CHAPTER 040 DIARRHEA AND CONSTIPATION PART 16

Chapter 040. Diarrhea and Constipation (Part 16) ANORECTAL AND PELVIC FLOOR TESTS Pelvic floor dysfunction is suggested by the inability to evacuate the rectum, a feeling of persistent rectal fullness, rectal pain, the need to extract stool from the rectum digitally, application of p[r]

Chapter 040. Diarrhea and Constipation (Part 1) Harrison's Internal Medicine > Chapter 40. Diarrhea and Constipation DIARRHEA AND CONSTIPATION: INTRODUCTION Diarrhea and constipation are exceedingly common and together exact an enormous toll in terms of mortality, morbidity, social in[r]

Chapter 040. Diarrhea and Constipation (Part 4) Acute Diarrhea More than 90% of cases of acute diarrhea are caused by infectious agents; these cases are often accompanied by vomiting, fever, and abdominal pain. The remaining 10% or so are caused by medications, toxic ingestions, ischemia, an[r]

Chapter 040. Diarrhea and Constipation (Part 17) Constipation: Treatment After the cause of constipation is characterized, a treatment decision can be made. Slow-transit constipation requires aggressive medical or surgical treatment; anismus or pelvic floor dysfunction usually responds to bi[r]

Chapter 040. Diarrhea and Constipation (Part 13) CONSTIPATION Definition Constipation is a common complaint in clinical practice and usually refers to persistent, difficult, infrequent, or seemingly incomplete defecation. Because of the wide range of normal bowel habits, constipation is diff[r]

Chapter 040. Diarrhea and Constipation (Part 12) A therapeutic trial is often appropriate, definitive, and highly cost effective when a specific diagnosis is suggested on the initial physician encounter. For example, chronic watery diarrhea, which ceases with fasting in an otherwise healthy[r]

Chapter 040. Diarrhea and Constipation (Part 11) FACTITIAL CAUSES Factitial diarrhea accounts for up to 15% of unexplained diarrheas referred to tertiary care centers. Either as a form of Munchausen syndrome (deception or self-injury for secondary gain) or eating disorders, some patients cov[r]

Chapter 040. Diarrhea and Constipation (Part 10) Postmucosal Lymphatic Obstruction The pathophysiology of this condition, which is due to the rare congenital intestinal lymphangiectasia or to acquired lymphatic obstruction secondary to trauma, tumor, or infection, leads to the unique constel[r]

Chapter 040. Diarrhea and Constipation (Part 9) OSMOTIC CAUSES Osmotic diarrhea occurs when ingested, poorly absorbable, osmotically active solutes draw enough fluid into the lumen to exceed the reabsorptive capacity of the colon. Fecal water output increases in proportion to such a solute l[r]

Chapter 040. Diarrhea and Constipation (Part 8) SECRETORY CAUSES Secretory diarrheas are due to derangements in fluid and electrolyte transport across the enterocolonic mucosa. They are characterized clinically by watery, large-volume fecal outputs that are typically painless and persist wit[r]

Chapter 040. Diarrhea and Constipation (Part 6) OTHER CAUSES Side effects from medications are probably the most common noninfectious cause of acute diarrhea, and etiology may be suggested by a temporal association between use and symptom onset. Although innumerable medications may produce d[r]

Chapter 040. Diarrhea and Constipation (Part 15) Approach to the Patient: Constipation A careful history should explore the patient's symptoms and confirm whether he or she is indeed constipated based on frequency (e.g., fewer than three bowel movements per week), consistency (lumpy/hard), e[r]

Chapter 040. Diarrhea and Constipation (Part 2) Neural Control The small intestine and colon have intrinsic and extrinsic innervation. The intrinsic innervation, also called the enteric nervous system, comprises myenteric, submucosal, and mucosal neuronal layers. The function of these layers[r]

Chapter 040. Diarrhea and Constipation (Part 5) Table 40-2 Association between Pathobiology of Causative Agents and Clinical Features in Acute Infectious Diarrhea Pathobiology/Agents Incubation Period Vomiting Abdominal Pain Fever Diarrhea Toxin producers Preformed toxin Bacillus cereus,[r]

Chapter 040. Diarrhea and Constipation (Part 3) Colonic Motility and Tone The small intestinal MMC only rarely continues into the colon. However, short duration or phasic contractions mix colonic contents, and high-amplitude (>75 mmHg) propagated contractions (HAPCs) are sometimes ass[r]

Chapter 040. Diarrhea and Constipation (Part 7) ACUTE DIARRHEA: TREATMENT Fluid and electrolyte replacement are of central importance to all forms of acute diarrhea. Fluid replacement alone may suffice for mild cases. Oral sugar-electrolyte solutions (sport drinks or designed formulations) s[r]

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