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Natures Quick Constipation Cure Summary


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I started using this book straight away after buying it. This is a guide like no other; it is friendly, direct and full of proven practical tips to develop your skills.

As a whole, this book contains everything you need to know about this subject. I would recommend it as a guide for beginners as well as experts and everyone in between.

Diagnosing Thyroid Disease

Often, when I'm (Ken) lecturing to large audiences of physicians, usually late in the evening, I ask, Who is tired Who is a bit overweight Who suffers from constipation Who has dry skin Each question results in a large number of raised hands. Then I ask, Is anyone here hypothyroid and not taking thyroid hormone No one raises his or her hand. Yet many of these symptoms are the same as those of hypothyroidism. The symptoms of hypothyroidism completely overlap with those of normal life variations or those of unrelated health disorders. The proper laboratory test acts as an honest broker, providing objective evidence for making the correct diagnosis. Know, however, that such tests are not infallible.

Argentine Hemorrhagic Fever Junin

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

Inflammatory Bowel Disease IBD

Hypothyroidism slows down the rate at which food travels through the stomach and intestines. This can result in gastroesophageal reflux disease (heartburn) and constipation. On the other hand, thyrotoxicosis from untreated Graves' disease causes more frequent bowel movements consequent to an increased rate of movement of food through the intestines. These functional differences may be mistaken for primary intestinal diseases, including IBD.

Adjuvant Treatment and Postoperative Care

Patients are limited to light activity for 6 weeks post-operatively. All patients are placed on a stool softener and are seen every 1-2 weeks postoperatively for a conservative endoscopic debridement. Debridements are performed to maintain patency of the paranasal sinuses on the side of the repair, avoid stasis of secretions, and help prevent bacterial infections. An antistaphy-lococcal antibiotic is appropriate until the finger cots are removed at the first postoperative visit, usually 5-7 days after the surgical repair. Patients return to normal activity at around 6 weeks postoperatively.

Clinical Manifestations

Common constitutional symptoms referable to the GI tract include dysphagia, odynophagia, vomiting, abdominal pain (which may be focal or generalized), colic, constipation obstipation, diarrhea and GI bleeding, with or without anemia. Non-specific symptoms of anorexia, fatigue and wasting may also be observed. Individuals with chronic hyper-chloremic metabolic acidosis resulting from excess GI bicarbonate loss may present with obtundation

Detection and Screening

Assessment of cancer-related GI tract sequelae should begin with a thorough history with close attention to symptoms attributable to GI tract pathology, including dysphagia, odynophagia, vomiting, chronic abdominal pain, chronic constipation or diarrhea and hematochezia (Table 12.1).Anorexia,

Management of Established Problems

Dysphagia resulting from abnormal motility associated with neuronal injury can be identified through manometric studies treatment with calcium channel blockers may ameliorate symptoms. Chronic constipation and obstipation may be predisposed by more severe motility abnormalities. Aggressive treatment with laxatives and enemas are required for individuals who develop stool impaction. Regular treatment with stool softeners and peristaltic stimulants reduces the risk of this complication.

Gestational Hypothyroidism

If hypothyroidism is suspected while you're pregnant, your doctor will give you a TSH test. Just as in nonpregnant women, your TSH levels will be increased if you're hypothyroid, and you'll be treated with thyroid hormone replacement. As discussed earlier, sometimes pregnancy itself can mask hypothyroid symptoms. For example, constipation, puffiness, and fatigue are all traits of pregnancy as well. These symptoms will likely persist after delivery if your hypothyroidism remains untreated, and they can seriously interfere with pregnancy and your postpartum health.

Treatment of Iron Deficiency

Iron deficiency has traditionally been separated into iron deficiency anemia and tissue iron deficiency, also referred to as ''depleted iron stores.'' Iron deficiency anemia is diagnosed as a low serum Tf saturation (less than 15 ), a low serum ferritin concentration (6mg dL) in the setting of microcytic anemia. However, anemia reflects a late stage of iron depletion with earlier stages often evidenced by low serum ferritin and slightly elevated TfR levels. Because both serum ferritin and serum iron concentrations are acute phase reactants to inflammatory cytokines, the presence of inflammation must be considered in a diagnosis of iron deficiency. After the diagnosis of true iron deficiency, restoration of an iron-replete state can be achieved by administering 125-250 mg of ferrous sulfate orally per day. This dose of the salt will deliver 39-72 mg of highly bioavailable iron per day. There is some evidence that doses greater than 250 mg ferrous sulfate convey additional benefits and...

Thyroid Disease ana Obesity

Fatigue, which can also lead to weight gain or aggravate preexisting obesity. The craving for carbohydrates is caused by a desire for energy. Consuming carbohydrates produces an initial rush of energy, but then it is followed by a crash, which is sometimes known as postprandial depression (or postmeal depression), exacerbating or contributing to hypothyroid-induced depression. Even in those with normal thyroid function, depression can cause cravings for simple carbohydrates such as sugars and sweets. In the absence of overeating, some of the weight gain in hypothyroidism is bloating from constipation. Increasing fluid intake and fiber will help the problem, which we discuss more in Chapter 20.

Adjunctive Medication

Anticholinergic agents effectively treat the EPS associated with first-generation 'conventional' neuroleptics. The justification for the use of anticholiner-gics with atypical antipsychotics is more limited. As noted previously, anticholinergics may contribute to cognitive deficits, as well as to peripheral side effects such as constipation, dry mouth, urinary retention, and blurred vision. Indications for use of anticholinergics with atypical antipsychotics include akathisia, rare EPS, and excessive salivation with clozapine.

Nonexcisional Options

The majority of patients evaluated for hematochezia that ultimately proves to be hemorrhoidal in origin can be and should be managed with fiber supplementation. Although it is not clearly proved that constipation contributes to hemorrhoidal symptoms, it is certainly reasonable to improve bowel function to reduce hemorrhoidal complaints in the majority of early-stage patients. The remaining nonoperative and operative interventions should be reserved for patients with advanced hemorrhoidal disease and patients who are unresponsive to this simple but effective medical management routine.

Juliane A Rocha Miranda Steven D Wexner

To many people constipation may mean the abnormally delayed, difficult, or infrequent passage of dessicated feces, but its significance in clinical practice may be broader and more varied according to distinct patient populations. Symptoms can include decreased stool bulk or caliber, the need to excessively strain to pass stool, and decreased stool volume. Because the range for stool weight in the United States varies from 35 to 224 g, a patient's complaint of decreased stool volume may be of limited clinical importance. Moreover, very few people complain about stool volume more often, they complain about its frequency or ease of passage. Although straining can be associated with a number of anorectal dysfunctions, many healthy individuals also experience this symptom. Dent et al. noted that 31 of normal individuals surveys reported the prevalence of frequent constipation to be 2 and 12.8 . Nevertheless, it was also shown that constipation is more prevalent in persons of lower...

Human TCell Lymphotrophic Virus Type

Clinical Features and Associated Findings. HTLV- 1-associated myelopathy-tropical spastic paraparesis is a slowly progressive spastic paraparesis marked by hyperreflexia, bladder dysfunction, constipation, and impotence in males. Sensory abnormalities due to demyelination of the posterior columns occur less frequently than motor abnormalities and present primarily as paresthesias of the lower extremities. y

Diseases Affecting

The major clinical feature of LEMS is weakness, often generalized and symmetric, and usually affecting proximal muscles more than distal. Affected patients will be areflexic or markedly hyporeflexic, with normal sensation. Signs and symptoms of autonomic dysfunction are also present, such as dry mouth, impotence, constipation, bladder retention, and abnormal papillary reactions, indicating that the autoantibody attack is not limited to VGCCs at NMJs. Infantile botulism occurs between 2 wk and 6 mo of age, and presents as hypotonia, constipation, poor feeding, and dyspnea during the course of hours or days. Food-borne botulism affects older children and adults and begins abruptly, with diplopia, ptosis, dysphagia, limb weakness, and respiratory compromise. External ophthalmoplegia, papillary paralysis, are-flexia or hyporeflexia, and limb weakness are found on examination. Respiratory failure can lead to death, but supportive care and use of botulism antitoxin provide for a good...

Clinical features

The child may awaken unaware of having wet the bed and dreams relating to bed wetting may follow rather than cause the event. In children enuresis tends to occur during the first third of the night, and may be associated with other conditions such as obstructive sleep apnoeas and constipation and respond to treatment of these.

Diffuse Autonomic Failure Pandysautonomia Central Preganglionic Disorders

Autonomic Peripheral Neuropathies and Neuropathies. Acute autonomic neuropathies with prominent sympathetic and parasympathetic involvement (i.e., acute pandysautonomia) occur in isolation or accompany the Guillain-Barre syndrome and acute paraneoplastic neuropathies. The CSF protein level may be elevated, and the autonomic features may respond to intravenous immunoglobulin. Paraneoplastic dysautonomia may occur in association with carcinoma of the lung, pancreatic carcinoma, Hodgkin's disease, testicular cancer, and other neoplasms. Paraneoplastic gastrointestinal dysfunction with constipation and intestinal pseudo-obstruction has been reported in patients with small-cell carcinoma of the lung and elevated titers of antineuronal nuclear (anti-Hu) antibodies. Acute autonomic dysfunction may also be a feature of porphyria and of the neuropathies due to drugs (e.g., vincristine, taxol, cis-platinum) and toxins (e.g., thallium, acrylamide). y Dysautonomia is a prominent feature of some...

Opiate Treatment of Chronic Pain

Opiate pain medications (Table 3) are effective analgesics and do not cause major organ damage when properly used. Toxic doses and certain side effects (such as constipation, oversedation, and cognitive slowing) are the primary concerns along with possible dependence and abuse (27). Withdrawal, tolerance, and physical dependence to opiates can develop very quickly and should be monitored (31,32). In some cases the effective treatment of pain outweighs the potential development of physical dependence (31). Schofferman (33) suggested that chronic pain patients can be divided into three groups, with Type 1 being typical chronic pain patients who have disability and pain sensation out of proportion to the etiology of pain, Type 2 having moderate refractory pain proportional to the stimulus, and Type 3 with severe pain proportional with severity of etiology. While long-term opiate use was not suggested for Type 1 patients, Type 2 and 3 patients are considered for chronic opiate use in this...

Side Effects of Antidepressants

Antimuscarinic cholinergic properties cause dry mouth, dental caries (due to dry mouth), blurred vision, constipation, sinus tachycardia, urinary retention, and memory loss and confusion. The most serious of these effects is the possibility of an anticholin-ergic delirium (atropine psychosis). This is usually associated with elevated plasma levels of TCA drugs but can be seen at therapeutic blood levels. Typical symptoms include impaired short-term memory, confusion, and peripheral signs of anticholiner-gic activity such as dry mouth, enlarged pupils, and dry skin. Older patients seem to

Important Findings In The Pediatric Emg Laboratory

The most common form of botulism in childhood is infant botulism, caused by ingestion of Clostridium botulinum spores from the soil. Endemic states include Pennsylvania, Utah, and California. Botulinum toxin inhibits the release of acetylcholine from the presynaptic terminal. Infants typically present with the acute onset of constipation, extremity weakness, bulbar weakness, sluggish pupillary responses, and oculomotor palsies. Reflexes may be either preserved or diminished. Because the infants ingest spores rather than preformed toxin as in adult botulism, the illness is caused by low levels of subacute toxin production rather than an overwhelming single dose. Thus, stool samples rather than blood samples should be sent for botulinum toxin testing in patients suspected of having infant botulism.

Orthostatic Hypotension

Management of orthostatic hypotension requires patient education to avoid factors that precipitate a fall In blood pressure. Patients should be made aware of the hypotensive effects of certain drugs, large meals, environmental temperature Increases, and physical activities. Other Instructions Include Institution of a high-fiber diet to lessen straining resulting from constipation and the use of physical maneuvers that help to Increase postural tolerance. These maneuvers Include crossing the legs, lowering the head In a stooped position, bending forward, and placing a foot on

N helmintoeca and Other Species

N. sennetsu infection is a human disease characterized by fever, malaise, anorexia, constipation, backache, and lymphadenopathy (138). Although mice are highly susceptible to N. sennetsu (139), whether this organism infects domestic animals is unknown. Some epidemiological data regarding N. sennetsu infection of humans suggested an association with the consumption of red mullet fish, although it has not yet been proven.

Sympathetic and Parasympathetic Tone

Another interesting example of tone is the background tone of the parasympathetics in the gastrointestinal tract. Surgical removal of the parasym-pathetic supply to most of the gut by cutting the vagus nerves can cause serious and prolonged gastric and intestinal atony with resulting blockage of much of the normal gastrointestinal propulsion and consequent serious constipation, thus demonstrating that parasympathetic tone to the gut is normally very much required. This tone can be decreased by the brain, thereby inhibiting gastrointestinal motility, or it can be increased, thereby promoting increased gastrointestinal activity.

Probiotic Activity Of Spirulina

Consumption of yoghurt and other fermented dairy products prepared with Lactobacillus, Streptococcus, and Bifidobacteria strains has increased all over the world in recent years. It is considered by both the general public and expert nutritionalist that they provide humans with major benefits protection from infection of intestinal pathogen microorganisms,123 stimulation of the immune system,124 as well as better digestion, and absorption of lactose and minerals,125 prevention of traveler's diarrhea,126 (Alm, 1991), reduction of diarrhea and rotavirus infection in infants,127 prevention of constipation in elderly people,126 contribution to a faster recolonization of the intestinal microflora after administration of antibiotics,128-131 improvement in lactose intolerance,132 reduction of cholesterol level in the blood,133 stimulation of

Antisterility Vitamin In Human Beings

Among the gastrointestinal symptoms of thiamine deficiency are indigestion, severe constipation, anorexia, gastric atony, and hypochlorhydria. All these effects presumably result from failure of the smooth muscle and glands of the gastrointestinal tract to derive sufficient energy from carbohydrate metabolism.

The Female Athlete Triad

The problem usually begins with disordered eating, which includes a spectrum of abnormal and harmful eating patterns such as binging and purging, restrictive eating, fasting, and the use of diet pills or laxatives. The preoccupation with food, a distorted body image, and intense fear of becoming fat are often present as well. Some athletes will meet the Diagnostic and Statistical Manual of Mental Disorders, revised edition IV 95 , criteria for anorexia nervosa or bulimia, whereas other athletes may display similar behaviors without meeting full diagnostic criteria. A new classification of eating disorder not otherwise specified (ie, ED-NOS) allows for the identification of women who do not meet other classification criteria. This classification has been helpful in this population because the athlete's weight may seem adequate as a result of increased lean tissue mass however they are not consuming enough calories to meet their energy needs.

Apathetic Hyperthyroidism

Apathetic hyperthyroidism refers to hyperthyroidism without clear symptoms of thyrotoxicosis (see Chapter 4). Normally, people who are thyrotoxic as a result of hyperthy-roidism have a racing heart, enlarged thyroid gland, tremor, restlessness and anxiety, and signs of thyroid eye disease (see Chapter 23). In apathetic hyperthyroidism, the telltale signs doctors count on to diagnose hyperthyroidism are absent instead, a person with apathetic hyperthyroidism may even seem calm and mild-mannered. Or, the person could exhibit more hypothyroid symptoms, such as depression and constipation. Typically, the only sign of hyperthyroidism in an older person is weight loss, fatigue, and irritability, which are easily attributed in most cases to normal aging. In other instances, heart rhythm disturbances (usually rapid heartbeats or atrial fibrillation) are the only clues to thyrotoxicosis. In short, many people with apathetic hyperthyroidism are missed, and the hyperthyroidism remains untreated...

REM sleep suppressant drugs

Both tricyclic antidepressants and selective serotonin re-uptake inhibitors (SSRIs) reduce the duration of REM sleep and are effective if OSA are confined or almost confined to REM sleep. Protriptyline 5-20 mg nocte has been most widely used, but has been withdrawn in the UK. It is non-sedating, but side-effects such as constipation and urinary retention are common with a dose of more than around 10 mg. Selective serotonin re-uptake inhibitor antidepressants, such as paroxetine, may also reduce the loss of upper airway muscle activity during NREM sleep. They reduce the frequency of OSA in NREM sleep slightly.

Antibody Based Antiangiogenesis Therapy

VEGF-Trap is a fusion protein connecting segments of human VEGF-R1 and of the extracellular domain of VEGF-R2 to a Fc-fragment of human IgG1. The effect is based on the binding and inactivation of circulating VEGF found in tissue. The strong affinity of VEGF-R1 to VEGF results in a binding of VEGF-Trap 100 times stronger than that of monoclonal antibodies to VEGF, the pharmacokinetics being the same in both cases. In contrast of humanized antibodies, it contains exclusively human amino acids, leading to a missing formation of anti-VEGF Trap antibodies. Moreover, only grade 1 toxicity was observed, e.g., fatigue, proteinuria, and constipation. Grade 3 and 4 toxicities as potential reasons for ending therapy early were not observed (Fayette et al. 2005).

How May A Particular Malignant Condition Present

Symptoms may include blood or mucus in the faeces changes in bowel habits (diarrhoea, constipation or both), anything abnormal or that lasts for more than two weeks the feeling of needing to go to the toilet even if the bowels have just been emptied pain or discomfort in the abdominal area a lump in the abdomen extreme tiredness, which might be due to bleeding. These symptoms may well be present for other reasons, the most common cause of bleeding being haemorrhoids, for example. However, it is important that anyone experiencing these symptoms should see their doctor (Cancer Research UK web site, 2002).

Gastrointestinal Dysmotility

The principles of management of any gastrointestinal motility disorder include restoration of hydration and nutrition by the oral, enteral, or parenteral route, suppression of bacterial overgrowth, use of prokinetic agents or stimulating laxatives, and resection of localized disease. Bowel Hypomotility. The first line of treatment of bowel hypomotility is to increase dietary fiber as well as water intake and exercise. Psyllium or methylcellulose with a concomitant increase in fluid intake may be used to further increase stool bulk. Some caution is required in diabetic patients, in whom high fiber may pose a risk of distention, cramping, and potential bezoar formation in the presence of gastroparesis. If these measures are ineffective, stool softeners (e.g., docusate sodium) or lubricants (e.g., mineral oil) together with an osmotic agent (e.g., milk of magnesia or lactulose) may be used. Glycerine suppositories or sodium phosphate enemas promote fluid retention in the rectum and thus...

Parkinsonism Plus Syndromes

Clinical Features and Associated Disorders. MSA encompasses three neurodegenerative syndromes, which in the past were considered clinically distinct striatonigral degeneration (SND), olivopontocerebellar atrophy (OPCA), and Shy-Drager syndrome (SDS). All these conditions share similarities with one another and with PD. The hallmark features of MSA are parkinsonism that is poorly responsive to levodopa therapy and varying degrees of autonomic, cerebellar, and pyramidal dysfunction. SDS is diagnosed clinically when dysautonomia far outweighs the other signs, SND is designated when anterocollis and pyramidal dysfunction are prominent, and OPCA is used to characterize the patient with prominent cerebellar features of ataxia, limb dyssynergia, and kinetic tremor. For all MSA patients, autonomic insufficiencies include orthostatic hypotension, postprandial hypotension, anhidrosis with thermoregulatory disturbances, poor lacrimation and salivation, constipation, and impotence. Disturbances...

Control of Brain Stem Autonomic Centers by Higher Areas

In Chapters 58 and 59, it is pointed out also that many of our behavioral responses are mediated through (1) the hypothalamus, (2) the reticular areas of the brain stem, and (3) the autonomic nervous system. Indeed, some higher areas of the brain can alter function of the whole autonomic nervous system or of portions of it strongly enough to cause severe autonomic-induced disease such as peptic ulcer of the stomach or duodenum, constipation, heart palpitation, or even heart attack.

Digestive Changes and Weight Gain

Because your system has slowed down, you'll suffer from constipation, hardening of stools, bloating (which may cause bad breath), poor appetite, and heartburn. Because the lack of thyroid hormone slows down your metabolism, you might gain weight as well. But often because your appetite may decrease radically your weight will stay the same. Hypothyroid patients can experience some, or all, of these symptoms, and sometimes, if the hypothyroidism is caught early enough, patients may not be conscious of any of these symptoms until their doctor specifically asks if they have noticed a particular change in their metabolism or energy. You'll need to adjust your eating habits to compensate, which is discussed in more detail in Chapter 16. The typical scenario is to gain roughly ten pounds during a period of about a year, even though you may not be eating as much. Some of the weight gain, however, is because of bloating from constipation.

A marginale and Closely Related Species Anaplasmosis of Ruminants

They include depression, weakness, fever, labored breathing, inappetence, dehydration, constipation, jaundice, abortion, and death. The pathogenic roles of A. centrale and A. ovis are comparatively weaker than that of A. marginale. Thus, little is known about the vectors and reservoirs of A. centrale and A. ovis.

TSH Deficiency

Central hypothyroidism is difficult to diagnose because of its subtle clinical and laboratory presentation. It is particularly difficult to recognize in patients whose growth is complete, because slowed growth rate can no longer be used as a sign. Symptoms of central hypothyroidism (e.g. asthenia, edema, drowsiness, adynamia, skin dryness) may have a gradual onset and go unrecognized until thyroid replacement therapy is initiated and the patient feels better 14 . In addition to causing delayed puberty and slow growth (Fig. 5.9 f), hypothyroidism may cause fatigue, dry skin, constipation, increased sleep requirement, and cold intolerance.


Binge eating involves the consumption of a large amount of food in a relatively short period of time along with a perception of loss of control over eating. Binge eating may be triggered by a number of factors, including hunger, negative mood, interpersonal stressors, and thoughts about weight and shape. Inappropriate compensatory behaviors are strategies aimed at controlling body weight and shape, including self-induced vomiting, misuse of laxatives and or diuretics, excessive exercising, and fasting. The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV American Psychiatric Association, 1994) divides Bulimia Nervosa into two subtypes. The purging subtype is distinguished by the presence of purging compensatory behaviors such as self-induced vomiting or laxative misuse. The nonpurging subtype is diagnosed in the presence of only nonpurging compensatory behaviors (e.g., excessive exercise). Individuals with Bulimia Nervosa also exhibit overconcern about their...

Colorectal cancer

Symptoms may include blood or mucus in the faeces, changes in bowel habits (diarrhoea constipation or both), anything abnormal or that lasts for more than 2 weeks, the feeling of needing to go to the toilet even if the bowels have just been emptied, pain or discomfort in the abdominal area, a mass in the abdomen or extreme tiredness, which could be the result of anaemia. These symptoms may well be caused by other conditions, e.g. a common cause of bleeding is haemorrhoids. However, it is important that anyone experiencing these symptoms should see their doctor (Cancer Research UK website, 2002b).


The common clinical manifestations of hypothy-roidism include cold intolerance, constipation, inordinate weight gain, dry skin and slowed mentation. Specific signs include a round puffy face, slow speech, hoarseness, hypokinesia, generalized muscle weakness, delayed relaxation of deep tendon reflexes, cold and dry skin, brittle hair and periorbital edema. The most common clinical picture of hyperthyroidism is similar to that of Graves' disease and usually characterized by a diffusely enlarged thyroid gland, oph-thalmopathy and dermopathy.


Although there are now many compounds with pharmacological properties similar to those produced by morphine, this old drug remains the most useful in clinical settings. However, in spite of its efficacy, morphine treatment has some associated problems. Side effects such as nausea, vomiting, constipation, drowsiness, confusion, and the variability in analgesic response between patients are common clinical problems during morphine therapy, with respiratory depression being a less frequent but more serious side effect (Martindale, 2002). Although the development of dependence and or tolerance is not generally a problem when morphine is used in patients with opioid-sensitive pain, the possibility of tolerance, dependence, and addiction with long-term use may complicate its clinical use and can create barriers to its adequate prescription (Schafer et al., 2001). In fact, the development of tolerance, physical dependence, and addiction with repeated use is a characteristic feature of all...


Types of intussusception include enteric (small bowel into small bowel), ileocolic (small bowel into colon), and colonic (colon into colon). Although colonic intussusception is rare in children, it accounts for approximately 50 of adult cases. The clinical presentation is that of mechanical bowel obstruction crampy abdominal pain, nausea, vomiting, and subsequent obstipation or diarrhea. Subacute or recurrent acute attacks are not uncommon in adults compared with children. Radiographic investigation of an individual with recurrent episodes of bowel obstruction should include barium contrast radiography or computed tomography scanning during an acute episode ( Fig. 6-1A and B ). The demonstration of an invaginated portion of the bowel secures the diagnosis. Predisposing factors common to all sites of volvulus include previous abdominal surgery and a history of chronic constipation. A detailed history should include potential comorbidities that must be incorporated into the overall...

Anthony J Senagore

The vascular cushions form the termination of the vascular supply within the anal canal and contribute to the maintenance of anal continence. Hemorrhoidal disease occurs as the result of abnormalities within the connective tissue of these cushions, producing bleeding with or without prolapse of the hemorrhoidal tissue. This can occur as the result of excessive straining and chronic constipation. A clear understanding of the pathophysiology is important when considering therapeutic interventions. At the earlier stages of disease progression, when the major manifestation is transudation of blood through thin-walled damaged veins or arterioles, ablation of the vessels should be adequate. Conversely, in late stages of the disease, when there is significant disruption of the mucosal suspensory ligament, fixation of the mucosa


The significant and critical information obtained from a very detailed clinical history is mandatory. Thorough abdominal and perineal examinations must be undertaken, with the performance of an inspection of the anal region, including a digital examination, anoscopy, and a rigid or flexible sigmoidoscopy. The abdominal examination should identify any masses, distention, scars, or tenderness. A digital examination can exclude distal obstructive causes of constipation and unveil the presence of any hard stool in the rectum. This latter finding may be common in patients who present with either irritable bowel syndrome, inadequate fiber intake, or adequate fiber intake with suboptimal fluid ingestion. No patient who complains of constipation should be considered to have a functional cause until mechanical and extracolonic causes are excluded. Therefore, sigmoidoscopy or proctoscopy should be supplemented by a double-contrast barium enema. Although colonoscopy is a better means of...

The Hypothyroid Diet

This is a general diet I (Sara) have created for people battling the symptoms of hypothy-roidism, which can aid with constipation, bloating, and a slower gastrointestinal tract. This is not the diet to follow if you are on a low-iodine diet. Because everything slows down when you're hypothyroid, you need to know how to eat and what to eat to compensate for your body's slowness during this time, as well as to avoid complications of hypothyroidism. A high-fiber diet low in saturated fat and rich in unsaturated fat (described later in this chapter) can help improve constipation and bloating, fatigue, and weight gain. In essence, this diet will help you feel better while combating periods of hypothyroidism when you're not properly balanced on thyroid hormone, while helping to prevent cardiovascular problems and colon health problems. It will also complement your thyroid medication if you are balanced right now.

Battling the Bloat

Feeling bloated and constipated is a classic hypothyroid ailment. Much of the bloat is actually caused by constipation much is also caused by not drinking enough water. But few people understand that when you increase fiber, you have to increase water intake. So here's what you need to know about fiber and water. You can take fiber supplements and stool softeners while hypothyroid, which will help you when your fiber content is low. But these supplements can be added to a high-fiber diet as well. It's important to note that fiber can interfere with the absorption of your thyroid hormone so you should take them as far apart as possible, for example, fiber at night and your thyroid hormone pill first thing in the morning. Insoluble fiber doesn't affect your cholesterol levels at all, but it regulates your bowel movements. How does it do this As the insoluble fiber moves through your digestive tract, it absorbs water like a sponge and helps to form your waste into a solid form faster,...

Opioid Agonists

Clinical Features and Associated Findings. The acute effects of opiates include euphoria and drowsiness. y Parenteral heroin produces a hit that lasts for about a minute. It is often compared to orgasm. The user then experiences a dreamlike and pleasant drowsiness. Visual hallucinations have been reported after morphine or heroin administration. Nausea and vomiting can also occur. Drug abusers often experience dryness of the mouth, pruritus, suppression of the cough reflex, respiratory depression, hypothermia, postural hypotension, and constipation.

Pain Syndromes

Proctalgia fugaxis described as brief and sometimes severe episodes of rectal pain similar to having a knife inserted up the rectum. Patients are often awakened from sleep and have associated irritable bowel syndrome and constipation. The syndrome is more common in men, and there are no physical signs. It is theorized that the pain results from spasm of the rectal muscle wall. For the purpose of this discussion, proctalgia fugax is considered a variant of levator spasm.

Side Effects

Despite their robust effectiveness, the clinical use of tri-cyclic antidepressants has been limited by their side effects. The problems range from minimal seriousness with high nuisance value that can markedly reduce patient compliance, to problems of potential lethality in certain patient populations. The most frequent side effects of tricyclics are due to their peripheral anticholinergic (antimuscarinic) effects, which account for dry mouth, constipation, tachycardia, and blurred vision (Richelson, 1989). In older patients, the anticholinergic effect can result in urinary retention and acute confusional states. The tricyclics also block histamine receptors, which may be related to the significant weight gain that is associated with long-term treatment in some patients.


Of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV American Psychiatric Association ApA , 1994) gives four criteria for diagnosis of Encopresis repeated passage of feces into inappropriate places the occurrence of this behavior at least once a month for at least three months a chronological age of the child of at least 4 years, or if there has been a developmental delay, a mental age of at least 4 years and an inability to attribute the fecal incontinence to a general medical condition (except constipation) or to the effects of substances (e.g., a laxative). The DSM-IV recognizes that fecal soiling may be voluntary or involuntary, but many family physicians and pediatricians would not diagnose voluntary fecal soiling as En-copresis, and would most often diagnose Encopresis as a consequence of constipation. The DSM-IV defines two subtypes of Encopresis. The first is with constipation and the inappropriate passage of feces due to overflow of fecal matter. About 80 of...


The electrodiagnostic abnormalities also show a distal to proximal gradient. The most sensitive NCS are the plantar mixed NCS, followed by the superficial peroneal and sural sensory NCS, followed by the upper extremity sensory NCS. The motor NCS abnormalities and needle electrode examination abnormalities follow this same pattern. When one considers that a nerve is made of sensory, motor, and autonomic axons ranging in size from small to large, it is easy to envision the range of clinical symptoms this disorder produces. Small fiber sensory disruption causes loss of pain and temperature perception, as well as more prevalent features of dysautonomia. Large fiber sensory involvement impairs proprioception, vibratory perception, gait (sensory ataxia), and reflexes. Motor axon dysfunction produces weakness, and autonomic axon involvement produces various dysautonomic features. Occasionally, patients present with disproportionate small fiber or large fiber sensory involvement or autonomic...

Review Questions

You are in practice in Pennsylvania when you are asked to perform nerve conduction studies and EMG on an inpatient at your local hospital, a 4-mo-old infant boy with an acute onset of weakness and hypotonia. On examination, he is intubated and quite flaccid, with ophthalmoparesis, sluggish pupillary responses, and hyporeflexia. His mother tells you that the first sign of difficulty was constipation 4 d ago. His father is not present because he is a foreman on a crew breaking ground for the new hospital outpatient building across the street. The highest yield studies on nerve conduction studies and EMG will be 10. The correct answer is D. Pennsylvania, along with Utah and California, are states with high incidences of infant botulism, because of the presence of botulinum spores in the soil. A parent of an affected infant typically works in construction or is otherwise in close and frequent contact with newly disrupted soil. Constipation is a frequent early sign. The most important...

Referred Pain

Often pain from a spastic viscus occurs in the form of cramps, with the pain increasing to a high degree of severity and then subsiding. This process continues intermittently, once every few minutes. The intermittent cycles result from periods of contraction of smooth muscle. For instance, each time a peristaltic wave travels along an overly excitable spastic gut, a cramp occurs. The cramping type of pain frequently occurs in appendicitis, gastroenteritis, constipation, menstruation, parturition, gallbladder disease, or ureteral obstruction.

Myotonic Dystrophy

It cannot be overemphasized that DM is a multisystem disorder. The heart is prominently involved, and the severity of cardiac symptoms does not correlate with severity of other symptoms in this disorder. All patients with DM need to undergo EKG evaluation, because sudden death is well documented, and as many as 90 percent of patients have conduction defects, particularly first-degree heart block and atrial arrhythmias. Both the diaphragm and intercostal muscles may be myotonic and weak, which leads to alveolar hypoventilation. In addition, there are smooth muscle abnormalities throughout the gastrointestinal system. Particularly important are the delayed relaxation of the pharynx and reduced motility in the esophagus that may lead to aspiration, constipation, and anal sphincter abnormalities in children.

Subjective Objective

General measures in the treatment of HE include maintaining adequate nutrition, good renal function, and acid-base status, as well as reducing colonic ammonia production. Because normal brain pH is 6.95 and blood pH is 7.4, there is a tendency for ammonia to enter the brain. By minimizing the interaction between enteric bacterial flora and nitrogenous substances, colonic ammonia production is reduced. Dietary protein restriction, avoidance of constipation, and GI tract evacuation are helpful in this respect. The GI tract is evacuated through the use of cathartics (e.g., lactulose) and enemas. Lactulose is a synthetic disaccharide capable of reducing arterial ammonia levels. In the colon, it is converted into acidic metabolites, which create a pH gradient across the intestinal wall. Colon acidification was thought to select for bacteria that did not contain urease. Instead, colon acidification decreases blood ammonia by trapping it in the acidified feces, thereby making it unavailable...


Its mechanism of action is uncertain, but it may inhibit noradrenaline and dopamine re-uptake, particularly in the limbic system. It has little effect on total sleep time, but reduces REM sleep. It increases alertness and may cause insomnia, but not euphoria. Loss of appetite, nausea, abdominal pain, constipation, hypertension, tremor and urinary retention may occur. Tolerance and abuse are also recognized.


Pain, nausea, alternating diarrhea and constipation, anemia, weight loss, and low fever. Autoinfection can produce an enormous number of worms and can be fatal. Persons with immune deficiencies from diseases such as cancer or acquired immune deficiency syndrome, or whose therapy requires immune suppression, may develop devastating hyperinfections from mild or inapparent strongyloidiasis. Therapy is usually effective, although side effects from drugs are common. Prevention is largely a matter of education and improved living conditions.

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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