous thrombosis.2,10,11 While the mechanisms are...
Viscido A, Aratari A, Maccioni F, et al. Inflammatory bowel diseases Clinical update of practical guidelines. Nucl Med Commun 2005 26 649-655. Lakatos PL, Fischer S, Lakatos L, Gal I, Papp J. Current concept on the pathogenesis of inflammatory bowel disease-crosstalk between genetic and microbial factors Pathogenic bacteria and altered bacterial sensing or changes in mucosal integrity take toll. World J Gastroenterol 2006 12(12) 1829-1841. Gismera CS, Aladren BS. Inflammatory bowel diseases A disease(s) of modern times Is incidence still increasing World J Gastroenterol 2008 14(36) 5491-5498. Sandler RS, Eisen GM. Epidemiology of inflammatory bowel disease. In Kirsner JB, ed. Inflammatory Bowel Diseases. Philadelphia WB Saunders, 2000 89-112. Achkara JP, Duerr R. The expanding universe of inflammatory bowel disease genetics. Curr Opin Gastroenterol 2008 24 429-434. Podolsky DK. Inflammatory bowel disease. N Engl J Med 2002 347 417-429. Cipolla G, Crema F, Sacco S, et al. Nonsteroidal...
Studies of patients with inflammatory bowel disease suggest that they may be more vulnerable than healthy comparison adolescents to developing psychiatric disorders, including symptoms of anxiety and depression (Hommel 2008 Mackner and Cran-dall 2006 Mackner et al. 2006). Anxiety symptoms can occur in the context of any treatment with a cor-ticosteroid. Evidence is mixed regarding whether patients' inflammatory bowel disease relapses are related to times of increased stress in adults (Creed and Olden 2005), and less is known about the role of stress in inflammatory bowel disease symptom exacerbation in pediatric patients (Mackner et al. 2006). structural, infectious, inflammatory, or biochemical etiology) have been found to have elevated levels of anxiety that, although similar to anxiety levels reported by children with organic gastrointestinal diagnoses, are significantly higher than those of healthy children (Banez and Cunningham 2003 Scharff 1997 Walker et al. 1993). Patients with...
There seems to be a connection between the gut and spondyloarthropathies. Of patients with inflammatory bowel disease (IBD ulcerative colitis and Cohn's disease), 10 to 20 have a peripheral arthritis different from other defined arthritides. Migratory arthralgias, especially of the knees, ankles, and feet, often coincide with periods of GI disease flares. Other joints, including the spine and sacroiliac joints, might be involved but are seemingly less coincident with bowel exacerbations. HLA-B27 is found in 50 of patients with IBD-associated spondylitis but is not found in a higher percentage than in the general population for this type of spondylitis. RF and ANA are negative. NSAIDs are normally used but must be taken with caution given the patient's underlying GI disease. As noted earlier, dietary factors might increase the patient's baseline inflammatory state, so a trial of dietary manipulation or the addition of omega-3 fatty acids is reasonable.
Although diseases of other organ systems (e.g., cardiovascular disease) may appear to be more dramatic illnesses with higher rates of morbidity and mortality, the overall impact of gastrointestinal (GI) disorders is often underestimated from both a biopsychosocial and a resource standpoint. Typically, diseases of the GI tract are misdiagnosed, mistreated, misunderstood, or missed altogether, ultimately leading to substantial psychological morbidity and tremendous direct and indirect expense. Digestive diseases cost an estimated 91 billion annually in U.S. health care costs, lost days from work, and premature deaths. More than 70 million Americans are diagnosed each year with disorders of the digestive tract, including gastroesophageal reflux disease, peptic ulcer disease, inflammatory bowel disease, GI cancers, motility
Skogseid and associates13,138 have recommended an annual biochemical screening program beginning in adolescence that consists of measuring glucose, insulin (proinsulin), gastrin, PP, glucagon, and chromogranin A (sensitivity, 35 to 70 ) (Table 76-7). PP is a nonspecific islet cell tumor marker whose levels must be adjusted for age. High levels correlate with large, radiographically detectable tumors.143 Chromogranin A is the most sensitive of the markers mentioned but generally requires a larger tumor burden for easy detection.144,145 False-positive results have been reported in the setting of hypertension, renal disease, stress, and inflammatory bowel disease. Gastrin levels are rarely elevated in young patients. When basal gastrin levels are increased, it is usually an indicator of multiple duodenal carcinoids or a larger pancreatic primary.13
CBT has the strongest empirical support when compared with other psychological treatment modalities. The results cross a wide variety of general medical conditions including irritable bowel disease, somatoform disorders, functional dyspepsia, inflammatory bowel disease, fibromyalgia syndrome, cystic fibrosis, juvenile rheumatoid arthritis, and polycystic ovary disease (Christian and D'Auria 2006 McQuaid and Nassau 1999 Rofey et al. 2008 Szi-gethy et al. 2004). CBT has been found useful for adverse effects of treatments (e.g., chemotherapy-induced nausea) and in decreasing maladaptive behavioral responses during medical procedures (Band and Weisz 1988). focus was more effective than a treatment-as-usual condition in improving depression and global functioning in youth with inflammatory bowel disease and mild depression. Not only did overall depressive severity improve, but neurovegetative symptoms (e.g., fatigue, appetite changes, sleep changes) usually attributed to the inflammatory...
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....
Inflammatory bowel disease, cholecystitis, operative contamination of the peritoneum, or diseases of the female genital tract such as septic abortion, postoperative uterine infection, endometritis, or salpingitis. Appendicitis is one of the most common causes of intra-abdominal infection. In 2006, 341,000 appendectomies were performed in the United States for suspected appendicitis.5
There is no conclusive evidence that CIDP patients have a higher incidence of other medical conditions, including autoimmune disorders. However, associated disorders, including systemic lupus erythematosus, Hashimoto's thyroiditis, thyrotoxicosis, chronic active hepatitis, inflammatory bowel disease, urticaria, eczema, and psoriasis do occur in some CIDP patients.y A CIDP-like disorder may occur in the setting of monoclonal gammopathies of uncertain significance (MGUS), as well as with multiple myeloma, osteosclerotic myeloma and other lymphoproliferative disorders. These disorders are discussed as distinct entities in the following sections.
Another important aspect to evaluation is to exclude certain medical conditions in the differential diagnosis as the primary cause of the symptoms. This includes such diverse problems as inflammatory bowel disease, hyperthyroidism, chronic infections, diabetes mellitus, and Addison's disease. The erythrocyte sedimentation rate (ESR) and serum albumin tend to remain normal in patients with eating disorders,
Viral hepatitis and, 413, 418 erectile dysfunction with, 885t in inflammatory bowel disease, 344 obstructive, 2361 oral contraceptives and, 846 with parenteral nutrition, 1696 in sickle cell anemia disease, 1145t Liver failure DIC with, 1131t nausea and vomiting with, 358t protein requirement in, 1689t respiratory alkalosis in, 504t treatment of, enteral nutrition, 1702t, 1710 tuberculosis and, 1261 Liver transplantation. See also Solid-organ transplantation acute rejection, signs and symptoms of, 944t epidemiology and etiology of, 941 Local anesthetics in irritable bowel syndrome, 379, 384, 384 in opioid withdrawal, 621 Lopinavir ritonavir
. strength of the relationship between this condition and PACNS remains unclear. PACNS associated with immunosuppressive illness represents a small subset of these cases, which include lymphomas, leukemias, myeloproliferative disorders, immunosuppressive therapy for inflammatory bowel disease or following renal transplant, and HIV. 10 These are unique cases in which the immunosuppressed state may appear crucial to susceptibility to the condition.
Episcleritis is a common, benign inflammatory condition of the episclera. It most often affects young adults. Most cases are idiopathic, though up to a third may be associated with systemic conditions, and some cases may also be caused by exogenous irritants or inflammatory stimuli. Associated systemic disorders include gout, systemic lupus erythematosus, rheumatoid arthritis, inflammatory bowel disease, and herpes zoster. The symptoms, which include foreign body sensation, mild pain, photophobia, and lacrimation, are generally self-limited. Visual acuity is normal.
Since there is no true excretion of iron from the body, iron-deficiency anemia (IDA) typically occurs because of either inadequate absorption of iron or excess blood loss. Inadequate absorption may occur in patients who have congenital or acquired intestinal diseases, such as inflammatory bowel disease, celiac disease, or bowel resection. Achlorhydria and diets poor in iron also may contribute to iron deficiency states. In contrast, iron deficiency also may occur in patients who exhibit a higher rate of iron loss from the body. This is manifested in blood loss, either from the GI system, menstruation, cancer, or trauma.7
What are externalbeam and conformal externalbeam radiation therapies What are the side effects of EBRT
Clinical stage T3 are the most likely to benefit from the higher radiation doses that can be achieved with confor-mal EBRT. They may benefit from combination therapy, such as hormone therapy for 6 months plus EBRT. For patients with locally advanced or high-grade disease (Gleason score 7) studies have demonstrated that 2 to 3 years of postradiation adjuvant therapy helps improve survival. The amount of radiation and the field of radiation differ for each individual and depend on the clinical stage and the Gleason grade. Contraindications to EBRT include a history of inflammatory bowel disease, such as Crohn's disease and ulcerative colitis or a history of prior pelvic radiotherapy.
Diarrhea and constipation frequently alternate in patients with colon cancer or diverticulitis. Loose bowel movements are common in diseases of the left colon, whereas watery movements are seen in severe inflammatory bowel disease and protein-losing enteropathies. Floating stools may result from malabsorption syndromes. Patients with ulcerative colitis commonly have stool mixed with blood and mucus. Any inflammatory process of the small bowel or colon can manifest with blood mixed with stool or undigested food. Irritable bowel syndrome classically produces more diarrhea in the morning.
Docosahexaenoic acid (DHA) and are mostly found in fatty fish, such as herring and salmon. Because inflammation plays a role in several common conditions, such as cardiovascular disease, asthma, arthritis, psoriasis, and inflammatory bowel disease, research has explored the role of omega-3 fatty acids in reducing symptoms and improving outcomes. Practical applications for recommending fish oil in the primary care setting included the following (Oh, 2005)
Clinical Features and Associated Disorders. In Von Gierke's disease, hypoglycemia causes many of the clinical difficulties seen in patients during the first year of life. In this period seizures are frequent, and long-standing hemiplegia and mental retardation occur. Failure to thrive, xanthomas, and isolated hepatomegaly are common, and excessive subcutaneous fat over the buttocks, breasts, and cheeks develops. Affected children usually have a protruding abdomen due to enlargement of the liver. Patients often have recurrent stomatitis frequent infections and may have isolated chronic inflammatory bowel disease.
Overall, the most common adrenal insufficiency is the secondary adrenal insufficiency resulting from exogenous steroid usage. Numerous and diverse conditions are treated with corticosteroids inflammatory bowel disease, asthma, arthritis, and dermatologie conditions, to name a few. Inhaled steroids are a mainstay of therapy for asthma and can produce the potential for adrenal insufficiency in both children and adults.12 Corticosteroids are part of the therapeutic regimen of transplantation immunosuppression and cancer chemotherapy. Short courses of high-dose corticosteroids are used in numerous inflammatory conditions. Corticosteroid use is so common that an inquiry regarding corticosteroid
Turner's syndrome, a form of gonadal dysgenesis resulting from a 45,X karyotype (X-chromosomal monosomy), is characterized by female phenotype, short stature, a shieldlike chest, a short and sometimes webbed neck, low- set ears, high-arched palate, small mandible, and sexual infantilism. y The frequency of 45,X in female live births is 0.1 to 0.6 per 1000. A variety of other malformations can be associated, including congenital lymphedema, particularly of the hands and feet, cardiac and renal defects, skeletal anomalies, and abnormalities of the nails. An increased number of pigmented nevi has also been reported. Other disorders have been associated with this disorder, including Hashimoto's thyroiditis, obesity, inflammatory bowel disease, and rheumatoid arthritis. Nerve deafness occurs in approximately half the patients, and olfactory as well as taste deficits have been described. Eighteen percent of patients studied in one series were mentally retarded, although this high prevalence...
Acquired hemophilia is due to the development of an autoantibody to factor VIII (FVIII). The estimated incidence is approximately 1 per 1 000 000 per annum. Most cases occur in healthy individuals without discernible risk factors, but the condition is associated with autoimmune conditions such as rheumatoid arthritis and SLE, inflammatory bowel disease, multiple sclerosis and malignancies. In up to 11 of cases, the associated factor is a recent or ongoing pregnancy50.
Metabolic disorders can cause degenerative arthritis. Hemochromatosis (caused by iron deposition) typically affects the second and third metacarpophalangeal (MCP) joints, wrists, knees, hips, and shoulders. Wilson's disease (caused by copper deposition) can cause premature OA in wrists and knees. Sickle cell disease can be complicated by knee arthritis arthritis is also often seen in patients with hemophilia and leukemia. Arthritis is associated with inflammatory bowel disease and primary biliary cirrhosis. Reactive carcinoma synovitis can be the presenting symptom of an underlying malignancy, particularly of the breast or the prostate.
While as yet untested by clinical trials, the effective treatment of systemic diseases linked with oxidative stress (diabetes, Hepatitis B C, HIV, malaria, haemo-chromatosis, haemoglobinopathies, inflammatory bowel disease, psoriasis, rheumatoid arthritis, depression) is likely to reduce overall oxidative stress in the body and benefit sperm function. It is therefore ideal that patients delay conception until after these systemic diseases are under effective control, unless the medications used to achieve control have a detrimental effect on sperm function (e.g. meth-otrexate treatment of inflammatory conditions).
Confirmed in recent double-blind randomized, placebo-controlled trials demonstrating that DHEA (200 mg day) was well tolerated, reduced the number of SLE flares, reduced disease activity and allowed reducing the dosage of glucocorticoids (Chang et al. 2002 Petri et al. 2002). It is important to note that these studies included women only and that it remains unclear whether similar results can be obtained in men. In a phase II uncontrolled pilot trial DHEA (200 mg day) was effective and safe in patients with refractory Crohn's disease and ulcerative colitis (Andus et al. 2003). However, to date no placebo-controlled trials have been performed in inflammatory bowel disease. In all these trials side-effects were mild with acne being the most frequently seen adverse event despite the use of undoubtedly supraphysiological DHEA doses (200 mg d).
With the advent of the technique of PN by a large central vein in the late 1960s, this modality of feeding quickly became popular. PN was used originally in patients with-inflammatory bowel disease (IBD) or congenital bowel abnormalities but was incorporated quickly into care of other types of patients such as the critically ill. The relative ease of PN administration, along with the perception that critically ill patients had prolonged high-energy expenditures, led to complications of overfeeding. In the United States, where no IV fat emulsion was available commercially for several years during the 1970s, the impact of dextrose overfeeding was observed. Complications included hyperglycemia, carbon dioxide overproduction leading to delays in weaning from mechanical ventilation, and liver abnormalities owing to hepatic steatosis.
For most of the enteric infections, a characteristic clinical illness is not produced by a given etiologic agent. When patients acquire enteric infection, a variety of symptoms other than diarrhea may result, including abdominal cramps and pain, nausea, vomiting, and fecal urgency and incontinence or the urge but inability to defecate. When patients experience fever as a predominant finding, invasive bacterial pathogens should be suspected (Salmonella, Shigella, and Campylobacter). Vomiting is the primary complaint in viral gastroenteritis (often due to rotavirus in an infant or Norwalk-like viruses in older children or adults), staphylococcal food poisoning, or foodborne illness due to Bacillus cereus. When dysentery (the passage of small-volume stools that contain gross blood and mucus) occurs, amebic Shigella or Campylobacter enteritis should be suspected. In salmonellosis, gatroenteritis stools are grossly bloody in just under 10 percent of cases. Other less common causes of...
Sweet syndrome, also known as acute febrile neutrophilic dermatosis, is characterized by fever, peripheral neutrophilia, and a nonvasculitic neutrophilic cutaneous eruption. The lesions are tender, well-demarcated violaceous to erythematous plaques that may have a central yellowish discoloration and can occur anywhere on the body, but most frequently on the upper extremities, neck, and face. The plaques generally cause a burning pain and are nonpruritic. While the cause of Sweet syndrome is unknown, it is thought to represent an abnormal immunological response. It seems to respond to anti-inflammatory and immunomodulatory treatment. Twenty percent of patients with Sweet syndrome have an associated malignancy. Other associated illness include bacterial and viral infections, inflammatory bowel disease, autoimmune disorders, and collagen vascular disease.
Patients complain of localized pain, swelling, and drainage but usually do not have systemic symptoms. The abscess begins with the formation of a small opening in the skin that develops into a cystic structure involving surrounding hairs. This opening is occluded by hair or keratin, creating a closed space that does not allow drainage. The acute abscess contains mixed organisms including Staphylococcus aureus and Streptococcus, but anaerobes and gram-negative organisms may also be present. Evidence of cellulitis in the sacrococcygeal area may result from a simple abscess or furuncle. However, other causes should be considered, such as anal fistulae, hidradenitis, inflammatory bowel disease, or tuberculosis.
Idiopathic retroperitoneal fibrosis is a chronic inflammatory process that comes to uro-logic attention when extrinsic compression and encasement of the ureter by surrounding retroperitoneal tissues cause ureteral obstruction. The progressive nature of the inflammatory process can lead to flank pain and renal deterioration. Radiographic findings on intravenous pyelogram or retrograde pyelogram may include medial deviation of the involved ureter and the absence of intraluminal obstruction. Whitaker test as well as nuclear functional studies often demonstrates delayed drainage as a result of extrinsic ureteral compression. Causes of retroperitoneal fibrosis are myriad and include inflammatory bowel disease, vascular aneurysms, radiation, malignancies, retroperitoneal bleeding, and idiopathic, which accounts for the majority of cases.
Although ileal ureter replacement can be performed for almost any ureteric pathology, certain conditions of the bowel contraindicate this type of surgery. Among these are short bowel syndrome, inflammatory bowel disease, radiation damage to the bowel, and marked scarring of the mesentery (e.g., desmoid tumors).
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.
Internal hemorrhoids present with painless rectal bleeding or the sensation of prolapse. Other diagnoses to consider include infection, perianal or perirectal abscess, inflammatory bowel disease, malignancy, local trauma, herpes or other sexually transmitted infection, rectal polyp, or rectal prolapse.
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...
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...
Although more commonly used as a salvage therapy (a procedure intended to rescue a patient after a failed prior therapy) for men who fail to respond to EBRT or interstitial seeds, cryotherapy can be used as a first-line therapy in individuals who have clinically organ-confined disease of any grade with a negative metastatic evaluation. The size of the prostate gland is a factor in patient selection and outcome. The larger the prostate the more difficult it is to achieve a uniformly cold temperature throughout the gland. Thus, those men with large prostate glands may benefit from the addition of hormone therapy (LHRH analogues) to decrease the size of the prostate prior to cryotherapy. A relative contraindication to performing cryotherapy is a large TURP defect. Cryotherapy achieves the best results when the starting PSA is less than 10 ng ml. Cryother-apy is a minimally invasive option when treatment is appropriate for men who either don't want or who are not good candidates for...
Pseudomembranous colitis was the first recognized manifestation of C. difficile infection and was originally thought to be a side-effect of clindamycin therapy. 7 The pseudomembranous intestinal lesions associated with C. difficile have a characteristic gross and histologic appearance (Figures 8.2 and 8.3). Early in the disease course small (1-2 mm) raised, yellowish-white plaques are noted which may enlarge and coalesce. 37 These lesions, which are composed of fibrin, mucous, necrotic epithelial cells and leukocytes, are restricted to the colon and stop at the ileocecal junction. Although pseudomembranous colitis can be visualized by the sigmoidoscope in 90 of the cases, some patients have disease limited to the right colon and the presentation may mimic appendicitis or Crohn's disease. 38'39 Complications of severe colitis include toxic megacolon and colonic perforation. Toxic megacolon is an important syndrome to recognize as it is associated with a high mortality and may occur...
LCV is associated with many chronic diseases (connective tissue diseases, malignancies, viral hepatitis, inflammatory bowel disease, and others), medications (penicillin, sulfonamides, thiazides, allopurinol, phenytoin, NSAIDs, PTU, IV dye, and G-CSF), infections (group A -hemolytic streptococci, hepatitis A virus, hepatitis B virus, hepatitis C virus, HIV), and idiopathic disorders (Henoch-Schonlein purpura HSP , acute hemorrhagic edema of childhood, and urticarial vasculitis).
Psychostimulant medications are believed to have antinociceptive properties that may be mediated by norepinephrine, serotonin, or dopamine or by endogenous opioid mechanisms. Indications for psychostimulants include reduction of drowsiness caused by narcotic medications as well as the potential to reduce the dose of narcotics without diminution of their analgesic effect. Methylphenidate and dextroamphetamine have been found to be safe and effective adjuncts to opiate analgesia and have also been used in the treatment of spasmodic torticollis, spastic colon, and headaches.
If metabolites or the serum gastrin levels are elevated, a Schilling test should be performed to evaluate for the presence of cobalamin malabsorption. Technically, patients with classic pernicious anemia have an abnormal test result when radioactive cobalamin alone is given by mouth (Part I of the Schilling test). This abnormality is corrected when the test is repeated with intrinsic factor (Part II of the Schilling test). Abnormally low secretion of cobalamin in Part II of the Schilling test indicates an intestinal cause for the cobalamin malabsorption, such as inflammatory bowel disease. Part II of the Schilling test may be repeated, after giving antibiotics or vermicides to exclude bacterial overgrowth (so-called blind loop syndrome) or fish tapeworm infestation due to Diphyllobothrium latum. Normal results on Part I of the test in a patient with cobalamin deficiency may be observed in total vegetarians. It may also occur in patients with food-cobalamin malabsorption who show...
The eye is the only organ outside the nervous system that is sometimes involved in MS. Uveitis and retinal periphlebitis each occur in at least 10 percent of MS patients. The uveitis can involve the posterior, intermediate (pars planitis), or rarely anterior portion and resembles that seen in other inflammatory (e.g., sarcoid, Reiter's syndrome, Behcyet's syndrome, inflammatory bowel disease, systemic lupus erythematosus) and infectious (e.g., syphilis, tuberculosis, Lyme disease) conditions. Periphlebitis is seen as venous sheathing on funduscopic examination and is histologically identical to the perivascular inflammation present in brain white matter. It is interesting that inflammation commonly occurs in the retina, which has a peripheral type of myelin produced by Schwann cells. Several systemic or organ-specific inflammatory conditions can involve the CNS white matter. Optic neuritis, myelitis, and other syndromes sometimes occur with systemic lupus erythematosus. Whether this...
The diarrhea of IBS is sudden and perhaps watery but likely loose, usually accompanied by urgency, bloating, and abdominal pain occurring upon arising in the morning or immediately following a meal. Inflammatory bowel disease is typically associated with the sudden onset of bloody diarrhea accompanied by urgency, crampy abdominal pain, and fever. Patients who experience bowel ischemia may develop bloody diarrhea, particularly if they progress to shock.
A 25-year-old woman with inflammatory bowel disease has had many admissions to hospitals for exacerbations of her disease. She fears the future and the possibility that a cancer may have already started to develop. She is engulfed by a feeling of terror and apprehension. She fears that some day she may require a colostomy and that she will be deprived of one of her most important functions bowel control. She acts inappropriately, has temper tantrums, and is indecisive. Her dependency on her parents is a manifestation of regression.
In inflammatory bowel disease, 175-76 arsenic, for leukemia, 198 arteriosclerosis, 17, 136, 138, 155 arthralgias, 163, 200, 202, 279, 287 arthritis, 39-42 in alkaptonuria, 141 in dracunculiasis, 99 gonococcal, 278 in gonorrhea, 150 in histoplasmosis, 163 in inflammatory bowel disease, 175-76 in lupus erythematosus, 200 in Lyme disease, 202 in meningitis, 215 in mumps, 223 atrial fibrillation, 104 Australia and New Zealand AIDS, 1 beriberi, 46 bubonic plague, 63 cirrhosis, 79 dengue, 86 echinococcosis, 110 encephalitides, 36 filariasis, 127 gout, 155-156 heart-related diseases, 160 hookworm infection, 167 infectious hepatitis, 173 inflammatory bowel disease, 176 influenza, 180 lactose intolerance, 183 lead poisoning, 188 leprosy, 193 leptospirosis, 196 Lyme disease, 201 measles, 213 meningitis, 216 multiple sclerosis, 221-222 ophthalmia, 230 osteoporosis, 238 Paget's disease of bone, 238 poliomyelitis, 260 Q fever, 267, 269-270 in Argentine hemorrhagic fever, 39 ascariasis and, 42 in...
Erythema nodosum is an acute inflammatory process involving the fatty tissue layer underlying the skin (pan-niculitis). The condition is more frequently seen in women, and although often idiopathic, many cases are associated with streptococcal infections of the upper respiratory tract, drugs such as estrogens oral contraceptives, sarcoidosis, and inflammatory bowel disease. Other, less frequent bacterial causes include tuberculosis, brucellosis, mycoplasma, and chlamydia. Fungal infections such as blastomycosis and his-toplasmosis may also cause erythema nodosum. Rare causes are Behcet's disease, acute myelogenous leukemia, and Hodgkin's disease.
Patients suspected of an anterior uveitis should be referred to an ophthalmologist for consultation and treatment. The most common cause of anterior uveitis is idiopathic other common causes include ankylosing spondylitis, inflammatory bowel disease, sarcoidosis, juvenile rheumatoid arthritis, Reiter's syndrome (urethritis, polyarteritis, and ocular inflammation), herpetic keratitis, and Lyme disease.
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