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Correct Uses Of Laxatives And Purges

Laxatives are like purges but weaker. All the products listed above are laxatives when taken in small doses and purges when taken in large doses. Laxatives soften and hurry the bowel movement purges cause diarrhea. Laxatives One can use milk of magnesia or other magnesium salts in small doses, as laxatives, in some cases of constipation. People with hemorrhoids (piles, p. 175) who have constipation can take mineral oil but this only makes their stools slippery, not soft. The dose for mineral oil is 3 to 6 teaspoons at bedtime (never with a meal because the oil will rob the body of important vitamins in the food). This is not the best way. Suppositories, or bullet-shaped pills that can be pushed up the rectum, can also be used to relieve constipation or piles (see pages 175, 383, and 392).

Constipation

A person who has hard stools and has not had a bowel movement for 3 or more days is said to be constipated. Constipation is often caused by a poor diet (especially not eating enough fruits, green vegetables, or foods with natural fiber like whole grain bread) or by lack of exercise. Drinking more water and eating more fruits, vegetables, and foods with natural fiber like whole grain bread, cassava, wheat bran, rye, carrots, turnips, raisins, nuts, pumpkin or sunflower seeds, is better than using laxatives. It also helps to add a little vegetable oil to food each day. Older people especially may need to walk or exercise more in order to have regular bowel movements. A person who has not had a bowel movement for 4 or more days, if he does not have a sharp pain in his stomach, can take a mild salt laxative like milk of magnesia. But do not take laxatives often. Do not give laxatives to babies or young children. If a baby is severely constipated, put a little cooking oil up the rectum...

Hyperaldosteronism Primary

ID CC A 55-year-old menopausal female comes to see her internist because of progressive constipation and excessive urination over the past 2 months she also complains of palpitations both at rest and during exercise. Primary hypersecretion of parathyroid hormone may be caused by an adenoma (vast majority of cases), chief-cell hyperplasia, or carcinoma of the parathyroid glands it is commonly asymptomatic and is frequently recognized during routine physical exams. When it is symptomatic, peptic ulcer pain, polyuria, polydipsia, constipation, and pancreatitis may be the presenting symptoms. May be associated with multiple endocrine neoplasia (MEN) syndromes I and II.

Alimentary Tract Radiopaques

Alternate Alimentary Tract Radiopaques. In figure 1-12, barium sulfate was ingested during an upper G.I. The patient did not drink adequate liquids to flush barium from his system, resulting in fecal impaction. The water is absorbed, leaving a residue of barium sulfate particles. These particles would irritate the tissue they come in contact with. This could result in inflammations, adhesions, or other undesirable complications. Contrast media used when gastrointestinal perforations are suspected should be soluble to avoid leaving an irritating residue. To achieve this end, pharmaceutical companies adjust the activity of water-soluble injectable media to nearly neutral. This renders them suitable for oral use. Two examples are Oral Hypaque and Gastrografin. These soluble media leave no particles as residue. Therefore, they are used as alternates in the alimentary canal when perforations are suspected.

Examples Of Digestants

Dehydrocholic acid is used to increase the volume of bile produced and secreted in the digestive system. It is used to relieve excessive constipation as well as to remove fragments of gallstones from the body. The usual dose of this drug is 3 to 5 milliliters of a 20 percent solution administered intravenously.

The Cathartic Laxative Habit

The physician seldom has the opportunity to prescribe cathartics, except in the hospital setting, since valid indications for the use of laxatives are limited. More commonly, the physician is faced with the problem of chronic misuse of these agents by his patients. The task the physician faces is a difficult one the patient must be helped to break the cathartic habit. The cathartic habit is the extensive, chronic misuse of self-prescribed cathartics by a bowel-conscious person. Cathartics are taken by many people because they believe they must have a bowel movement at least once each day.

Mitoxantrone and Prednisone

A Canadian study led by Tannock et al. 17 randomized 161 symptomatic patients with HRPC to receive either mitoxantrone every 3 weeks with daily prednisone or prednisone alone. The primary end point of this study was palliative response, which was defined as a significant improvement in either pain or analgesic usage or both (neither could get worse). In the mitox-antrone arm, a statistically significant improvement in pain relief (29 vs. 12 , p .01) and a prolonged duration of this palliative response (43 weeks vs. 18 weeks, p < .0001) was demonstrated. These patients also reported improvements in physical and social functioning, global quality of life, anorexia, drowsiness, constipation, and other symptoms 18 . The use of mitoxantrone was also associated with a higher PSA response rate and time to progression. There was no survival benefit of chemotherapy, although a crossover to mitoxantrone in patients who progressed on prednisone was allowed and may have impacted on the survival...

Admitting Discharging and Transferring Patients

Prescribe all the patients regular medications plus analgesia and intravenous fluids if necessary. This will prevent you being disturbed in the night for the sake of the patient wishing to have two paracetamol tablets. If you are prescribing opioids then add laxatives too.

Femoral Herniastrangulated

Treatment Acute thrombosis will subside spontaneously in most cases with sitz baths, anti-inflainmatories, local steroids, and laxatives. If recurrent, surgical resection is warranted. If acutely painful or if conservative treatment fails, excision with local anesthesia may be done.

Clinical Course and Manifestations in Patients Who Receive Antimicrobials

The approximate frequencies of symptoms and signs expected to be found in hospitalized patients in endemic areas of the developing world are summarized in Tables 17-3 and 17-4. Before hospitalization, most of these patients will have been ill for 6 to 12 days, most will have seen a healthcare provider at some point, and most will have received short courses of antibiotics. Fever is universal and, although present daily, is usually higher in the late afternoon and evening. Chills and dull frontal or diffuse headaches are common. The headaches often prevent patients from sleeping comfortably. Most patients are anorectic. They complain of abdominal pain, but cannot localize it well. Both diarrhea and constipation are common normal bowel function is unusual.50,77 Children frequently have diarrhea. Bloody dysentery is occasionally encountered. The incidence of cough and chest discomfort varies considerably. Sore throats are common during the first week of illness, but less common later....

Would Rational Polypharmacy Improve Quality of Life

Another lacuna which becomes obvious is the lack of studies on quality of life (QOL) of patients on antidepressant medications. QOL may be compromized by adverse drug reactions such as weight gain, nausea, constipation, sexual dysfunction, agitation, orthostatic hypotension, dry mouth and other anti-cholinergic side effects.

Thoracoscopic Sympathectomy

A review of symptoms was negative for weight loss, malaise, fatigue, chills and fever. The patient denied any constipation, diarrhoea, chest pain, shortness of breath or palpitations. She had no polydipsia, polyuria, or loss of strength or function in the extremities. She also denied any Raynaud's syndrome-like symptoms.

Physiologic Age Related

The exact etiology for this deterioration in detrusor function may result from collagenous ingrowth in the detrusor, disrupting the smooth muscle syncytium. There may also be impairment in neuromuscular transmission that is related to the myopathic degeneration. These authors stressed the absolutely crucial nature of urodynamic evaluation to exclude outlet obstruction as a component of the presenting scenario (80). Also, it is necessary to exclude components such as fecal dysfunction, constipation, and medication effect as being causative to the dysfunction. Other patients manifest less overt detrusor hyperactivity and poor contractility and indeed may present only with impaired contractility that may lead to chronic detrusor decompensation and retention. Most common causes for this include medication affect, immobility, and fecal impaction. The underlying contribution of aging to this entire syndrome cannot be under estimated (Fig. 6).

Chronic Abdominak Pain

Recurrent abdominal j ain iRAP) occurs in about 10-15 of children between 5 and 15 years of age. Organic causes include diseases of the GI tract such as constipation, lactose intolerance, parasites (Giardia sp), inflammatory bowel disease, and peptic ulcer disease. Pancreatitis and cholelithiasis are pancreatic causes of RAP. Urinary tract infections, abdominal epilepsy, porphyria, sickle cell anemia, and lead poisoning are non-GI causes. In contrast to younger children (< 2 years), only 10 of children with RAP have an organic cause. Nonorganic causes include functional abdominal pain (irritable bowel syndrome and nonulcer dyspepsia).

Congenital Hypothyroidism

Symptoms appear gradually. Prolonged jaundice may be the earliest sign. Poor feeding, somnolence, a large tongue, constipation, and an umbilical hernia may be present. The skin may be cold and mottled. The full clinical picture develops by 3-6 months. Growth and development are retarded. The fontanels stay widely open. Hair is coarse and brittle. There is a generalized muscle hypotonia.

Acquired Hypothyroidism

Growth deceleration is usually the first sign, but may be subtle. Patients also develop constipation, cold intolerance, and decreased energy. Schoolwork and grades do not suffer. Osseous maturation is delayed. In lymphocytic thyroiditis, growth retardation and goiter are the first signs.

Role of TRPV1 in airway responses

Cough is a dominant and persistent symptom of many inflammatory lung diseases, including asthma, COPD, viral infections, pulmonary fibrosis and bronchiectasis. Chronic cough can also be idiopathic in nature where no obvious causal mechanism is evident. Cough is the most common complaint for which medical attention is sought and although effective treatments for cough are not available, narcotic agents, such as the opioid codeine, are often used. However, such agents have only limited beneficial value due to the associated side effects such as constipation, nausea, vomiting and drowsiness. Therefore, the identification of novel therapies, devoid of central activity, for the treatment of chronic cough would be of significant therapeutic benefit and greatly enhance the quality of life of patients who suffer from this condition 68 .

Depressive Disorders in the Elderly A Fresh Perspective

Chiu et al point out that nosological systems do not take account of age-related features. The recent research suggests an excess of somatic features, such as weight loss, constipation and hypochondriasis, over psychological features. This is borne out in the general practitioner surgeries and hospital clinics, where the elderly consistently present with a ''physical ticket''. It may be that the present generation of old people find it difficult to express emotions directly and resort to biological quotients to communicate their distress.

Depression in the Elderly Predictors and Prognostic Factors

When the outcome was assessed in terms of mortality, major depression 10 and the symptoms of dissatisfaction, weight loss, anorexia and constipation, predicted higher mortality, which was not explained by the poor baseline somatic health of the depressed elderly. The mortality of dysthymic patients was also higher than that of nondepressed subjects, but this was explained by the high occurrence of physical diseases among them 11 .

Clinical Presentation

The most common pattern of symptoms is chronic abdominal pain that is associated with involuntary weight loss. The pain is usually epigastric, dull, or colic. The patient experiences the pain 15 to 30 minutes after eating, and it lasts for 1 to 3 hours before disappearing. The pain becomes so severe that soon the patient develops fear of food and limits the oral intake. This results in a pronounced weight loss. Absence of weight loss may put in doubt the diagnosis of chronic visceral ischemia. Other gastrointestinal complaints may include diarrhea, nausea or vomiting, and constipation. The most typical feature of the clinical presentation is that the symptoms are atypical. We and others have shown that the majority of the patients affected are women in their sixth decade of life. The reasons for this sex predilection remain undetermined. On examination, the patient looks emaciated, mimicking a patient with advanced malignant disease. These is often an epigasric bruit present.

Munchausen Syndrome By Proxy

The patient may have chronic diarrhea from laxatives, rashes from caustic substances rubbed into the patient's skin, foreign blood or stool discovered in urine and blood samples, seizures from injection of insulin, and apnea from being suffocated with a pillow.

Historical perspective

The history of wine has been documented as far back as 2000 bc. In Babylon, salves were mixed with wine to treat various skin conditions. The Ancient Egyptians are also recorded to have used it for the treatment of other ailments, including asthma, constipation, epilepsy, indigestion, jaundice and depression. Perhaps as a deterrent to self-medication, various bizarre and somewhat unlikely ingredients were added, including pigs' eyes, bats' blood, dogs' urine and crocodile dung (Pickleman 1990).

Irritable bowel syndrome

IBS is an ill-defined syndrome consisting of abdominal pain, bloating, cramping and a change of bowel habits - constipation or diarrhea, or both - without any other diagnosed gastrointestinal condition and without evidence of other organic or anatomic disease.9 It accounts for 12 of visits to primary-care physicians and 28 of visits to gastroenterologists, accounting for 30 million individuals in the USA.10,11 It has been considered a diagnosis of exclusion. Criteria for diagnosis of IBS have been developed (the Rome II) (see Table 21.3).12 The prevalence in women is twice that in men.11 The symptoms are often transient many individuals who describe symptoms at one point do not have symptoms a year later.11

Pharmacological Treatment

A limited number of medications are currently available in the pediatric age group for use as adjuncts to behavioral management. Sibutramine (Meridia) is currently available for the treatment of adolescents 16 yr of age or older. Sibutramine is a norepinephrine and serotonin reuptake inhibiter and has side effects that include hypertension, tachycardia, dry mouth, headache, constipation, and insomnia. When used in conjunction with a group-based behavioral therapy, sibutramine plus behavioral therapy led to a more rapid decline in BMI than behavioral therapy alone (91). Sibutramine should not be administered in conjunction with monoamine oxidase inhibitors or other serotonin reuptake inhibitors. Another pharmaceutical alternative is orlistat (Xenical). Orlistat binds gut lipase and prevents hydrolysis of dietary fats into free fatty acids and monoacylglycerols. Its side effects, which often lead to discontinuation of the medication, include flatulence, diarrhea, steatorrrhea, and...

Fungal Infections Candidiasis

Vulva Insert

Although some clinicians and patients believe that diet, use of oral or vaginal lactobacillus supplements, and special disinfecting of underwear can minimize or treat vulvovaginal candidiasis, there are no data to support these beliefs (50,51). In addition, there is no evidence that vulvovaginal candidiasis produces systemic symptoms of depression, bloating, constipation, headaches, etc (Table 15).

Protein Differences Between Omnivores And Vegetarians Or Vegans

A varied diet based on plant proteins is adequate, yielding growth and body maintenance results equivalent to a diet based on meat protein.39 The lower incidence of obesity, constipation, lung cancer, hypertension, coronary artery disease, type 2 diabetes, gallstones, reduced risk of breast cancer, diverticular disease, colon cancer, calcium kidney stones, and osteoporosis appear to be obvious advantages particularly of the well balanced vegan diet for the elderly.3,39,40 Key et al.,40 (Table 11.1) show the protective effect of daily fresh fruit intake in ischemic heart disease, cerebrovascular disease, and lung cancer, and daily raw salad protection for ischemic heart disease. They also presented a higher incidence of breast cancer in the vegetarian women, but the confidence interval was broad. The smokers in their study population demonstrated a higher rate of ischemic heart disease, cerebrovascular disease, and, of course, lung cancer, to emphasize the disease problems associated...

Primary Hyperaldosteronism

She has a history of burning epigastric pain that is relieved by food. Her history also reveals anorexia, confusion, irritability, constipation, easy fatigability, excessive thirst, and polyuria. Most commonly caused by adenomas hyperplasia and malignancy are less common causes. Usually asymptomatic and discovered 011 routine lab check-up. Symptoms result from hypercalcemia and include renal stones, polyuria, bone pain, constipation, nausea, vomiting, lethargy, peptic ulcers, mental status changes, and pancreatitis.

Nonketotic Hyperosmolar Coma

Primary hypersecretion of parathyroid hormone may be caused by an adenoma (vast majority of cases), chief-cell hyperplasia, or carcinoma of the parathyroid glands it is commonly asymptomatic and frequently recognized during routine physical exams. When symptomatic, pcptic ulcer pain, polyuria, polydipsia, constipation, and pancreatitis may be the presenting symptoms. May be associated with multiple endocrine neoplasia (MEN) syndromes I and II.

Pediatrics and Neonatology

The answer is d. (Behrman, 16 e, pp 2156-2159.) Lead poisoning produces a motor neuropathy and is associated with anemia, a gingival lead line, colicky abdominal pain, and basophilic stippling of red blood cells. Patients with acute intermittent porphyria (AIP) present with recurrent bouts of abdominal pain, confusion, and peripheral and cranial neuropathies. Kernicterus is accumulation of bilirubin in the newborn that may cause neuronal death and scarring. Children with fragile X syndrome present with mental retardation, large ears, and a prominent jaw. The triad of macroglossia, abdominal distension, and constipation is consistent with cretinism.

Neoplasia and Blood Disorders

A 22-year-old man comes to the emergency room of your hospital because he has a diffuse, erythematous rash involving nearly all of his body His total WBC count is greater than 100,000 cells mm3. He also complains of bone pain, severe irritability, weakness, fatigue, nausea and vomiting, constipation, photophobia, and polyuria. His electrocardiogram (ECG) shows shortening of the QT interval, prolongation of the PR interval, and nonspecific T wave changes. The most likely cause of his symptoms is

Alternative Pharmacotherapy

Discussion Obesity contributes to atherosclerosis, CAD, hyperlipidemia, hypertension, and type II diabetes. Anti-obesity drugs currently on the market include orlistat and sibutramine. They are indicated lor weight loss and maintenance in conjunction with a calorie-reduced diet in patients with a body mass index 30. Orlistat is a lipase inhibitor that acts in the GI tract and blocks the absorption of dietary fat. The most common adverse effects are GI-related and include spotting, flatus, and fatty stools. Absorption of lipid-soluble vitamins (e.g., vitamin K) or medications (e.g., griseofulvin) may be decreased. Sibutramine treats obesity through appetite suppression it acts centrally by blocking serotonin and norepinephrine reuptake. Adverse effects include headache, dry mouth, constipation, insomnia, and a substantial increase in blood pressure and heart rate in some patients. Unlike the discontinued drug fenfluramine, sibutramine does not cause pulmonary hypertension or cardiac...

Principle Paracrine Secretion Involved In Inhibition Of Gastric Secretions

The answer is a. (Fauci, 14 e, pp 242-247.) The two major types of diarrhea are osmotic and secretory. Osmotic diarrhea is the result of excess solute in the lumen of the small intestine (undigested nutrients) or colon (laxatives). The excess solute produces a bulk flow of water into the lumen in volumes that eventually overwhelm the absorptive capacity of the gut. In osmotic diarrhea, stool osmolarity is greater than normal. Secretory diarrhea is the result of crypt cell secretion of an isosmotic chloride solution combined with inhibition of electroneutral NaCl absorption from the small intestine. Diarrhea is defined as the excretion of 200 grams or more of water in the stool per day.

The Correct Uses Of Enemas

Simple enemas can help relieve constipation (dry, hard, difficult stools). Use warm water only, or water with a little soap in it. PURGES AND LAXATIVES THAT ARE OFTEN USED PURGES AND LAXATIVES THAT ARE OFTEN USED These are salt purges. Use them only in low doses, as laxatives for constipation. Do not use them often and never when there is pain in the belly. This is sometimes used for constipation in persons with piles but it is like passing greased rocks. Not recommended.

Collection Of Gastrointestinal Tract Specimens

Some protozoans and helminthes are passed with more frequency in a loose stool. The use of purgatives (e.g., cathartic or laxatives) has been found to be beneficial in enhancing the recovery of intestinal parasites from constipated patients.

Mechanisms Of Action Of Cathartics

The person taking a bulk-forming cathartics should be told to drink a full glass of fluid (one glass 8 fluid ounces 240 milliliters) when ingesting the cathartic. Persons taking bulk-forming cathartics should not expect immediate results. Instead, they should be told that the bulk-forming cathartics take from one to three days to produce their effects. Furthermore, it is generally recommended that the patient taking antibiotics, anticoagulants, digitalis preparations, or salicylates wait at least two hours after they take a dose of these drugs before they ingest the cathartics. This is recommended because the interaction between the drug and the cathartic could result in less of the drug being absorbed. Side effects are rare with the bulk-forming cathartics. However, intestinal impaction has occurred in patients who did not drink enough water while taking the products. The cathartic habit does not occur with bulk-forming laxatives. Consequently, they are...

Uterine Leiomyomata Definition and Symptoms

Leiomyoma may also cause pelvic pain, either through a mass effect, or by the spontaneous necrosis of the tumor. Acute onset pelvic pain may occur when a myoma either outgrows its blood supply, producing a necrotic central core, or when a pedunculated fibroid undergoes torsion on its stalk and becomes ischemic. Pelvic discomfort, pressure, or pain may also result from compression of adjacent organs by an enlarging fibroid uterus. Urinary frequency and constipation may result from compression of bladder or bowel, respectively.

Endocrine Causes of Obesity

Many patients are concerned that they have a metabolic or glandular cause for their obesity. This may be a reflection of the frustration that some of these individuals feel over the difficulties that they have had in battling a weight problem over many years. They may be looking for a medical explanation of why they have not succeeded in their goal of losing weight. Endocrine causes of serious obesity are not common. The three most commonly cited are hypothyroidism, Cushing's syndrome, and hypothalamic obesity. To evaluate the patient for hypothyroidism, questions can be asked about cold intolerance, constipation, irregular menses, fatigue, or depression. The presence of easy bruisability, proximal muscle weakness (difficulty getting out of a chair, trouble getting things out of a high cupboard), a change in appearance, or osteoporosis may be signs of hypercortisolism. The patient can be examined for signs of hypothyroidism including bradycardia, cool dry skin, a firm palpable...

Disrupted Micturition Balance

Conscious control allows voiding to occur at convenient times. Inhibitory reflexes (autonomic and somatic) coordinated by the pons are needed to keep the sacral micturition reflex in balance. If these reflexes are overly inhibited, the balance is tipped towards urgency and urge incontinence. If they are overly facilitated, the balance is shifted towards urinary retention. Viewed in this way, detrusor instability and urge incontinence simply represent the flip side of urinary retention. Both syndromes represent a central nervous system (CNS) dysfunction, which secondarily affects pelvic visceral function. It also follows that symptoms of bowel dysfunction (irritable bowel or chronic constipation) are likely to be owing to the same imbalance of reflexes. It becomes clear that any therapy directed at the end organ (i.e., anticholinergics, denervation procedures, augmentation) or any therapy that does not positively affect both bladder and bowel function (i.e., anticholinergics) is...

Chronic lung disease

Drinking enough fluids will help to counteract the constipation often caused by analgesics. If the gastrointestinal tract is not too tender, then constipation may be alleviated by high-fiber foods such as whole-grain breads, raw fruit and vegetables, dried fruits, seeds, and nuts.

Encopresis

Encopresis occurs more commonly in boys (4-6 1). The cause is usually psychological, secondary to toilet phobia, overly aggressive management of constipation, starting toilet training too early, or painful defecation after diarrhea, fissures, or severe perianal rashes.

Response to Therapy

Measures of response such as PSA do not necessarily indicate whether a patient is benefiting from therapy. Survival and quality of life are the most important measures of patient benefit in the evaluation of treatments in HRPC. Several studies now incorporate palliative end points such as pain, analgesic use, physical activity level, fatigue, appetite, constipation, urinary difficulties, relationships, mood, and overall well-being, through the use of questionnaires such as the Present Pain Intensity (PPI) Index or the Prostate Cancer-Specific Quality of Life Instrument (PROSQOLI). In fact, on the basis of quality of life improvements alone, the chemotherapy regimen of mitoxantrone and pred-nisone has been approved for use in HRPC.

Indications

This preparation is routinely used at our institution in all patients referred for screening for colorec-tal cancer, change in bowel habit, iron deficiency anaemia, constipation, heme positive stool, etc. (see Chap. 2). Intravenous contrast is never used as the polyps may enhance and simulate tagged stool causing a false negative finding.

Summary

A life-style health advantage can be rated relative to improved mortality of those in other life-styles. Certainly, we must also relate to improved quality of life, or as reduced morbidity. Vegetarians, as health-conscious people, have reduced mortality from ischaemic heart disease, cerebrovas-cular disease, and all causes combined.40,41 More specifically, they experience reduced morbidity and mortality due to obesity, constipation, lung cancer, hypertension, Type II diabetes, and gallstones compared with omnivores.40 Diet and immune function are a very important part of the reduced mortality

Etiology

Recent initiation of symptoms may allow the examiner to determine a transient etiology such as endocrine dysfunction, urinary tract infection, immobility, bowel dysfunction (including fecal impaction), or psychogenic cause. Any of these etiologies, alone or in combination, can produce acute loss of bladder contractile capabilities. Medication dose adjustments or addition of new medications to a therapeutic regimen is a particularly important cause of voiding dysfunction in patients with chronic neurologic conditions such as Parkinson's disease, treatment of which is dependent on several classes of drugs with significant anticholinergic side effects (13).

Diabetic Neuropathy

Gastrointestinal disturbances, including esophageal dysfunction, gastroparesis, diabetic enteropathy, diarrhea and fecal incontinence (including bacterial overgrowth), and constipation. Patients may experience delayed gastric secretion and emptying, and present with episodes of nausea and vomiting. Other symptoms can include anorexia, bloating, epigastric discomfort, and alternating episodes of constipation and diarrhea (with diarrhea being more prominent in patients with autonomic neuropathy). Diarrhea can result from pancreatic insufficiency, bacterial overgrowth, malabsorption, or intestinal hyper-motility. Amitriptyline may cause some unwanted side effects, including seizures, hypotension, increased sedation, hyperthermia, and other effects, including constipation and pseudodementia. This can be especially problematic in the elderly patient population, which may be prone to develop cardiac and other side effects. effect. Dose-dependence and drug abuse have raised some concern in...

Tardive Dyskinesia

A 26-year-old female is brought to the ER by her boss after fainting at work. The day before she had complained of a dry mouth along with constipation and urinary retention. Discussion Antipsychotic drugs such as thioridazine and chlorpromazine manifest a number of adverse effects, making drug compliance difficult. Muscarinic blockade produces typical anticholinergic effects such as tachycardia, loss of accommodation, urinary retention, and constipation. Alpha blockade produces orthostatic hypotension. Other side effects include extrapyramidal signs (akathisia, tardive dyskinesia, akinesia, dystonia, convulsions). Pigmentary retinopathy is restricted to thioridazine use.

And Nutrition

400, The answer is c. (Hardmant p 924.) Dioctyl sodium sulfosuccinate (docusate) is a detergent that, when given orally, softens the stool and prevents straining. Mineral oil also softens the stool, but it tends to inhibit the absorption of fat-soluble vitamins and other nutrients. Castor oil phenol-phthalein, and cascara sagrada are strong laxatives and cause watery stools.

Diet

Changes in diet may prevent up to 80 of bowel cancer.12 Diets high in fruits, vegetables, and fibers are linked to a decreased risk of colon cancer, as compared with diets high in red meats. Ingestion of two portions of red and processed meats daily was associated with an increased risk of 1.8 in two large studies of professionals. Alcohol use increases the risk, while appropriate dietary intake of folate may decrease the risk.13 Constipation and low stool weights are related to an increased risk of cancer.

Pharmacotherapy

Avariety of classes of laxatives can help induce more normal bowel movements. If an immediate effect is not needed and a long-term treatment is required, then bulk laxatives, which are a form of non-starch polysaccharides, are useful.2 These include wheat, plant-seed mucilage, and methylcellulose. Ispaghula, plant-seed mucilage, and psyllium are available in a variety of formulations that are swallowed with water. They ferment in the colon and can quadruple fecal bulk. More immediate therapy or relief, within two to three days, maybe obtained by osmotic laxatives. Lactulose, sorbitol, and other non-absorbed sugars create an osmotic load. The dose of lactulose is 15 ml twice a day, reduced as needed this can also be used for chronic diarrhea. Magnesium and sulfate salts are not absorbed and can be used chronically and safely. The dose of magnesium hydroxide is 1.2-3.6 g daily.2 Combinations may work more efficaciously, especially in the older women. Stimulant laxatives should be used...

Clinical symptoms

IBS can present as abdominal pain of variable intensity and position, although often it is in the lower abdomen or left lower quadrant and often it is crampy. Usually there is a change or alteration in bowel habits - diarrhea, constipation, or a combination. Other symptoms may include nausea, vomiting, and gas. Weight loss is usually not a symptom and suggests other causes. Women with IBS may have other chronic pain syndromes, including headaches, dyspepsia,

Items 69 through 610

A 53-year-old woman presents with complaints of weakness, anorexia, malaise, constipation, and back pain. While being evaluated, she becomes somewhat lethargic. Laboratory studies include a normal chest x-ray serum albumin, 3.2 mg dL serum calcium, 14 mg dL serum phosphorus, 2.6 mg dL serum chloride, 108 mg dL BUN of 32 mg dL creatinine of 2.0 mg dL.

Electrolyte Tests

Recent trauma, surgery, or shock may cause increased sodium levels. Oral contraceptives, anabolic steroids, corticosteroids, and laxatives may be linked to increased sodium levels. Decreased levels may be caused by diuretics, vasopressin, and sodium intravenous (IV) fluids. Prescription and over-the-counter drugs such as heparin, magnesium salts, oral contraceptives, aspirin, and corticosteroids and excessive use of laxatives may cause a decrease in plasma calcium. Drugs that influence an increase of plasma calcium include lithium, vitamin D, thiazide diuretics, thyroid hormone, and hydralazine, an antihypertensive medication. Interfering Circumstances. A variety of medications can interfere with laboratory measurement of magnesium levels. Prolonged treatment involving lithium, magnesium products such as antacids and laxatives, and salicylate products such as aspirin will cause a false increase in plasma magnesium levels. This is particularly possible in the...

Physiology

A 24-year-old man becomes paraplegic after he severs his spinal cord at T1 in an automobile accident. Chronic constipation is a problem, but he wants to be as independent as possible in its treatment. His physician advises him to distend the rectum digitally on a regular schedule to initiate the defecadon reflex. Rectal distention causes which of the following in this patient

Enuresis

Enuresis can be divided into two major types primary enuresis (90 ), in which the patient has never achieved dryness for any significant period of time, and secondary enuresis, in which a previously continent child becomes incontinent. Secondary enuresis is usually secondary to emotional difficulties (e.g.,, birth of a sibling, significant loss, family discord). It is usually transient and has a better prognosis. Primary enuresis can be further divided into nocturnal only, diurnal only, and nocturnal diurnal. Nocturnal diuresis is associated with maturational developmental delay of the bladder and may be a disorder of sleep and arousal. Diurnal enuresis is associated with waiting too long to void, urinary tract infections, constipation, diabetes, and stress incontinence.

Portal Hypertension

Acute thrombosis will subside spontaneously in most cases with sitz baths, anti-inflammatones, local steroids, and laxatives. If recurrent, surgical resection is warranted. If acutely painful or if conservative treatment fails, excision with local anesthesia may be done.

Block

The answer is e. (Tintinalli, 5 e, pp 539-541.) The patient has a past medical history of appendectomy, which predisposes him to adhesions and small bowel obstruction (SBO). Other etiologies for SBO include incarcerated hernia, stricture, and malignancy. The high-pitched bowel sounds, the peristaltic rushes, and the tympany with percussion are physical findings when air is under pressure in viscera and intestinal fluid is present (i.e., obstruction). The hallmarks of intestinal obstruction are abdominal pain, distension, vomiting, and obstipation. Abdominal radiographs may reveal dilated loops of bowel in a ladderlike pattern and air-fluid levels. Large bowel obstruction (LBO) is due to malignancy, diverticulitis, and volvulus. A mnemonic for abdominal distension is the 6 Fs Fat, Fluid, Food, Fetus, Feces, and Flatus.

History

After a thorough assessment of a patient's presenting symptoms, the history should then focus on related areas. There are several aspects of a patient's history that may be intimately related to voiding function. Sexual and bowel dysfunction are often associated with voiding dysfunction. Therefore the review of symptoms should focus on these areas including defecation (constipation, diarrhea, fecal incontinence, changes in bowel movements), sexual function, dysparunia, and pelvic pain. As neurological problems are frequently associated with voiding dysfunction, a thorough neurological history is critical, including known neurologic disease as well as symptoms that could be related to occult neurological disease (back pain, radiculopathy, extremity numbness, tingling, or weakness, headaches, changes in eyesight, and so on). In addition to a focused history regarding LUTS and voiding dysfunction, a thorough urological history is important. This includes a history of hematuria, urinary...

C Typhoid Fever

The victim experiences increasing malaise, headache, sore throat, diarrhea or constipation, abdominal pain, vomiting, and the fever ascends in stepladder fashion with each day's maximum higher than the preceding day. (b) Fastigium. The fever stabilizes after 7-10 days, and the victim becomes quite sick. He is motionless and unresponsive, has half-shut eyes, and appears wasted and exhausted. He has marked abdominal distention along with pea soup diarrhea or severe constipation.

Constipation Prescription

Constipation Prescription

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

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