Constipation Help Relief In Minutes
Patients with idiopathic constipation with normal bowel diameter have an increased whole-gut transit time. This may be related to an imbalance of enteric transmitter release. For example, VIP levels are reduced in the myenteric plexus and muscle layers of patients with this colonic motility disorder, while levels of SP and NPY are normal (271,272). Disturbances in the function of cholinergic innervation of the taenia coli of the colon have also been reported. 5-HT levels are elevated in circular smooth muscle and mucosa in this disorder but unchanged in preparations containing the plexuses (273). Reduced numbers of SP- and VIP-im-munoreactive nerve fibers in colonic circular muscle have been reported in biopsy samples taken from children with severe intractable constipation (274). Reduced levels of SP have also been reported in the mucosa and in submucosa isolated from rectal biopsies from patients with slow transit constipation showing normal levels of VIP and somatostatin (275). It...
If opioids need to be maintained, the laxatives need to be peristaltic stimulants, not bulkforming agents. Aim for firm faeces with bowels open about every third day. e.g. senna (Senokot) 2 daily or bd bisacodyl (Durolax) 5-10 mg bd Rectal suppositories, microenemas or enemas may be required, e.g. Microlax. Shaw's cocktail is useful for severe constipation. With a small quantity of water melt one tablespoon of Senokot granules in a microwave oven. Add 20 mL Agarol and constitute to 100 mL with cold milk or icecream.
Patients who are undergoing treatment for cancer need particular attention given to the type of laxative used for constipation. It is important to provide immediate relief in the most gentle way, even if an aggressive approach is needed to relieve severe constipation and prevent more severe problems. The patient's total physical condition and the presence of bulky disease in the abdomen must be considered, as addressed in the following paragraphs. Patients undergoing chemotherapy that may cause myelosuppression need preventative laxative therapy because the treatment options for myelosuppressed patients with constipation are limited manual disimpaction, suppositories, and enemas are contrain-dicated in patients with low platelet counts or altered prothrombin time or partial thromboplastin time because of the potential for bleeding. When patients have abdominal pain from a large tumor burden and are constipated, it is best to avoid stimulant cathartics and instead give a hyperosmotic...
Breath test is a simple, inexpensive, and noninvasive technique to diagnose SBBO. The lactulose breath test is performed after 12 hours fasting previous to the test. Hydrogen breath samples are taken at baseline, and subsequently every 10-30 minutes after the test meal that contains 10-12 g of lactulose. The hydrogen breath samples are analyzed gas chromatographically (81). Baseline samples average 7.1 +5 parts per million (ppm) of H2 and 0-7 ppm for CH4 (82). Values of the baseline sample over 20 ppm H2 are suspect for bacterial overgrowth. Values between 10 and 20 suggest incomplete fasting before the test or ingestion of slowly digested foods the day before the test, the colon being the source of the elevated levels (82). Slowly digested foods like beans, bread, pasta, and fiber must not be consumed the night before the test because these foods produce prolonged hydrogen excretion (82). The patient is not allowed to eat during the complete test. Antibiotics and laxatives must be...
Pharmacotherapy assessment starts with the assessment for need, followed by information on patient comprehension and ability. Need is based on identifying the cause of the pain, the types of pain, and the optimal drug to use for the identified pain. If, for example, a patient has back pain exacerbated by abdominal distention secondary to constipation, more opioid to treat the pain should not be given laxatives should be given instead. The laxative is not an analgesic per se, but for this patient, it is indeed the treatment of choice for increased back pain. Therefore, the assessment of need is the most important first step in pharmaco-therapy selection and design.
Identifying the multiple epistatic determinants underlying a developmental disorder Hirschsprung disease
Hirschsprung disease (HSCR) is a condition characterized by hypomotility of the large intestine attributable to the absence of intramural enteric ganglia. The clinical consequences are constipation, intestinal obstruction and life-threatening enterocolitis in newborns. The condition can be divided into a short segment form where lack of innervation only affects the distal large intestine and a long segment form characterized by absence of ganglia over more extensive regions of the colon. The length of affected intestine is correlated to the sib recurrence risk and inversely proportional to the ratio of affected males to females (Table 13.4 Garver et al., 1985 Badner et al., 1990).
Of an individual patient may often hinge on effective relief from symptoms and having each symptom treated as it arises. Symptoms may range from minor irritations to serious distress, including dysphagia, anorexia, constipation, nausea, vomiting, incontinence, hiccup, cough, breathlessness, restlessness, and confusion (Enck, 1994 Saunders & Baines, 1989). Attending to the details of each symptom is important. Indeed, it has been shown that relief of minor symptoms often goes a long way to relieve the pain accompanying any serious illness. A patient who is terminally ill with cancer and is at the same time suffering from untreated constipation is a neglected patient, however much effort is or has otherwise been extended on that patient's behalf. Such treatment may not be heroic or dramatic, but is nevertheless important. Often those who compile lists of ways of relieving symptoms are apologetic for their simplicity, but it is all of the niggling things that can detract so much from the...
The hypothyroid patient can be very difficult to diagnose in the early stages, especially if the patient is being seen frequently. Hypothyroidism often has a gradual onset with general symptoms such as constipation and lethargy, and the diagnosis is usually made late by which time the disorder is quite florid in manifestation. If suspected, serum thyroid-stimulating hormone (TSH) should be requested.
Clinical features related to uterine pathology are most commonly those of abnormal uterine bleeding. In premenopausal patients this may take the form of menorrhagia (heavy periods), dysmenorrhoea (painful periods) or a variety of other forms of abnormal uterine bleeding. In postmenopausal patients, the most common symptomatology is postmenopausal bleeding. This should always be taken seriously and uterine malignancy excluded. Other symptomatologies related to uterine pathology include a palpable abdominal or pelvic mass, pain within the pelvis or abdomen (often deep seated), a feeling of fullness within the abdomen and uterine prolapse. Uterine pathology may also be associated with symptoms such as constipation, urinary frequency or infertility.
Symptomatic Medications Acetaminophen codeine (Tylenol 3) 1-2 tab PO q3-4h prn OR Oxycodone acetaminophen (Percocet) 1 tab q6h prn pain. Milk of magnesia 30 mL PO q6h prn constipation. Docusate Sodium (Colace) 100 mg PO bid. Dulcolax suppository PR prn constipation. A and D cream or Lanolin prn if breast feeding. Breast binder or tight brazier and ice packs prn if not to breast feed. Labs Hemoglobin hematocrit in AM. Give rubella vaccine if titer
The health benefits of probiotics can be direct or indirect through modulation of the composition and or activity of the endogenous microbiota or of the immune system. Many health claims have been made concerning probiotics, especially concerning their potential to prevent or help cure gastrointestinal and related ailments. These include improved lactose digestion and other direct enzymatic effects, prevention, and curative treatment of gastroenteritis, antibiotic-associated diarrhea, traveler's diarrhea, constipation, intestinal
How to define and treat constipation. Geriatrics 1977 32 85-87. Bruera E, Suarez-Almazor M, Velasco A, et al. The assessment of constipation in terminal cancer patients admitted to a palliative care unit retrospective review. J Pain Symptom Manage 1994 9 515-519. Cimprich B. Symptom management of constipation. Cancer Nurs Suppl 1985 8 39-42. Glare P, Lickiss JN. Unrecognized constipation in patients with advanced cancer a recipe for therapeutic disaster. J Pain Symptom Manage 1992 7 369-371. Lembo A, Camilleri M. Chronic constipation. New Engl J Med 2003 349 1360-1368. Levy MH. Constipation and diarrhea in cancer patients. Cancer Bulletin 1991 43 412-422. Locke GR III, Pemberton JH, Phillips SF. American Gastroenterological Association medical position statement guidelines on constipation. Gastroenterology 2000 119 1761-1778. Mancini I, Bruera E. Constipation in advanced cancer patients. Support Care Cancer 1998 6 356-364. Portenoy RK. Constipation in the cancer...
Bone pain, which may classically be found in metastatic choriocarcinoma or seminoma, is an example of somatic pain. Bone destruction arises from the activity of tumor products on osteoclasts, causing increased resorption and decreased bone density. Periostial stretching, mechanical stress of weakened bone, and the entrapment of small surrounding nerves are thought to be the etiologic factors of the pain.11 Pain is experienced in the area of the affected bone, most commonly the vertebrae, pelvis, ribs, femur, and skull.12 It frequently develops gradually, becoming progressively more severe, especially at night or upon weight bearing. The pain is predominantly somatic unless there is invasion of adjacent neural structures, in which case there will be an additional neuropathic component. A sudden increase in pain may signify a pathologic fracture. Hypercalcemia, which is frequently associated with bone metastases, can cause weakness, lethargy, confusion, and constipation, all of which...
Normalization means bringing the bowel back to a normal state without constipation or impaction and with no more than 3 bowel movements per day. When a patient is constipated or has a fecal impaction, the buildup of stool or the impaction must be removed. If a patient has diarrhea, the motility of the GI tract must be slowed to decrease the frequency of bowel movements to 3 or fewer per day. A bowel management program will be ineffective if it is begun before the bowel is returned to a normal state. constipation or dehydration from diarrhea. Patient education is crucial in helping patients prevent bowel problems.
There may be effects on physical activity, with unwanted excessive movement - agitation (agitated depression) - or marked reduction of activity - the so-called retardation (retarded depression) - where the patient may take to bed or chair and become physically slow. This may progress to depressive stupor, although this is now very rare. Older patients may show marked intellectual impairment (depressive pseudodementia). Other physical symptoms include constipation or diarrhoea, disturbances of the menstrual cycle including cessation of the menstrual periods (amenorrhoea), loss of energy, and loss of interest in sex (loss of libido).
In recent years, high-fibre diets and fibre supplements have been commonly recommended in primary- and secondary- care management of IBS. This has been particularly the case for people with IBS characterised by constipation. However, a systematic review of the role of different types of fibre in IBS concluded that insoluble fibre can exacerbate IBS symptoms and that although soluble fibre can benefit patients with constipation, it does not have a significant effect on abdominal pain (Bijkerk et al 2004).
Tiating opioid analgesic therapy for the elderly. If the patient has a history of chronic constipation and laxative use, then opioids can exacerbate the bowel dysfunction. A more aggressive laxative and bowel regimen should be started at the same time as the analgesic therapy, especially when opioid analgesics are involved. Patients receiving opioid analgesics should be placed on stimulant laxatives such as senna on a scheduled basis. Use of only stool softeners such as docusate is usually not adequate in preventing constipation induced by opioid analgesics.
A common culprit causing fecal impaction is recent diagnostic procedures using barium. This type of impaction can be prevented by routinely prescribing a laxative to be taken until evidence of barium excretion abates. Although laxatives are prescribed in many cases, the dose may be too small to fully eliminate the barium. Patients need to be instructed about the desired outcome from laxatives after barium ingestion so that they can inform their health care professional if the laxative does not work. If patients are assessed as having a high risk for constipation, a request to use Gastrografin (mixture of meglumine diatrizoate with sodium diatri-zoate) in place of barium is appropriate.
Hirschsprung disease causes extreme, chronic constipation and abdominal distension. The part of the large intestine distal to the distension lacks innervation. As a result, the person does not feel the urge to defecate. The problem begins in the embryo, when an abnormal gene prevents neurons from migrating to this portion of the gastrointestinal tract. Surgery may be used to treat Hirschsprung disease, which was once lethal.
Supportive treatment of brain tumor patients is primarily concerned with controlling the symptoms caused by elevated intracranial pressure and minimizing seizure activity 1,2 . The use of other medications to ameliorate symptoms, such as nausea and emesis (i.e., secondary to edema or chemotherapy), constipation, pain, anxiety, and depresssion are beyond the scope of this chapter but are summarized in recent review articles 14-20 .
Gastrointestinal side effects are the most common side effects of almost all antiret-roviral drugs - nucleoside analogs, NNRTIs and particularly protease inhibitors -and occur especially during the early stages of therapy. Typical symptoms include abdominal discomfort, loss of appetite, diarrhea, nausea and vomiting. Heartburn, abdominal pain, meteorism and constipation may also occur. Nausea is a common symptom with zidovudine-containing regimens diarrhea occurs frequently with zidovudine, didanosine and all PIs, particularly nelfinavir, as well as with saquinavir and lopinavir r, atazanavir and ritonavir. Treatment with zidovudine rarely leads
There is some truth to the old saying that you are what you eat, but individual differences in metabolism certainly play a role in determining how a person is affected by what he or she ingests. Old age is sometimes caricatured as a time of digestive and eliminative disturbances, and, like many other caricatures, this one has some degree of accuracy. As a person grows older, there is a decline in esophageal and intestinal peristalsis and fewer stomach contractions. Food moves more slowly down the digestive tract and metabolism is slower. Appetite is usually not as keen, and almost all foods are less appealing. Constipation, which is exacerbated by low fluid intake, lack of fiber in the diet, and lack of exercise, is more common, leading to increased use of laxatives, Periodontal disease, hemorrhoids, and diverticulosis (inflammation of the walls of the colon) may compound the digestive problems of older adults. Contributing to these functional changes are declines in stomach acid and...
Endometriosis should be considered in any woman of reproductive age who has pelvic pain. The most common symptoms are dysmenorrhea, dyspareunia, and low back pain that worsens during menses. Rectal pain and painful defecation may also occur. Other causes of secondary dysmenorrhea and chronic pelvic pain (eg, upper genital tract infections, adenomyosis, adhesions) may produce similar symptoms. Gastrointestinal tract (constipation, irritable
Typical narcotic side effects include pruritus, nausea, vomiting, urinary retention, constipation, sexual dysfunction, and respiratory depression. The exact mechanism of pruritus is unclear. Histamine release is not thought to be the etiology, but antihistamines, such as diphenhydramine, are often effective. Nausea and vomiting are common with intrathecal opioids. It is thought that the side effects result from interaction with opioid receptors in the area postrema. Nausea could also be caused by unresolved constipation. These symptoms tend to be dose-related and are usually relieved by anti-emetics, such as metoclopramide, prochloroperazine, and ondansetron. Urinary retention is an adverse effect most commonly found in elderly men with enlarged prostates. It is not a dose-related phenomenon, but rather a drug interaction with opioid receptors in the sacral spinal cord. Their stimulation causes detrusor muscle relaxation and an increase in bladder capacity. Adjunctive treatment with...
History of the Present Illness Fatigue, cold intolerance, constipation, weight gain or inability to lose weight, muscle weakness thyroid swelling or mass dyspnea on exertion mental slowing, dry hair and skin, deepening of voice carpal tunnel syndrome, amenorrhea. Somnolence, apathy, depression, paresthesias.
Associated Symptoms Fever, chills, nausea, vomiting (bilious, feculent, blood, coffee ground-colored material) vomiting before or after onset of pain jaundice, constipation, change in bowel habits or stool caliber, obstipation (inability to pass gas) chest pain, diarrhea, hematochezia (rectal bleeding), melena (black, tarry stools) dysuria, hematuria, anorexia, weight loss, dysphagia, odynophagia (painful swallowing) early satiety, trauma. Aggravating or Relieving Factors Fatty food intolerance, medications, aspirin, NSAID's, narcotics, anticholinergics, laxatives, antacids.
Although the focus of routine follow-up visits between PD patients and neurologists is typically on motor symptoms of the disease, autonomic problems are frequently present and can be identified if patients are specifically asked. In one study of 48 men with PD, 89 had at least one autonomic symptom compared with 43 of elderly control subjects (2). Autonomic symptoms seen in these men with PD included erectile dysfunction (60 ), urinary urgency (46 ), constipation (44 ), dysphagia (23 ), and orthostatism (22 ), and each of these symptoms was more common in PD patients than controls. Siddiqui et al. (3) performed a comprehensive symptom survey of autonomic symptoms in 44 patients with PD, comparing the frequency and severity of these symptoms with 24 aged-matched controls. Using a five point scale to rate symptom severity, the authors tabulated the severity of symptoms in each of five areas GI, urinary, sexual dysfunction, cardiovascular, and thermoregulatory. They found that PD...
Haemorrhoids (piles) comprising engorgement of submucosal veins, they are common and predisposed to by increased pelvic pressure, e.g., constipation, pregnancy, obesity, pelvic tumour. They bulge into the anal canal and are traumatised by straining at stool and hard faeces. Complications include bleeding, reversible prolapse into the anal canal or persistent prolapse outside the anal margin - these so-called external haemorrhoids which are located below the dentate line and covered by anal skin are particularly prone to painful strangulation and thrombosis which is an indication for surgical excision.
There is good evidence that prebiotics can relieve constipation and control hepatic encephalopathy, and lactulose is currently used pharmaceutically for these purposes. Additionally, a number of other health targets proposed for prebiotics have accumulating evidence of benefits. The most promising targets have been discussed in this chapter and include increasing calcium uptake, boosting colonization resistance against intestinal pathogens, and ameliorating IBD. Evidence for these benefits is still largely preliminary, but is sufficiently encouraging to warrant continuing investigation. While research efforts have naturally focused on the health benefits of prebiotics, and to date few reports of deleterious effects have surfaced, further quantification of the potential risks of prebiotics at different doses, in combination with different diets, and for different demographics, both healthy and diseased should be conducted. It is also important that prebiotics be trialed in the context...
Clear deficiency signs are difficult to establish because the symptoms may vary enormously. Local signs and symptoms of an imbalance of the intestinal flora (intestinal dysbiosis) include bloating, flatulence, abdominal pain, diarrhoea and or constipation and fungal overgrowth (such as Candida). Imbalance of the intestinal flora may result from the use of antibiotics, chronic diarrhoea or constipation. Additionally, babies exclusively fed on infant formulas will have slower colonisation of the gut than those who are breastfed, as breast milk allows for the transfer of oligosaccharides to the baby. This appears to be of particular concern in premature babies requiring intensive care as they acquire intestinal organisms slowly, which allows for the colonisation of bacterial species that tend to be virulent. It has been suggested that the aberrant colonisation of the premature infant's gut may contribute to the development of necrotising enterocolitis and, therefore, probiotics...
Oral administration of calcium supplements may cause gastrointestinal irritation, constipation and flatulence. Hypercalcaemia Increased serum calcium may be associated with anorexia, nausea and vomiting, constipation, hypotonia, depression and occasionally lethargy and coma. Prolonged hypercalcaemic states, especially if associated with normal or elevated serum phosphate, can precipitate ectopic calcification of blood vessels, connective tissues around joints, gastric mucosa, cornea and renal tissue (Wilson et al 1991).
History of the Present Illness Vomiting (bilious, feculent, bloody), nausea, obstipation, distention, crampy abdominal pain. Initially crampy or colicky pain with exacerbations every 5-10 minutes. Pain becomes diffuse with fever. Hernias, previous abdominal surgery, use of opiates, anticholinergics, antipsychotics, gallstones colon cancer history of constipation, recent weight loss.
Pinch biopsies of colonic and rectal mucosa may be taken for the evaluation and determination of the severity and extent of Hirschsprung's disease in children. The innervation and motility of the gut can be determined using enzyme histochemistry for acetylcholinesterase activity . If there is no staining the bowel is innervated. Positive staining indicates an aganglionic or hypogan-glionic area which results in a bowel stricture and constipation. Using a series of biopsies, the distribution of the hypoganglionic segments can be mapped out prior to surgical resection.
Patients with small-intestinal disease may present with vague symptoms and signs such as poorly localised dull central (periumbilical) abdominal pain. If there is full-thickness inflammation the peritoneal somatic pain receptors are stimulated and the pain becomes more severe and localised. A patient with an obstructing lesion will classically present with vomiting, colicky abdominal pain (cramps), absolute constipation (i.e., neither flatulence or faeces passed per rectum) and abdominal distension.
Platelets 388,000 mm3, with a white blood cell count of 5600 mm2. The reticulocyte count was 5 . A smear showed basophilic stippling. The patient had been seen 9 months previous to this admission, at which time her hematocrit was 39 and hemoglobin 13 gm dl. One month before this last admission, she came to the hospital complaining of constipation and gnawing dull periumbilical and epigastric abdominal pain. She had had a 20-lb weight loss over the previous 4 months.
Bowel dysmotility (eg, irritable bowel syndrome and constipation) may be the primary symptom source in 50 percent of all cases of CPP and may be a contributing factor in up to 80 percent of cases. Pain from irritable bowel syndrome is typically described as a crampy, recurrent pain accompanied by abdominal distention and bloating, alternating diarrhea and constipation, and passage of mucus. The pain is often worse during or near the menstrual period. A highly suggestive sign is exquisite tenderness to palpation which improves with continued pressure.
Nalbuphine (Nubain) 5-10 mg IV SC q2-3h prn OR Butorphanol (Stadol) 0.5-1 mg IV q1.5-2h prn OR Meperidine (Demerol) 25-75 mg slow IV q1.5-3h prn pain AND Promethazine (Phenergan) 25-50 mg, IV q3-4h prn nausea OR Hydroxyzine (Vistaril) 25-50 mg IV q3-4h prn Fleet enema PR prn constipation.
AXR - will show signs of colonic obstruction. Any dilatation of the colon 6 cm in diameter heralds the onset of toxic megacolon. In ischaemic colitis there will be dilated colon with characteristic thumbprinting . In colovesical fistula gas is present in the bladder. Free intraperitoneal gas will be seen in colonic perforation. In patients being investigated for chronic constipation radio-opaque markers are ingested and an AXR is taken five days later with passage of 80 of the markers considered abnormal.
Bowel dysfunction in MS has received less attention than disturbances of micturition. However, studies have shown a prevalence rate of constipation ranging from 39 to 53 (139-142). The suggested causes include slow colonic transit due to autonomic dysfunction, abnormal rectal function, and intussuception (141-143). The problem is often compounded by a tendency of patients to reduce fluid intake in an attempt to decrease urinary frequency and urgency. In a recent survey of unselected outpatients, Hinds et al. (139) found that 51 of patients had experienced bowel incontinence at least once in the preceding three months, whereas 25 had experienced the symptom at least weekly. Fecal incontinence appeared to correlate with degree of disability, duration of disease, and the presence of urological symptoms.
Haemorrhoids - if haemorrhoids are small and asymptomatic then no treatment is necessary except for measures to avoid constipation. Non-prolapsing piles are probably best treated by injection sclerotherapy. Larger prolapsing piles above the dentate line are treated by rubber-band ligation. Both the above procedures can be performed during routine proctoscopy without anaesthesia. Piles too large to band and or which extend below the dentate line can be treated by formal haemorrhoidectomy. The procedure most commonly used involves excision of the three main piles, with preservation of the intervening anal mucosa. The wounds are left open to heal by secondary intention.
Haemorrhoids or piles are common and tend to develop between the ages of 20 and 50. About one out of two Westerners suffers from them by the time 50 is reached. 3 Internal haemorrhoids are a complex of dilated arteries, branches of the superior haemorrhoidal artery and veins of the internal haemorrhoidal venous plexus Fig 32.2 . The commonest cause is chronic constipation related to a lack of dietary fibre.
An ethic of care for terminally ill persons must be responsive to needs. Generally, the needs of dying persons will span the needs of life itself, from physical and medical care issues to psychological and social needs and often to spiritual concerns. To focus the point, consider persons dying from cancer. Sometimes these people will have to experience the deterioration of their bodies over a period of weeks or months. Anxiety, fear, loneliness, and depression are common. Most people can expect to experience symptoms from the primary disease. When a curative therapy is no longer possible, sometimes quite complicated medical care issues arise not only from the primary disease but from secondary sources, issuing in pain and discomfort. These may include appetite disturbance, fever, dysphagia (swallowing problems), persistent constipation, infections, dyspnea (difficulty in breathing), bladder dysfunction and incontinence, and
Strong laxatives such as aloe latex are contraindicated in children. Avoid in patients with known hypersensitivity to aloe or with nausea, vomiting or signs and symptoms of gastrointestinal obstruction. Avoid excessive use and long-term use (more than 2 weeks), as potassium losses may occur, which may alter cardiac electrophysiology. Use with caution in people with thyrotoxicosis.
These factors have a role to play in preventing cardiovascular disease and to a lesser extent in blood pressure control, cancer, diabetes and constipation. They have an even greater role to play in improving general well-being and preventing morbidity.
Medications Associated with Hematuria Warfarin, aspirin, ibuprofen, naproxen, phenobarbital, allopurinol, phenytoin, cyclophosphamide. Causes of Red Urine Pyridium, phenytoin, ibuprofen, cascara laxatives, levodopa, methyldopa, quinine, rifampin, berries, flava beans, food coloring, rhubarb, beets, hemoglobinuria, myoglobinuria.
Porphyrias are a group of metabolic disorders characterized by defects in the synthesis of heme, a metalloporphyrin that is the product of porphyrin metabolism. Presentation of the disorder typically involves abdominal pain, vomiting, constipation, hypertension, tachycardia, photosensitivity, psychosis, and neuropathy. Neuropathy is estimated to affect 10 to 40 of patients and is primarily motor (126). Cranial neuropathies have been
In a review by Smith (17), the safety and tolerability of rHuIL-11 administered sc at the recommended dose of 50 g kg d was compared with placebo in two phase 2 studies. The dataset included 308 patients, ranging from 8 mo to 75 yr of age, who received up to eight sequential 1-28-d courses of oprelvekin. In this group, aside from complications associated with underlying malignancy or cytotoxic chemotherapy, most adverse events were of mild or moderate severity and were reversible after cessation of the growth factor. The incidence and type of adverse events were similar between patients who received oprelvekin and those who received placebo. Edema, dyspnea, tachycardia, conjunctival injection, palpitations, and pleural effusion occurred more frequently in the oprelvekin-treated patients. Adverse events that occurred in 10 of patients and were observed in equal or greater frequency among patients receiving placebo included asthenia, pain, chills, abdominal pain, infection, anorexia,...
It is important to utilise a type of fail-safe mechanism to avoid missing the diagnosis of these disorders. Some practitioners refer to consultations that make their 'head spin' in confusion and bewilderment, with patients presenting with a 'shopping list' of problems. It is in these patients that a checklist is useful. Consider the apparently neurotic patient who presents with headache, lethargy, tiredness, constipation, anorexia, indigestion, shortness of breath on exertion, pruritus, flatulence, sore tongue and backache. In such a patient we must consider a diagnosis that links all these symptoms, especially if the physical examination is inconclusive this includes iron deficiency anaemia, depression, diabetes mellitus, hypothyroidism and drug abuse.
By four years of age, most children are toilet trained for bowel movements. After that age, when inappropriate bowel movements occur regularly over a period of several months, a child may be diagnosed with encopresis. Encopresis can be intentional on unintentional. Intentional soiling is associated with several psychiatric disorders. Involuntary or unintentional soiling is often the result of constipation. The only symptom of encopresis is that a person has bowel movements in inappropriate places, such as in clothing or on the floor. This soiling is not caused by taking laxatives or other medications, and is not due to a disability or physical defect in the bowel. There are two main types of encopresis, and they have different causes. Involuntary soiling usually results from constipation. A hard mass of feces develops in the large intestine and is not completely expelled during a regular bowel movement in the toilet. This mass then stretches the large intestine out of shape, allowing...
Historical note Fenugreek's seeds and leaves are used not only as food but also as an ingredient in traditional medicine. It is indigenous to Western Asia and Southern Europe, but is now mainly cultivated in India, Pakistan, France, Argentina and North African countries. In ancient times it was used as an aphrodisiac by the Egyptians and, together with honey, for the treatment of rickets, diabetes, dyspepsia, rheumatism, anaemia and constipation. It has also been described in early Greek and Latin pharmacopoeias for hyperglycaemia and was used by Yemenite Jews for type 2 diabetes (Yeh et al 2003). In India and China it is still widely used as a therapeutic agent. In the United States, it has been used since the 1 9th century for postmenopausal vaginal dryness and dysmenorrhea (Ulbricht & Basch 2005).
And neck cancers or into intrahepatic and intrapancreatic tumor masses revealed no maximal tolerated dose or dose-limiting toxicity after doses as high as 2 x 1012 viral particles injection (18,168,169). No clinically significant incidence of hepatitis or pancreatitis was seen. The most frequently reported adverse events were fever, chills, injection site pain, asthenia, and nausea. In addition to intratumoral injection, the intraperitoneal, intra-hepatic arterial, and intravenous administration routes have also been used with this vector (18,168,169). Intraperitoneal administration was feasible at doses as high as 1013 viral particles divided over 5 d. The most common toxic effects included fever abdominal pain nausea, vomiting, or both and bowel-motility changes (i.e., diarrhea and constipation). No dose-limiting toxicities were seen for doses as high as 2 x 1012 viral particles single dose with intra-hepatic arterial administration or 2 x1013 particles cycle (single injection week...
Temozolomide was shown to have clinical anti-glioma activity and was well tolerated in smaller studies 46,49 . This led to the major multicenter phase II study conducted by Yung et al. 45 . That study evaluated the efficacy and safety profile of TMZ in 111 patients with anaplastic astrocytoma (AA) or AOA 45 . Tumors with 80 to 90 per cent oligoden-droglial component were classified as pure AO and tumors with less than 20 per cent oligodendroglial component were classified as AA. Anything else was considered mixed AOA. The objective response rate for all patients studied was 35 per cent. The response rate for the fourteen patients (9 per cent) with AOA was 42.9 per cent (2 CR, 4 PR) and PFS at 6 months was 46 per cent. Median overall survival in this group was 14.8 months. In the chemotherapy-naive group, 43 per cent of the patients responded and 26 per cent had stable disease compared to a 30 per cent response rate and 28 per cent rate of stable disease in patients who received TMZ as...
Constipation Opioid analgesics inhibit gastrointestinal propulsive peristalsis, but increase static tone of the gut, thereby causing constipation and cramping. This is especially true in the elderly population because of decreased activities, and bodily fluids. Find alternative opioid analgesic for patient. Selection may depend on patient history or by trial and error. Anti-emetics can be used to treat this side effect, however, sedation and cognition can further be comprised by the anti-emetics in the vulnerable patient population. Anticholinergic anti-emetics can exacerbate constipation, and urinary retention effects of the opioid analgesics. Opioid analgesic-induced constipation needs to be treated aggressively in the elderly population to prevent impaction and bowel obstruction. Stool softeners alone do not work Opioid-induced constipation must be treated with adequate hydration, along with stimulant laxatives such as senna, cascara, or bisacodyl. Osmotic laxatives such as...
Although physical complaints are remarkably few given the degree of emaciation (73), patients present with a variety of signs and symptoms referable to low body weight, including constipation, abdominal pain, cold intolerance, hypothermia, hypotension, bradycar-dia, edema, lanugo, and dry skin (74). the most frequent reason for presentation to a general practitioner of the bulimic patient was to request a weight loss diet (82). Other common presenting complaints include gastrointestinal symptoms, such as bloating or constipation, and amenorrhea or irregular cycles (83). Rarely, patients may present with palpitations or cardiac arrhythmias secondary to electrolyte imbalance. Pathognomonic signs in bulimia nervosa include a ''chipmunk'' cheek appearance, due to noninflammatory stimulation of the salivary glands, particularly the parotids (84) (Fig. 1). Erosions of the lingual surface of the teeth and multiple dental caries are seen, due to the exposure to acid from repeated vomiting...
- Diarrhea Constipation injurious effects of certain bile acids 71 . They may increase LES pressure, decreasing the amount of gastroesophageal reflux. Alginic acid forms a foamy barrier on top of the refluxate to protect the esophagus from acid-induced damage. These agents have been shown to be more effective than placebo in providing relief of mild to moderate reflux symptoms 20 . Relief of symptoms can be expected in up to 20 of patients. Antacids and alginic acid are not likely to promote healing of the esophageal mucosa, or any other complications of chronic GERD 2 . There are some adverse effects, which may be of particular concern in the elderly, including constipation with aluminum containing preparations and diarrhea with magnesium containing products. Combination products may lessen these effects. Aluminum containing antacids can cause dialysis encephalopathy and osteomalacia, and should be used with caution in those with renal impairment. Antacids may promote salt overload,...
Historical note Bitter melon is used as a traditional medicine wherever it is found. It has a long history of use in Asia, Africa and Latin America and has been widely acclaimed as an important remedy for diabetes mellitus since ancient times. Theterm momordica means 'to bite' and refers to the jagged edges of the leaf, which appear as if bitten. Bitter melon has been used to treat fevers, viral infections and as an emmenagogue in reproductive health. It has also been used as a treatment for gastrointestinal complaints, worms, constipation, headaches, skin conditions and diabetes. The fruit is used topically for wound healing. The plant has also been used in traditional ceremonies and considered a powerful charm which is worn as a necklace, wrist or ankle bracelet or crown (Beloin et al 2005). The ritual ceremonial importance of the plant is accompanied by its considerable reputation as a medicinal plant for the treatment of disease.
Although the antibiotic is reasonably well tolerated in current clinical studies, early experience with the antibiotic when administered every 8 hours suggested skeletal muscle toxicity. However, using a dosing schedule from every 12 to every 24 hours, elevated serum concentrations of creatine phosphokinase occur in only 2.8 of prospectively studied adults, compared to 1.8 of vancomycin-treated control patients. The mechanism of muscle toxicity is unknown, but current guidelines suggest following CPK concentrations on a weekly basis. Adverse events which occurred in greater than 5 of adults include constipation, nausea, headache, diarrhea, vomiting, and injection site reactions, although these side effects occurred in control patients with a statistically similar frequency (Stein, 2005 Tedesco and Rybak, 2004).
Opioids can frequently cause constipation and postoperative ileus the elderly patient is at the highest risk of developing these symptoms. If left untreated, constipation frequently can exacerbate lower back pain and discomfort from abdominal distention. Therefore, constipation and ileus need to be managed concurrently with the use of opioid analgesics to avoid stool impaction. Early mobilization after an injury is an important therapy in the elderly population to prevent constipation and reduce the risk for developing venous thrombosis.
Dry mouth, blurred vision, and constipation are common, and urinary retention may occur. Postural hypotension may be dose-limiting, especially in the elderly. Tricyclics can also cause confusion in elderly patients, or those with organic brain disease. Tricyclics lower the convulsive threshold, but this effect should not stop their use in a depressed epileptic, where the benefits of effective treatment far outweigh the risk of precipitating a fit.
Nausea, constipation, and constricted pupils are seen in the acute stages. Large doses cause respiratory depression and death for example, this occurs by injection of a stronger than usual supply, or resumption after release from prison of a previous high dose when tolerance has worn off. Chronic use produces a characteristic greyish skin colour, weight loss that can be extreme, and flat affect.
These patients will often present in the general hospital, and are frequently on a medical 'take'. Probably the commonest type would be 'acute-on-chronic' that is, a person with a - perhaps unrecognized - background of mild cognitive impairment who becomes acutely confused in association with an intercurrent medical problem such as chest infection - or even something as mild as constipation.
Bulimia nervosa is an eating disorder characterized by binge eating and engaging in inappropriate ways of counteracting the bingeing (using laxatives, for example) in order to prevent weight gain. The word bulimia is the Latin form of the Greek word boulimia, which means extreme hunger. A binge is consuming a larger amount of food within a limited period of time than most people would eat in similar circumstances. Most people with bulimia report feelings of loss of control associated with bingeing, and some have mildly dissociative experiences in the course of a binge, which means that they feel disconnected from themselves and from reality when they binge. Purging Inappropriate actions taken to prevent weight gain, often after bingeing, including self-induced vomiting or the misuse of laxatives, diuretics, enemas, or other medications.
This was a 41 year old woman with a history of scleroderma, who presented with painful ulcers in the fingers and heels. She was diagnosed with scleroderma when she experienced shortness of breath and esophageal dysmotility. Previously, she had been admitted to the hospital with bilateral hand and foot pain, sclerodactyly and Raynaud's syndrome. On that admission, an echocardiogram showed right atrial and ventricular dilatation, and moderate to severe tricuspid regurgitation. Recently, she was unable to ambulate due to bilateral heel ulcers. She had also developed constipation, abdominal pain and mild dysuria. Her social history included smoking 25 packs a year and previous cocaine abuse (for which she received rehabilitation).
Neonatal opiate withdrawal 0.08-0.2 mg kg every 3-4 hrs prn. Adverse effects dependence, CNS and respiratory depression, nausea, vomiting, urinary retention, constipation, hypotension, bradycardia, increased ICP, miosis, biliary spasm, allergy may occur, histamine release (may cause itching and bronchospasm).
Autonomic symptoms are common in patients with PD, though often under-recognized. As in the case of constipation, evidence for autonomic dysfunction may precede the onset of motor features by years however, most autonomic symptoms increase in severity with the progression of motor disability. Careful attention by treating physicians to the autonomic features of PD is necessary in order to recognize these problems early and begin treatment in a timely fashion. In most areas of autonomic dysfunction in PD, the field remains in its infancy with many additional studies being needed to better understand the pathophysiology of the problem and to discover more effective treatments.
Children may develop botulism from ingestion of contaminated food, wound infection, or intestinal infection in infants. Infants usually come to attention because of lethargy, weakness, feeding difficulty, a feeble cry, and constipation.240 Older children report nausea, vomiting, blurred vision, dysphagia, and pooling of secretions in the mouth, followed by generalized weakness and diplopia. In both groups, ophthalmologic findings are common and may include any type or degree of external ophthalmoplegia, dilated pupils that react poorly to light, and
Hirschsprung's disease is a common cause of neonatal intestinal obstruction that is of great interest to pediatric surgeons throughout the world. Prior reports concerning the historical origins ascribe the initial description of this condition to Fredericus Ruysch, a Dutch anatomist in Amsterdam in 1691 20, 33, 91, 137 . He described a 5-year-old girl with abdominal pain who did not respond to the usual treatment of the day to relieve pain, pass wind and kill worms . She eventually died. The information regarding the patient was incomplete in regard to the events that occurred at the time of her birth and except for enormous dilatation of the colon, the autopsy findings were not clearly described. Although this may have represented a case of Hirschsprung's disease there was inadequate evidence to be sure of the actual diagnosis 33 . Similarly, Domenico Battini in Italy in 1800 described a child whom he followed for 10 years with severe constipation who eventually died and demonstrated...
Magnesium, aluminium-induced constipation, interference with other drugs taken etc). Therefore, antacids can only be recommended in patients with infrequent heartburn (which according to the definition of GERD that includes impaired quality of life cannot be regarded as sufferers from reflux disease but from sporadic reflux symptoms).
An uncontrolled study of 553 patients with non-specific digestive disorders (dyspeptic discomforts, functional biliary colic, and severe constipation) experienced a significant reduction of symptoms after 6 weeks of treatment with artichoke extract. Symptoms improved by an average of 70.5 , with strongest effects on vomiting (88.3 ), nausea (82.4 ), abdominal pain (76.2 ), loss of appetite (72.3 ), constipation (71.0 ), flatulence (68.2 ), and fat intolerance (58.8 ). In 85 of patients the global therapeutic efficacy of artichoke extract was judged by the physicians as excellent or good. (Fintelmann 1996).
Melanosis coli characterised by pigmented macrophages in the lamina propria that impart a dusky mucosal appearance mimicking ischaemia. The pigment is lipofuscin and degenerative in nature, and is thought to relate to cellular apoptosis. There is an association with use of laxatives and bowel dysmotility. Volvulus usually comprises a markedly dilated atonic sigmoid colon in either Africans (due to a high-fibre diet with bulky stools), or constipation-related acquired megacolon in the elderly. The sigmoid loop twists on its mesentery, obstructs and may become secondarily ischaemic. Resection specimens are often dilated, thinned and featureless. Melanosis coli may be present. Congenital megacolon and Hirschsprung's disease are discussed elsewhere (see page 232). Pneumatosis coli submucosal gas cysts lined by macrophages and giant cells with overlying mucosal chronic inflammation or pseudolipomatosis. There is an association with volvulus, constipation, diverticulosis and chronic...
Physical manifestations of WBS usually include involvement of the cardiovascular system, most often as a narrowing of the ascending aorta (SVAS) although a generalized arteriopathy can lead to vascular stenoses in other vessels, and hypertension is common in later life. Stellate irides, flat nasal bridge, short, up-turned nose with anteverted nostrils, long philtrum, full lips and lower cheeks, and a small chin are the recognizable facial features. Other symptoms include hernias, visual impairment, hypersensitivity to sound, chronic otitis media, malocclusion, small or missing teeth, renal anomalies, constipation, vomiting, growth deficiency, infantile hypercalcemia, musculoskeletal abnormalities, and a hoarse voice (11,12). As WBS individuals grow older they may also present with premature graying of the hair, diabetes and impaired glucose tolerance, decreased bone mineral density, sensorineural hearing loss, and a high frequency of psychiatric symptoms (13).
While binge eating is a symptom of bulimia nervosa, it differs from this disorder in that behaviors intended to get rid of the food (fasting, excessive exercise, or using laxatives or inducing vomiting to purge the food from the system) are present among those with bulimia, but are generally absent among binge eaters. Binge eating may also occur in anorexia nervosa.
Hg is a well-known inductor of allergic contact dermatitis, which was first recognized at the end of the 19th century (Boyd et al., 2000). Heavy proteinuria, usually a nephrotic syndrome, has been described during Hg exposure since the 19th century. In modern times, Kazantzis et al. (1962) described four cases of occupa-tionally mercury-exposed workers with a nephrotic syndrome among a cohort of similarly exposed individuals. Stewart et al. (1977) described proteinuria in 9 of 21 technicians occupationally exposed to mercury after spillage of corrosive sublimate and with a wide excretion rate of Hg. In these case reports, the heavy proteinuria dominated by albumin suggests a glomerular damage in contrast to the more modest, low-molecular weight proteinuria associated with the tubulotoxic effect of Hg. A number of case reports have described an IC-mediated membranous GN after occupational exposure to Hg, after use of skin-lightening creams and laxatives containing Hg, as well as other...
This chapter addresses concepts used as a foundation for bowel management in patients with cancer. Because cancer treatment can be very noxious and disrupt bowel function, a preventive approach is an important part of bowel management for patients with cancer. The 6 steps to good bowel management are assessment and diagnosis of bowel dysfunction, normalization of the bowel, establishment of expectations for bowel-movement frequency, development of a bowel management program, assessment of outcomes, and adjustment of the bowel management program through problem-solving. New and innovative approaches to management of bowel dysfunction covered in this chapter are (1) differentiation between low and high impactions in the treatment of impactions (2) administration of milk-and-molasses enemas (3) use of a bowel training program for patients with constipation or diarrhea or frequent stooling and (4) use of a proven, nontraditional fiber regimen for patients with frequent stooling after...
11 (58 per cent) had a mixed response (MR), six (32 per cent) had SD, and one (5 per cent) had progressive disease (PD). There were 11 episodes (3.5 per cent) of grade 3 or 4 hematologic toxicity seen in six patients this presented as thrombocytopenia in six, neutropenia in three, and combined thrombocy-topenia and neutropenia in two. Two patients had grade 3 constipation and one patient had grade 3 nausea and vomiting. While the study aimed to provide an objective assessment of the effectiveness of temozolomide, there is no uniformly agreed imaging end point in patients with WHO grade II tumors. While it is reasonable to interpret changes in the size of high signal abnormality as a reduction in tumor size, and therefore tumor cell mass, there is no definite imaging-pathological correlation to ensure that the changes represent purely a reduction in the number of tumor cells. FLAIR sequences detect alterations in free water in the soft tissues. In low-grade glioma, the areas of altered...
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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.