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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.

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.

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 .

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.

Diverticular disease

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.

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.

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...

Shaped 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 .

Preimplantation Genetic Diagnosis For Single Gene Disorders

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...

Hirschsprungs disease 109

Older children present with failure to thrive, chronic constipation, abdominal distension. Abdominal distension with tinkling bowel sounds if obstruction. PR examination may reveal a tight anal sphincter and hard stools in the rectum, and in the infant may result in sudden passage of stool and flatus, decompressing the abdomen. Constipation, bowel obstruction, enterocolitis, caecal perforation. Of surgery anastomotic leak with perirectal or pelvic abscess.

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...

Post Operative 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...

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 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.

Cobalaminfolate relationship

Intracellular Metabolism

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

Categories of Weight Loss Drugs

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.

Gynecological Causes of Acute Abdominal Pain

Adnexal Mass

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...

Materials and Methods

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...

Complications of Radioiodine Treatment

Order Thyroid Cancer Severity

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.

Psychological Aspects of Thyroid Cancer

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 .

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

Causes of iron deficiency Table

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.

Flexible sigmoidoscopy and colonoscopy Diverticulae can be seen and

Cystoscopy Angiodysplasia

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.

IH Commonly asymptomatic

_P Excessive straining causes engorgement of the cushions, together with shearing by hard stools resulting in disruption of tissue organisation, hypertrophy and fragmentation of muscle and elastin fibres and downward displacement of the anal cushions as well as raised resting anal pressures and bleeding from presinusoidal arterioles. Classified as internal or external. Internal haemorrhoids arise from the superior haemorrhoidal plexus and lie above the dentate line while external haemorrhoids occur below the dentate line, arising from the inferior haemorrhoidal plexus. A combination of types can coexist. Also classified by degree of prolapse 1st degree Haemorrhoids that do not prolapse. 2nd degree Prolapse with defecation, but reduce spontaneously. 3rd degree Prolapse and require manual reduction. 4th degree Prolapse and cannot be reduced. M Conservative Advice on a high-fibre diet, fluid intake, exercise, bulk laxatives. Topical creams are available that contain mild astringents...

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 & Gupta, 2001a). The eating disorders can be associated with a wide range of dermatological (Gupta et al., 1987 Gupta & 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 & 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 & Gupta, 2000). In these patients the disfigurement...

Thyroid Disease Conclusion

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 .

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 .

Anorexia Nervosa

The two basic types of anorexia nervosa are the restricting type and the binge-eating purging type. The restricting type is characterized by an extremely limited diet, often without carbohydrates or fats. This may be accompanied by excessive exercising or hyperactivity. Up to half of anorexics eventually lose control over their severely restricted dieting and begin to engage in binge eating. They then induce vomiting, use diuretics or laxatives, or exercise excessively to control their weight. People who are in the binge-eating purging group are at greater risk for medical complications.

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....

Hospital Routine

On postoperative day one, pain is controlled with an epidural, and sips of liquid are begun, and hemoglobin and creatinine are checked. On postoperative day 2, the epidural is removed, and oral analgesic begun, and the diet is advanced as tolerated Catheter teaching is begun and one drain is removed in the afternoon after ambulation, if the output remains low. On postoperative day 3, the second drain is removed, and the patient is discharged on oral pain medications, a stool softener and macrodantin 50 mg per day for suppression of bacturia, while the catheter is in place.

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 ( 10s) increase after eating and may increase luminal transit. Short duration spike bursts (


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.


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...


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...

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.

Abnormal Bowel Loop

Gaseous Distension

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.

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.

Femoral hernia

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.

Anal fissure

A Commonly caused by passage of a large hard stool, resulting in pain and sphincter spasm that interferes with local blood supply and hence, healing. A self-perpetuating cycle of pain, spasm and re-injury results. 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...


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.


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.

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