ebook Natures Quick Constipation Cure

The First Step-by-step Plan To Cure Constipation Using A Combination Of Unique All-natural Remedies. This plan uses a strategically organized and ordered combination of the safest and most effective natural remedies for constipation. Everything used in this plan is from natures garden. No use of harmful laxatives. People who have used these swear they work Better than over-the-counter laxatives! Every strategy is carefully researched for safety and effectiveness. Each remedy builds on the last while helping out the next. The plan takes into account human physiology, anatomy, nutrition, metabolic needs and deficiencies while using specific dietary remedies and the almost always neglected but extremely powerful, mechanical remedies. All of these have been carefully planned and refined to provide you the most powerful, synergistic constipation relief plan that will relieve you of even the most stubborn of constipation episodes within as quick as 15 minutes and less than 24 Hours....[more here]

Natures Quick Constipation Cure Overview


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ebook Natural Remedies For Constipation

Here is a comprehensive constipation e-book that cover all aspects of colon health. If ever you wanted to find answers on how to keep your colon healthy, how to elminated constipation, or follow a health lifestyle, then this is an e-book you should read. It just not for constipation, but for gaining your health back when you hav an illness. This e-book is about how to eliminate constipation, how to keep regular by maintaining a healthy colon, and how to prevent constipation in the future. Here's what you will discover in, Constipation Natural Cures: Why drugstore laxatives will kill you if you continue to use them (page 26 27) Which drugstore laxative is the safest to use (page 28) How many bowels movements should you have each day (page 19) How to tell if you are constipated (page 20) How long does it take for food you eat to come out the rectum (page 18) One thing that will keep your colon healthy and keep you from having constipation (page 46) Two areas that you need to massage to keep your stools moving in the right direction (page 40) The best good bacteria supplement you should take (page 45, 46) What you can feed your good bacteria so that the bad bacteria doesn't take over (page 46 and 47) What happens when bad bacteria in your colon takes over (page 49)...[more here]

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ebook Solutions For Infant And Child Constipation

Can You Ignore Your Child's Constipation Any Longer? Are digestive enzymes safe for your children? Important research you should know before treating your child yourself. Top 10 gas forming foods that can cause constipation in children . including babies. (page 18) What is the significance of exercise and having a healthy bowel? What does the color of your babys stool mean? See the stool chart below. Treatment of infant constipation and how to help children to move their bowels regularly without the drama. Symptoms of constipation that dont appear to be related to the bowel . and are often overlooked. Whats the primary reason that infants get constipated and how you can fix this (page 10) Can chiropractic care really help constipation? How to create healthy bowel habits in your children . and keep them safe from diseases in adult life. Warning: mothers you can be affecting your childs bowel by what you eat during pregnancy! You Can Avoid This. What damage is eating 3 meals a day doing to your childs bowel . or yours too for that matter. 17 foods that bring constipation relief in children of all ages (page 31) Discover the secret to eating that virtually eliminates constipation symptoms for your toddler and older kids. (page 20) The 10 most common foods that can cause constipation in your child. (page 23) What does sugar have to do with the health of your childs bowel? (page 13) Even if your child drinks lots of water they can still become constipated .find out why (page 15) Say Goodbye to Bloating and that Pregnant Belly Look. The 7 top causes for child constipation and how knowing this will help your child live in comfort (page 12) Am I mixing fibre sources together in a way that is leading to my baby's constipation rather than helping to resolve it? What fibre is, what is the best forms, how to utilise them for maximal digestion. Yes it is a science and an art. If your child wets the bed they could be constipated? Discover how constipation can to bedwetting. (page 16) Enjoy Time With Your Happy, Contented Child . Every Day. No More Headaches and other complications caused by Cronic Constipation...[more here]

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ebook Stop Constipation Naturally

You are about to discover: Why a vegan diet was the solution to eliminating 3 decades of chronic constipation. What is constipation? The major causes of constipation in the western world today. Why so many people suffer from chronic constipation. Why constipation is so bad for your long term health. Why a vegan diet can help you stop constipation naturally. What foods vegans eat Where do you get your protein? Vegan vitamins and supplements. The impact of your food choices on the environment. How a vegan diet can help save you, the planet and the animals of the world. A new way of eating that may well help save your life! You will discover that a vegan diet can also help save you from other diseases as well. Why you will so easily lose weight on a whole food, fresh, plant based vegan diet. Why I Experimented with a Vegan Diet (page 13) A Holistic Approach Body, Mind and Spirit (page 15) What is Constipation (page 24) Constipation and The Western Diet (page 30) The Importance of Fibre (page 37) The answers to the most Faqs about a vegan diet. What foods does a Vegan eat? (page 42) Where does a vegan get their Protein? (page 44) Where does a vegan get their Iron? (page 45) Where does a vegan get their Calcium? (page 45) Plus the answers to many more questions. Vegan Vitamins and Supplements (page 49) About Western Disease (page 56)...[more here]

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Discover The 7 Most Common Causes of Constipation That Every Woman Should Know and Avoid. Discover 5 Simply Ways to Eliminate Constipation, Bloating and Indigestion Without Making Any Major Lifestyle Changes. Find out why letting unhealthy gut bacteria share your meals causes flatulence as well as constipation. Find out why letting unhealthy gut bacteria share your meals causes flatulence as well as constipation. Find out why letting unhealthy gut bacteria share your meals causes flatulence as well as constipation. Dr. Mauro reveals in this part a simple change you can make to your diet that may reduce or eliminate pain in your body, decreasing your need to rely on a constipating prescription....[more here]

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Categories of Weight Loss Drugs

1. Affect catecholamines dopamine and norepinephrine. These noradrenergic agents are useful for short term treatment and include the drugs phenteremine, diethylpropion, phendimetrazine and benzphetamine. Stimulants act via catecholamine neurotransmitters, such as amphetamines and phenylpropanolamine. Phenylpropanolamine, which was an over-the-counter medication, was removed secondary to an association with hemorrhagic stroke. Side effects of this class of medications include insomnia, dry mouth, constipation, euphoria, palpitations and hypertension.

Cobalaminfolate relationship

Many symptomless patients are detected through the finding of a raised mean corpuscular volume MCV on a routine blood count. The main clinical features in more severe cases are those of anaemia. Anorexia is usually marked and there may be weight loss, diarrhoea or constipation. Other particular features include

Info Uqn

Patients with GI tract involvement will present with abdominal pain periumbilical or diffuse with lower abdominal cramping, diarrhea with or without blood in the stool, nausea and vomiting, constipation growth delay or hypoalbuminemia Marciano et al. 2004 .

Volvulus 207

A R Adults Long sigmoid colon and mesentery, mobile caecum, chronic constipation and debility, very high residue diet, tumour, adhesions, Chagas' disease of the colon and parasitic infections. Severe colicky abdominal pain and swelling, absolute constipation, and later, vomiting. There may be a history of transient attacks in which spontaneous reduction of the volvulus has occurred. Neonatal volvulus presents at 3months with distress due to pain and bile-stained vomiting.

Anorexia Nervosa and Bulimia

Bulimia is an eating disorder characterized by massive binge eating followed by induced vomiting and the use of laxatives. It is probably a variant of AN. The authors are attracted to the view that bulimia, like AN, is a manifestation, peculiar to the female, of a deranged appetite-satiety mechanism in the hypothalamus. At present, proof of this hypothesis is lacking.

Info Hbp

Cascio S, Flett ME, De la Hunt M, Barrett AM, Jaffray B 2004 MACE or caecostomy button for idiopathic constipation in children a comparison of complications and outcomes. Ped Surg Int 20 484-487 Chait PG, Weinberg J, Connolly B, Pencharez P, Richards H, Clift JE et al 1996 Retrograde percutaneous gastrostomy and gastrojejunostomy in 505 children a four-and-a-half year experience. Radiology 201 691-695 Norman J 2001 Practical pediatric interventional radiology. Curr Probl Diagn Radiol 30 61-86 Ohtsuka Y, Iwasaki K, Okazumi S, Yoshida H, Matsunaga T, Kouchi K et al 2003 Management of blunt hepatic injury in children usefulness of emergency transcatheter arterial embolization. Pediatr Surg Int 19 1-2 29-34 Pereira JK, Chait PG, Miller SF 1996 Deep pelvic abscesses in children transrectal drainage under radiologic guidance. Radiology 198 393-396 Pomier-Layrargues G, Villeneuve JP, Deschenes M, Bui B, Per-reault P, Fenyves D et al 2001 Transjugular intrahepatic portosystemic shunt TIPS...


Thalidomide was marketed in Europe as a sedative, but was withdrawn 30 years ago because it has potent teratogenic effects that cause stunted limb growth dysmelia in humans. In vitro data suggested that thalidomide has antiangiogenic activity induced by basic fibroblast growth factor in a rabbit cornea assay.112 A report on a randomized phase II study of thalidomide in patients with androgen-independent prostate cancer has recently been released. A total of 63 patients were enrolled in the study 50 patients were on the low-dose arm and received a dose of 200mg day, while 13 patients were on the high-dose arm and received an initial dose of 200mg day that escalated to 1200mg day. A serum PSA level decline of greater than or equal to 50 was noted in 18 of patients on the low-dose arm, but in none of the patients on the high-dose arm. Also, a total of 27 of all patients had a decline in PSA of greater than or equal to 40 , often associated with an improvement of clinical symptoms. Only...


Colonic stents may be placed endoscopically or with fluoroscopic guidance alone by the interventional radiologist 64 . Uncovered stents are usually used. Before stent placement, it is helpful to obtain a contrast enema to determine the location, caliber, and length of the obstructing lesion 65 . Water-soluble contrast media is preferable to barium because barium may interfere with visualization during endoscopy, and it is not necessary to demonstrate mucosal detail. After stent placement, plain films and a water-soluble contrast enema may be obtained to confirm stent position and patency. Plain films may serve as a baseline to evaluate for stent migration in the future Fig. 6.37 . Complications include stent malposition, stent migration including spontaneous expulsion of the stent , stent obstruction from tumor ingrowth or fecal impaction , and colonic perforation. Colonic perforation may not require surgery in all cases. Stent obstruction by tumor growth can be avoided by using...

Approach to Travelers Diarrhea

Preventive measures and supportive therapy should be reviewed, as well as the indications for empiric antimicrobial therapy. Antimotility agents such as loperamide and diphenoxylate can improve diarrhea, but should not be used if dysentery or fever is present. Anticholinergic effects may lead paradoxically to abdominal distension, constipation, or paralytic ileus. The older traveler may be wise to begin antimicrobial therapy early in an illness in order to minimize the risk of complications. A fluoroquinolone is the treatment of choice the dose must be reduced if renal failure is present, and caution is


Functional Diarrhoea or constipation. Output from ileostomies can be of large volume liquid resulting in dehydration and electrolyte imbalances can be managed by fluid replacement and bowel antispasmodics . Urinary tract calculi are more common in individuals with an ileostomy hence the importance of hydration.


The EORTC QLQ-C30 is a 30-item instrument designed to capture cancer-specific quality of life across several malignancies, such as prostate, lung, head and neck, breast and ovarian, and to be a readily available tool for clinical trials.26'27 The instrument is copyrighted and according to their website, www.eortc.be home qol, it has been translated and validated into 38 languages and used in more than 1500 studies worldwide. The QLQ-C30 addresses various domains common to cancer treatments. The general scales include physical, role function, emotions, cognitive and social function. In addition, a global health scale, symptom scales fatigue, nausea vomiting, pain , and single items covering dyspnea, insomnia, appetite loss, constipation, diarrhea and financial difficulties.

Info Jjx

Patients normally present in the neonatal period or in infancy and there is a male-to-female ratio of 1 2. The patient may present with constipation, with obstruction if the cyst is of large size, or may present with bleeding if the cyst communicates with the normal gut lumen, and if there is ulceration of gastric mucosa within the duplication cyst. Duplication cysts may be associated with recto-genital or recto-urinary fistula, duplication of the internal or external genitalia, vertebral anomalies and multi-system congenital anomaly complexes. Female patients

Info Vpx

Imaging in Functional Constipation The plain abdominal radiograph is no longer indicated in cases of chronic functional constipation. Barium enema may still be performed to assess the degree of bowel dilatation and the degree of colonic loading. However, a conclusive diagnosis is rarely reached by this method alone. Biopsies are routinely performed to exclude a previously missed diagnosis of Hirschsprung's disease. Pellet studies may be performed for transit times the patient is given a pellet containing tiny radio-opaque markers on each of the 3 days preceding an AXR. The markers in the pellets are different on each day allowing for estimation of transit time. Defecography is performed in some children with chronic constipation and defaecation disorders after the third to fourth year of life. Defecography allows assessment of the degree or relaxation of the internal anal sphincter during retrograde filling and during defaeca-tion. The anorectal angle can be assessed as can the degree...

HistoryTaking and Physical Examination

Nerves. Moreover, ganglioneuromas may be present throughout the gastrointestinal tract and cause symptoms, including constipation and diarrhea, the latter often beginning in infancy.

Antiangiogenesis agents

Thalidomide is a glutamic acid derivative thought to have antiangiogenic activity. A randomized, phase II trial of 63 patients utilized low-dose 200 mg daily and high-dose up to 1200 mg daily thalidomide in AIPC patients.47 Prior cytotoxic treatment was allowed. The high-dose arm was terminated early as none of the 13 patients enrolled had a 50 reduction in PSA. The low-dose arm was then expanded to 50 patients. Nine patients 14 had a 50 decline in PSA. Four patients 6 had a PSA decline of 50 that was sustained for gt 150 days. No complete or partial responses were seen in patients with measurable disease on CT scan or bone scan. A total of 560 adverse events were reported. The most common complaints were fatigue, constipation and peripheral neuropathy. Median survival for all 63 patients is 15.8 months.

Info Rii

Imaging in Constipation In suspected neurogenic causes of constipation Hirschsprung's disease, NID and hypogangliono-sis a contrast enema is often performed. It is not advisable to prepare the bowel before this procedure because the narrow segment may be dilated up and therefore missed.

Info Mbw

Onset of chronic intestinal pseudo-obstruction can be at any age but tends to be more severe with the earlier presentation. In the neonatal period symptoms include failure to pass meconium, abdominal distention or bilious vomiting. Constipation may subsequently develop. In older children presenta

Info Xwd

Functional Constipation Approximately 90 -95 of cases of childhood constipation are likely to represent functional constipation. Rectal distention is present in nearly all cases and failure of the external anal sphincter and or pub-orectalis muscle to relax during defaecation attempts has been found in the majority of these children. Whilst delayed colonic transit time may be part of the problem, pelvic floor dysfunction seems to be the dominating factor Loening-Baucke 1993 .

Anorexia Nervosa

B. Complications of Anorexia Nervosa. All body systems may be affected, depending on the degree of starvation and the type of purging. Leukopenia and anemia, dehydration, metabolic acidosis due to vomiting , or alkalosis due to laxatives , diminished thyroid function, low sex hormone levels, osteoporosis, bradycardia, and encephalopathy are commonly seen.

Info Ede

Constipation Constipation is a common problem in infants and children and accounts for approximately 3 of visits to paediatric outpatients Loening-Baucke 1993 it is also likely that constipation is the most common digestive complaint outnumbering all other chronic gastrointestinal conditions Mezwa et al. 1993 . Constipation is defined clinically as an alteration in the frequency, size, consistency or ease of passage of stools Seth and Heyman 1994 . A common working definition for constipation in children is a stool frequency of less than three per week, but painful bowel movements and or stool retention can be regarded as constipation even if the stool frequency is three or more per week Loening-Baucke 1993 Seth and Heyman 1994 . Encopresis is the voluntary or involuntary passage of a normal bowel movement into the underwear after the age of 4 years, and faecal soiling is defined as the involuntary seepage of faeces which is often associated with faecal impac-tion and is reflected in...

PostOperative Complications

3. Functional complications. The occurrence of faecal incontinence or obstructed defecation can be considered functional complications after this operation. Although some degree of both may be well tolerated by patients, excessive incontinence or constipation may severely affect their quality of life, sometimes dictating a return to an abdominal colostomy. Soiling is a common finding due to the mucosal exposure in the perineum, but true faecal incontinence may result from insufficient increase of neoanal pressure during muscle stimulation. On the contrary, obstructed defecation may be a consequence of neo-anal stricture or rectocele, but most commonly of a combination of factors due to the anatomical and functional changes induced by the surgical procedure in the perineum, including the loss of fine pro-prioceptive and somatic anal sensitivity 31 , the loss of the rectal ampulla and part of the pelvic floor muscles, and the reduced propulsion motility of the transposed colon compared...

Paralytic ileus

IH Failure to open bowels, constipation. Initally, abdominal distension without pain, but later symptoms may mimic those of true obstruction. History relevant to cause, e.g. recent surgery.

Materials and Methods

Some years later. A wide mobilisation of the splenic flexure was necessary to easily transpose the colon stump to the perineal plane this part of the operation obviously being much more difficult in the delayed procedure. In the stoma patient group a pre-operative RX enema was performed to evaluate the colon length. In all patients, after two or three months the sizer placed around the perineal colostomy was removed and easily replaced with the cuff of ABS. Then the other components of ABS were implanted Figs. 1, 2 . A protective loop ileostomy was performed in all the patients to deactivate the device until the complete healing of the surgical wounds. The patients were evaluated with manometry and defecography to assess the effectiveness of the device. Manometry was performed to measure the basal pressure both with the cuff deflated and with the cuff inflated. The grade of continence was measured according to the Wexner score system 22 Wexner score ranges from 0 in case of normal...

Info Qpw

The current suggested diagnostic approach is therefore to consider an AXR, not to make the diagnosis of appendicitis, but to exclude complications such as free intraperitoneal air, or to exclude other confounding diagnoses such as renal colic, small bowel obstruction or constipation. In the presence of a normal AXR or non-specific signs, ultrasound is then advised. If the clinical findings strongly suggest appendicitis ultrasound should be performed as the first investigation. Following the results of the ultrasound, clinical examination and laboratory tests, CT may then be considered depending on the degree of confidence in the diagnosis and the institution.

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Constipation 203 Functional Constipation 203 Neurogenic Constipation 204 Hirschsprung's Disease 204 Chronic Intestinal Pseudo-obstruction 204 Imaging in Constipation 205 Imaging Findings in Hirschsprung's Disease 205 Imaging Findings in NID, Hypoganglionosis, Chronic Intestinal Pseudo-obstruction, Ultra Short Segment Hirschsprung's Disease and Total Colonic Aganglionosis 206 Imaging in Functional Constipation 207

Info Qfa

Fig. 5.27. A boy with cystic fibrosis complicated with distal intestinal obstruction syndrome. Note the dilated intestinal loops and huge fecal impaction in the terminal ileum and caecum Fig. 5.27. A boy with cystic fibrosis complicated with distal intestinal obstruction syndrome. Note the dilated intestinal loops and huge fecal impaction in the terminal ileum and caecum

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A contrast enema with a water-soluble diluted gastrographin 1 3 contrast medium will show fecal impaction in the terminal ileum and proximal colon. This procedure may also have a therapeutic effect Devos and Meradji 2003 .

Info Szp

Bowel obstruction may be present at birth due to meconium ileus. Older children might present with distal intestinal obstruction syndrome DIOS , colonic stricture s and, less commonly, intussusception, fecal impaction of the appendix, gastroesophageal reflux or recurrent rectal prolapse Fig. 5.24 .

Info Ojr

Patient complaints include loss of appetite, vomiting, abdominal pain, obstipation, GI bleeding or a palpable mass in the right lower quadrant.

Info Sel

Plain film shows most frequently a dilated small bowel with only a few or even no fluid levels and an absence of air in the rectum. Because of air-trapping in stools, a mottled appearance can be seen in the right side of the abdomen Fig. 5.13a,b . US will show dilated small bowel loops ileum fully filled with huge hypoechogenic masses Fig. 5.13c . A contrast enema with nonionic media shows fecal impaction in upper colonic segment or higher ileum. This pro- Fig. 5.13. a A premature infant with intestinal dysfunction, so-called meconium ileus-like syndrome. The supine abdominal film shows dilated intestinal loops because of fecal impaction in ileum. b Cross-table radiograph. Meconium-like ileus with dilated intestinal loops without fluid levels. The whole colonic tract and rectum are airless. c Ultrasound of the right lower quadrant of abdomen demonstrates the impacted and inspissated stool in the ileum Fig. 5.13. a A premature infant with intestinal dysfunction, so-called meconium...

Clinical presentation Hkj

Mild hypercalcaemia 2.75-3.2 mmol L is usually asymptomatic. Moderate to severe hypercalcaemia gt 3.2 mmol L anorexia, gastro-oesophageal reflux, vomiting, constipation rarely diarrhoea . Other symptoms and signs

Example of metabolic reaction

Normal subjects have rapid diffuse spread of water soluble radioisotopes through the colon, with the majority of activity being lost to faeces after 24 h112. In patients with intractable constipation, some will show normal transit, but in those with colonic inertia the major site of isotope hold-up is the transverse colon and splenic flexure. Other constipated patients show delay of label at a later stage and accumulation of activity in the descending and rectosigmoid colon. Diarrhoea causes changes in the electrolyte and water content of the colonic lumen which therefore alters luminal pH, resulting in changes in the rate of absorption of drugs from the lumen. As a result the effectiveness of colonic delivery may be unpredictable in patients with constipation or diarrhoea. The increased rate of transit would also be responsible for the premature voiding of sustained release formulations, and would also be expected to alter the sieving function of the colon. Diarrhoeal diseases are...


Diagnosis of endometriosis is often problematic. Although patients classically present with pelvic pain, dysmenorrhea, dyspareunia, pelvic mass and infertility, there are also many patients who are asymptomatic. It has been found that 25 of all women who experience pelvic pain and 40-50 of infertile women have endometriosis. Most symptoms that women experience are a result of local infiltration of endometriosis into the pelvis pelvic pain, dyschezia painful defecation , abdominal bloating, dyspareunia, back pain, dysuria and suprapubic pain. Menstruation can greatly accentuate these symptoms.

Electrical activity

Spike potentials may be superimposed on the slow waves or may exist as bursts unrelated to slow wave activity, and are thought to initiate functional colonic contractions. Spike bursts of long duration gt 10s increase after eating and may increase luminal transit. Short duration spike bursts lt 3.5s are seen in patients with constipation and are not associated with movement of the intestinal contents. Such contractions only occur when the membrane potential rises above a prevailing threshold level which is set by both neural and humoral mechanisms.

Inguinal hernia 113

A R Male, prematurity, age, obesity, raised intra-abdominal pressure, e.g. chronic cough, constipation, bladder outflow obstruction, intraperitoneal fluid, e.g. ascites.

Clinical Disease

Non-specific symptoms, such as abdominal pain and malaise, are common. Intermittent diarrhea is the most common symptom of intestinal involvement and may alternate with constipation. The stool may occasionally contain blood and mucus. Frank schistosomal dysentery is uncommon Cheever, 1978 . A severe form of intestinal involvement is colonic polyposis El Masry et al., 1986 . This condition generally effects young males and, in addition to bloody diarrhea, protein-losing enteropathy, hypo-kalemia and severe dehydration are often found. On sigmoidoscopy and biopsy, intense granulomatous inflammation with parasite ova is found. Occasionally, inflammatory masses are observed along the colon and need to be differentiated from malignant lesions Mohamed et al., 1990 . Intestinal schistosomiasis is most commonly confused clinically with ulcerative colitis or Crohn's disease and occasional abdominal tuberculosis. The condition responds well to effective antiparasitic treatment.


Repeated treatments are usually necessary except in light infection. In the past, laxatives were routinely given before and after treatment they are now considered unnecessary except in the presence of constipation.

Hirschsprungs disease 109

Older children present with failure to thrive, chronic constipation, abdominal distension. Constipation, bowel obstruction, enterocolitis, caecal perforation. Of surgery anastomotic leak with perirectal or pelvic abscess.

Conclusion Hhh

Efforts should be made to reduce at least some of the radiation sources to the gonads. These include generous hydration 2-3 liters per day with frequent micturition and avoidance of constipation using regular laxatives prior and during iodine administration. As with any form of radiotherapy, careful appraisal of the risks and benefits of radioiodine treatment is mandatory, especially when advising repeated doses to young patients 23 . Since there is evidence of cumulative gonadal damage with repeated iodine administration, it is recommended that the total cumulative iodine activity should be kept as low as possible 24 . In vivo dosimetry, which measures the actual absorbed dose received by remnant thyroid tissue, functioning metastatic disease, and normal organs with a view to optimizing the administered iodine dose, may help in achieving this goal 25 .

TlD There is a wide variety of hernias of the abdomen other than inguinal and

Obstruction Constipation, colicky abdominal pain, nausea, vomiting. Richter hernias have symptoms of obstruction but still pass flatus as the bowel lumen is still patent.

Complications of Radioiodine Treatment

The radiation dose delivered by 131I to each organ is difficult to estimate from established mathematical models uptake by metastases may modify the dose delivered to a given organ and the hypothyroid status at the time of iodine administration decreases renal clearance of 131I, thereby increasing the body retention of iodine by a factor of 2-4. Liberal fluid intake, frequent micturition, and use of laxatives will promote iodine excretion and reduce radiation exposure.


Patients with Chagas' disease and early colonic dysfunction can be managed with high-fiber diets and occasional laxatives and enemas. Fecal impaction necessitating manual disimpaction can occur, as can toxic megacolon, which requires surgical treatment Kobayasi et al., 1992 . Volvulus is another complication of megacolon that requires surgical intervention. Initially, endoscopic emptying can be done in patients without clinical, radiographic, or endo-scopic signs of ischemia in the affected portion of the colon. More complicated cases require surgical decompression. In either event, surgery is eventually required because recurrence of the volvulus is highly likely. Several surgical procedures have been used to treat severe chagasic megacolon, all of which include removal of part of the rectum and resection of the sigmoid colon.

Haemorrhoids continued 101

Flow pain and shorter convalescence in randomised control trials . Post-op, lactulose should be prescribed to avoid constipation.

IH Commonly asymptomatic

M Conservative Advice on a high-fibre diet, fluid intake, exercise, bulk laxatives. Topical creams are available that contain mild astringents combined with local anaesthetic those with corticosteroids should only be used on a short-term basis. Local therapy for 1st or 2nd degree

Preimplantation Genetic Diagnosis For Single Gene Disorders Gwn

The father was also born with an anal stricture see Figure 3.34, III 3 requiring anal dilatation, and also had sacral defect detected by x-ray, involving a central anomaly from S2 downward. One of his two sisters see Figure 3.34, III 1 was born with imperforate anus and anterior meningocoele and also had rectovaginal fistula, and a vesicoureteric reflux resulted in the need for renal transplantation a sacral x-ray showed the same central defect with absence of the distal one third of the sacrum. The other sister see Figure 3.34, III2 was clinically asymptomatic, but sacral x-ray revealed no coccyx and a MRI scan disclosed an anterior meningocoele. His mother had undeveloped coccyx and urinary tract bilateral ureteropelvic junction obstruction see Figure 3.34, II 4 . Of her three siblings, only one of two brothers had anal stricture see Figure 3.34, II 1 , while the asymptomatic sister see Figure 3.34, II2 was identified as a carrier of the mutation because of the finding of...

Clinical features Cio

Which may last from hours to several days, may be associated with either diarrhoea or constipation, and perhaps with more intense haemoglobinuria. Recurrent dysphagia and erectile dysfunction may also occur.

JShaped Colonic Pouch

In 1986 a colonic J-pouch was described by Parc et al. 29 and by Lazorthes et al. 30 , independently, to replace the excised rectal reservoir. The procedure comprises of identification of limbs with closed distal colon and seromuscular apposition. Long coloto-my, closure of posterior and anterior wall may be performed using either conventional continuous suturing or a GIA stapling device with the final attachment colonic pouch to the anus with circular stapler. Ideal pouch dimensions are 6-7 cm of bowel circumference and with limb lengths about 5 cm. Most surgeons are of the crucial step of the procedure is mobilization of the splenic flexure of the colon and preserving the first branch of the inferior mesenteric artery to enable blood perfusion through the pouch 28 . Patients with colonic J-pouch may experience varying degrees of incomplete defecation requiring provoked evacuation with laxatives or daily enema use, unless J-pouch limbs are limited to a 5 cm size 31 .

Attention to Quality of Life

The physician in charge of the continuity in care of the thyroid cancer patient likely the endocri-nologist is instrumental in promoting compliance with the long-term follow-up and the required repeat investigations. Compliance can be enhanced by giving attention to many details which - although not determining the main outcome of the disease - may severely affect the patient's life. The cost of care should not be forgotten, as patients may have no or insufficient insurance 44 . The incidence of chronic xerostomia as a result of 131I-induced sialadenitis may decrease considerably with amifostine pretreat-ment 45 . During thyroid hormone withdrawal, hypothyroid symptoms are common such as fatigue, weight gain, peripheral edema, muscle cramps, skin dryness, anxiety, constipation, cold, depression, and impairment of memory and concentration these complaints are more pronounced in the elderly than in younger patients 45 . It is thus not surprising that quality-of-life questionnaires...

Femoral hernia 69

A R Females have a wider angle between the inguinal ligament and pectineal part of the pubic bone and a wider femoral canal , pregnancy, raised intraabdominal pressure heavy lifting, cough or straining due to constipation or prostatism . H As femoral hernias are often small, they often go unnoticed until they become strangulated or obstructed, presenting as a surgical emergency up to 80 with symptoms of pain, abdominal distention, nausea, vomiting, absolute constipation. Also presents with lower abdominal discomfort, or lump or bulge in the groin region.

Bulimia Nervosa

Persons who have bulimia nervosa are similar in behavior to the subset of anorexics who binge and purge, but they tend to maintain their weight at or near normal for their age and height. They intermittently have an overwhelming urge to eat, usually associated with a period of anxiety or depression, and can consume as many as 15,000 calories in a relatively short period of time, typically one to two hours. Binge foods are usually high calorie and easy to digest, such as ice cream. The binge eating provides a sense ofnumb-ing of the anxiety or relief from the depression. Failing to recognize that they are full, bulimics eventually stop eating because of abdominal pain, nausea, being interrupted, or some other non-hunger-related reason. At that point, psychological stress again increases as they reflect on the amount they have eaten. Most bulimics then induce vomiting, but some use laxatives, diuretics, severe food restriction, fasting, or excessive exercise to avoid gaining weight....

Associated Medical Problems

Women with anorexia nervosa stop menstruating. Anorexics may also have abdominal pain, constipation, and increased urination. The heart rate may be slow or irregular. Many develop downy, dark body hair lanugo over normally hairless areas. They may have bloating after eating and swelling of the Self-induced vomiting can lead to erosion of tooth enamel, gum abscesses, and swelling of the parotid glands in front of the ear and over the angle of the jaw. About one-third of women with bulimia have abnormal changes in their menstrual cycles. Some bulimics consume so much food in such a short period of time that their stomachs rupture. More than 75 percent of these individuals die. Use of ipecac and laxatives can lead to heart damage. Symptoms include chest pain, skipped heartbeats, and fainting, and these heart problems can lead to death. In addition, bulimics are at increased risk for ulcers of the stomach and small intestine and for inflammation of the pancreas.

Assessing Evidence about Contraception

Precautions organ prolapse chronic vaginitis, constipation. precautions organ prolapse chronic vaginitis, constipation.


Eating disorders are best thought of as problems involving body weight and distorted body image on a continuum of severity. The most serious is anorexia nervosa, a disorder characterized by weight loss greater than or equal to 15 percent of the body weight normal for the person's height and age. Bulimia nervosa is usually found in persons of normal weight and is characterized by consumption of large amounts of food followed by self-induced vomiting, purging with diuretics or laxatives, or excessive exercise. Binge-eating disorder, found usually in persons with some degree of overweight, is characterized by the consumption of large amounts of food without associated vomiting or purging. Other, milder, forms of eating disorders are at the least serious end of the continuum. Obesity may or may not be part of this continuum, depending on the presence or absence of underlying psychological problems. About one-third of obese persons have binge-eating disorder.

Flexible sigmoidoscopy and colonoscopy Diverticulae can be seen and

Chronic High-fibre diet with bulking agent e.g. methylcellulose . Laxatives may be required if constipation is severe. Encourage high fluid intake. Surgery May be necessary with recurrent attacks or when complications develop, e.g. severe bleeding or infection. Sigmoid colectomy, Hartmann's procedure, fistulectomy or drainage of pericolic abscesses are some operations performed.

Diverticular disease 63

Alternating constipation pellet faeces and diarrhoea. GI bleed PR bleeding may be acute or chronic. Diverticulitis Pyrexia and LIF or suprapubic abdominal pain. Features of complications For example, pneumaturia, faecaluria and recurrent UTI may be due to a vesico-colic fistula.

Answer Nvg

Hirschsprung's disease is caused by failure of development of ganglion cells. The disease starts at the anus and a variable amount of bowel is affected proximally. Presentation can be with neonatal bowel obstruction or constipation in later life. The aganglionic segment does not transmit peristalsis so the proximal bowel dilates and the affected segment appears normal or small calibre. In the case example, there is a transition zone with dilated proximal bowel and a normal small calibre aganglionic bowel segment. A well-recognised complication present in the example above is necrotising enterocolitis.

Bowel Dysfunction

These adverse effects after rectal cancer surgery on bowel function are related to sphincter or innervation damage 48 and the loss of rectal reservoir. The type of resection and the level of anastomosis may also play a role 49, 50 . Frequency of bowel motion, urgency, faecal leakage and incontinence are the most reported symptoms. Diarrhoea, constipation and flatus 51, 52 are also reported. Usually, these problems improve over time 53 , but, especially in older patients, it can take a long time 54 . The incidence of diarrhoea in patients with or without a stoma seems to be equal 55 , while constipation is a more common problem in patients undergoing APE 45 .

BDD and other body image pathologies

Patients with eating disorders such as anorexia nervosa and bulimia nervosa often present with excessive concerns about their cutaneous body image in addition to concerns about their weight and shape Gupta amp Gupta, 2001a . The eating disorders can be associated with a wide range of dermatological Gupta et al., 1987 Gupta amp Gupta, 2000 complications related to starvation, bingeing and purging, abuse of laxatives and other related symptoms American Psychiatric Association, 1994 . Acne has a peak incidence during mid-adolescence, a life stage that is associated with a high incidence of eating disorders. In some vulnerable adolescents even mild acne may exacerbate or precipitate an eating disorder such as bulimia nervosa Gupta et al., 1987 Gupta amp Gupta, 2000 . The endocrine changes associated with binge eating may cause a flare-up of acne Gupta et al., 1992 , which is frequently observed in patients with eating disorders Gupta amp Gupta, 2000 . In these patients the disfigurement...

Diagnostic Frameworks for General Practice

Some causes of a condition are commonly misdiagnosed, and should be considered. An example is constipation as a cause of a child's abdominal pain. There are also symptom complexes that present in a variety of nonspecific ways that can be missed if not considered. These are the masqueraders. An example is hypothy-roidism, which can present as depression, dementia, weight gain, tiredness, hoarse voice, or even cardiac failure.

Constipation Adynamic Ileus

Constipation nejm 2003 349 1360 bulk laxatives psyllium, methylcellulose. polycarbophil t colonic residue, t peristalsis osmotic laxatives Mg, sodium phosphate, lactulose, etc. draw water into intestines stimulant laxatives senna, castor oil. bisacodyl. docusate sodium motility amp secretion rectal enema suppository phosphate, mineral oil, tap-water, soapsuds, bisacodyl tegaserod motility, but recently withdrawn from market b c CV toxicity lubiprostone secretion useful for severe constipation

Psychological Aspects of Thyroid Cancer

Other diagnostic group. Thyroid cancer patients who had been treated with radiation were almost twice as likely to report an overall effect on their health as those who had not received radiation. Almost a quarter of the sample described symptoms that could be associated with thyroid dysregulation, for example dry skin hair loss poor concentration sleep disturbance fatigue weight change palpitations heat cold intolerance diarrhea constipation depression anxiety. Thyroid cancer survivors reported psychological problems, memory loss, and migraine headaches more frequently than survivors of other types of cancer. The authors conclude that the morbidity associated with a diagnosis of thyroid cancer is significantly more pronounced than generally understood 13 .

Preservation of Continence

Although avoiding a permanent stoma is often taken sine qua non for a good outcome after rectal cancer surgery, functional success must be considered separately. Functional disturbances after low anterior resection LAR like frequency of bowel action, diarrhoea, faecal incontinence and even constipation have been reported 19, 20 . Low colorectal or colo-anal anastomoses especially are associated with worse functional results than a high anterior resection 21 . Thus it is important to evaluate the sphincter function to avoid permanent faecal incontinence, as a sphincter-sparing operation in a patient with poor sphincter function does not make sense 22 .

Gynecological Causes of Acute Abdominal Pain

In adnexal torsion, the ovary twists with the vascular pedicle. Torsion leads initially to compromise of lymphatic and venous drainage, followed later by arterial occlusion and thrombosis and eventual hemorrhagic infarction of the involved organs. It is most common in prepubertal girls, due to increased adnexal mobility prior to menarche. Right-sided torsion is more common as the sigmoid colon prevents excessive movements of the left ovary and fallopian tube. Adnexal torsion is a true surgical emergency which clinically may mimic acute appendicitis, gastroenteritis, or intussusception. The pain may be intermittent and localized to one or other lower quadrant, or it may be severe, acute, and generalized. Associated nausea, vomiting, or constipation may occur. A palpable abdominal mass and a paralytic ileus may also be present. US is the most important imaging modality for the diagnosis of adnexal torsion. The US findings are variable. Typically, the ovary involved appears noticeably...

Causes of iron deficiency Table 34

Drug of first choice 200 mg of ferrous sulphate contains 67 mg of iron. Where smaller doses are required, 300 mg of ferrous gluconate provides 36 mg of iron. It is usual to give 100-200 mg of elemental iron each day to adults and about 3 mg kg per day as a liquid iron preparation to infants and children. The side-effects of oral iron, such as nausea, epigastric pain, diarrhoea and constipation, are related to the amount of available iron they contain. If iron causes gastrointestinal symptoms, these can usually be ameliorated by reducing the dose, or taking the iron with food, but this also reduces the amount absorbed. Enteric-coated and sustained-release preparations should not be used, as much of the iron is carried past the duodenum to sites of poor absorption. Iron reduces absorption of tetracyclines and vice versa and of ciprofloxacin.

European Organization for Research and Treatment of Cancer EORTC QLQC30

The EORTC QLQ-C30 is a cancer-specific 30-item questionnaire Aaronson et al., 1993 see Appendix E6. The QLQ-C30 questionnaire was designed to be multidimensional in structure, appropriate for self-administration and hence brief and easy to complete, applicable across a range of cultural settings, and suitable for use in clinical trials of cancer therapy. It incorporates five functional scales physical, role, cognitive, emotional, and social , three symptom scales fatigue, pain, and nausea and vomiting , a global health-status QoL scale, and a number of single items assessing additional symptoms commonly reported by cancer patients dyspnoea, loss of appetite, insomnia, constipation, and diarrhoea and perceived financial impact of the disease.

Anal fissure 11

A R Constipation. H Severe acute pain at the anus on defecation that may last from a few minutes to hours, often with a small amount of bleeding seen as bright red blood streaked on the toilet paper, not mixed with stool . There is subsequent fear of defecation and constipation. Medical Chemical sphincterotomy by the topical application of 0.2 glyceryl trinitrate ointment. This releases local nitric oxide that mediates smooth muscle relaxation, reducing spasm and allowing healing major side-effect is headache . Other agents that have been shown to be effective are topical calcium channel blocker, diltiazem and injections of botulinum toxin. Pain relief is given in the form of local anaesthetic gel 1 lignocaine applied before defecation. Laxatives may be necessary stool softeners or bulk laxatives to relieve straining. General advice on the avoidance of constipation should be given e.g. a high-fibre diet, water intake and appropriate exercise .

Gastrointestinal Emergencies in the Infant and Young Child

Acute abdominal pain is a common complaint in the pediatric age group. A total of 10 of school-age children have recurrent abdominal pain and in only 10 of these children can etiology be detected. The majority of these children have self-limited disease. The most common associated conditions include upper respiratory tract infection, pharyngitis, viral syndrome, gastroenteritis, and constipation Henderson et al. 1992 . Therefore, it is uncommon for the underlying condition in these children to require surgical intervention. The most frequent surgically treated causes of acute abdomen are appendicitis, intussusception, adhesions causing bowel obstruction, incarcerated hernia, midgut volvulus and complicated Meckel's diverticulum. Non-surgically treated conditions frequently have a digestive origin including gastroenteritis, severe constipation, mesenteric lymphadenitis, ileocecitis, Schonlein-Henoch purpura, inflammatory bowel disease, or paralytic ileus.

Schizoaffective Disorder Admitting Orders

Zolpidem Ambien 10 mg po qhs prn insomnia. Tylenol 650 mg po q 4 hours prn pain or fever. Milk of magnesia 30 cc po q 12 hours prn constipation. Mylanta 30 cc po q 4 hours prn dyspepsia.

Info Jon

A positive family history is encountered in about 10 of patients with short segment disease and in 25 of patients with total colonic aganglionosis. Hirschsprung's disease is associated with esopha-geal dysmotility syndromes, malrotation and ileal or colonic atresia. Approximately 3 of patients with Down's syndrome have Hirschsprung's disease. The disease has also been associated with other neuro-cristopathies neuroblastoma, pheochromocytoma, MEN IIA syndrome and is thought to be related to their common neuroblastic origin Rescorla et al. 1992 . The severity of the symptoms does not depend entirely on the length of the aganglionic segment. Abdominal distension, failure to pass meconium in the first 24 h of life, constipation, and bilious vomiting are the predominant symptoms, with the signs of obstruction appearing within a few days after birth.

Opiate Dependence Admitting Orders

Zolpidem Ambien 10 mg po qhs prn insomnia. Milk of magnesia 30 cc po q 12 hours prn constipation. Mylanta 30 cc po q 4 hours prn dyspepsia.

Major Depression Admitting Orders

Trazodone Desyrel 100 mg po qhs prn insomnia. Tylenol 650 mg po q 4 hours prn pain or fever. Milk of magnesia 30 cc po q 12 hours prn constipation. Mylanta 30 cc po q 4 hours prn dyspepsia.