Gas, Belching and Bloating
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General Signs and Symptoms of Abdominal Diseases
General signs and symptoms of abdominal diseases Dr. Förhécz Zsolt Semmelweis University 3rd Department of Internal Medicine Faculty of Medicine, 3rd Year 2018/2019 1st Semester • For descriptive purposes, the abdomen is divided by imaginary lines crossing at the umbilicus, forming the right upper, right lower, left upper, and left lower quadrants. • Another system divides the abdomen into nine sections. Terms for three of them are commonly used: epigastric, umbilical, and hypogastric, or suprapubic Common or Concerning Symptoms • Indigestion or anorexia • Nausea, vomiting, or hematemesis • Abdominal pain • Dysphagia and/or odynophagia • Change in bowel function • Constipation or diarrhea • Jaundice “How is your appetite?” • Anorexia, nausea, vomiting in many gastrointestinal disorders; and – also in pregnancy, – diabetic ketoacidosis, – adrenal insufficiency, – hypercalcemia, – uremia, – liver disease, – emotional states, – adverse drug reactions – Induced but without nausea in anorexia/ bulimia. • Anorexia is a loss or lack of appetite. • Some patients may not actually vomit but raise esophageal or gastric contents in the absence of nausea or retching, called regurgitation. – in esophageal narrowing from stricture or cancer; also with incompetent gastroesophageal sphincter • Ask about any vomitus or regurgitated material and inspect it yourself if possible!!!! – What color is it? – What does the vomitus smell like? – How much has there been? – Ask specifically if it contains any blood and try to determine how much? • Fecal odor – in small bowel obstruction – or gastrocolic fistula • Gastric juice is clear or mucoid. Small amounts of yellowish or greenish bile are common and have no special significance. • Brownish or blackish vomitus with a “coffee- grounds” appearance suggests blood altered by gastric acid. -
THE SKY IS the LIMIT for WIND POWER Wind Energy Is One of the Best Sources of Alternative Energy
Mechanical Contractors July— Sept 2018 THE SKY IS THE LIMIT FOR WIND POWER Wind energy is one of the best sources of alternative energy. Wind refers to the movement of air from high pressure areas to low pressure areas. Wind is caused by uneven heating of the earth’s surface by the sun. Hot air rises up and cool air flows in to take its place. Winds will always exist as long as solar energy exists and peo- ple will be able to harness the energy forever. Windmills have been in use since 2000 B.C. and were first developed in Persia and China. Ancient mariners sailed to distant lands by making use of winds. Farmers used wind power to pump water and for grinding grains. Today the most popular use of wind energy is converting it to electrical energy to meet the critical energy needs of the planet. It is a renewable source of energy and does not produce any pollutants or emissions during opera- tion that could harm the environment. Wind power is one of the cleanest and safest method of generating renewable electricity. Wind farms can be created to trap wind energy by placing multiple wind turbines in the same location for the purpose of generating large amounts of electric power. Wind energy is mostly harnessed by wind turbines which are as high as 20 story buildings and usually have three blades which are 60 meters long. They resemble giant airplane propellers mounted on a stick. The blades are spun by the wind which transfers motion to a shaft connected to a generator which produces electricity. -
Pancreatic Cancer
A Patient’s Guide to Pancreatic Cancer COMPREHENSIVE CANCER CENTER Staff of the Comprehensive Cancer Center’s Multidisciplinary Pancreatic Cancer Program provided information for this handbook GI Oncology Program, Patient Education Program, Gastrointestinal Surgery Department, Medical Oncology, Radiation Oncology and Surgical Oncology Digestive System Anatomy Esophagus Liver Stomach Gallbladder Duodenum Colon Pancreas (behind the stomach) Anatomy of the Pancreas Celiac Plexus Pancreatic Duct Common Bile Duct Sphincter of Oddi Head Body Tail Pancreas ii A Patient’s Guide to Pancreatic Cancer ©2012 University of Michigan Comprehensive Cancer Center Table of Contents I. Overview of pancreatic cancer A. Where is the pancreas located?. 1 B. What does the pancreas do? . 2 C. What is cancer and how does it affect the pancreas? .....................2 D. How common is pancreatic cancer and who is at risk?. .3 E. Is pancreatic cancer hereditary? .....................................3 F. What are the symptoms of pancreatic cancer? ..........................4 G. How is pancreatic cancer diagnosed?. 7 H. What are the types of cancer found in the pancreas? .....................9 II. Treatment A. Treatment of Pancreatic Cancer. 11 1. What are the treatment options?. 11 2. How does a patient decide on treatment? ..........................12 3. What factors affect prognosis and recovery?. .12 D. Surgery. 13 1. When is surgery a treatment?. 13 2. What other procedures are done?. .16 E. Radiation therapy . 19 1. What is radiation therapy? ......................................19 2. When is radiation therapy given?. 19 3. What happens at my first appointment? . 20 F. Chemotherapy ..................................................21 1. What is chemotherapy? ........................................21 2. How does chemotherapy work? ..................................21 3. When is chemotherapy given? ...................................21 G. -
Diagnostic Approach to Chronic Constipation in Adults NAMIRAH JAMSHED, MD; ZONE-EN LEE, MD; and KEVIN W
Diagnostic Approach to Chronic Constipation in Adults NAMIRAH JAMSHED, MD; ZONE-EN LEE, MD; and KEVIN W. OLDEN, MD Washington Hospital Center, Washington, District of Columbia Constipation is traditionally defined as three or fewer bowel movements per week. Risk factors for constipation include female sex, older age, inactivity, low caloric intake, low-fiber diet, low income, low educational level, and taking a large number of medications. Chronic constipa- tion is classified as functional (primary) or secondary. Functional constipation can be divided into normal transit, slow transit, or outlet constipation. Possible causes of secondary chronic constipation include medication use, as well as medical conditions, such as hypothyroidism or irritable bowel syndrome. Frail older patients may present with nonspecific symptoms of constipation, such as delirium, anorexia, and functional decline. The evaluation of constipa- tion includes a history and physical examination to rule out alarm signs and symptoms. These include evidence of bleeding, unintended weight loss, iron deficiency anemia, acute onset constipation in older patients, and rectal prolapse. Patients with one or more alarm signs or symptoms require prompt evaluation. Referral to a subspecialist for additional evaluation and diagnostic testing may be warranted. (Am Fam Physician. 2011;84(3):299-306. Copyright © 2011 American Academy of Family Physicians.) ▲ Patient information: onstipation is one of the most of 1,028 young adults, 52 percent defined A patient education common chronic gastrointes- constipation as straining, 44 percent as hard handout on constipation is 1,2 available at http://family tinal disorders in adults. In a stools, 32 percent as infrequent stools, and doctor.org/037.xml. -
Symptoms What Is IBS?
IBS Irritable Bowel Syndrome What is IBS? Symptoms IBS is a functional gut disorder, meaning the normal way the intestine moves, the sensitiv- ity of nerves in the intestine, or the way the brain controls the intestinal functions, is • People with IBS normally experience recurring episodes of diarrhea (IBS-D), constipation (IBS-C) impaired. The exact cause of IBS is still not or a mixture of both (IBS-M), alongside intense understood, but the research suggests a cramping that can last for hours. combination of factors can lead to IBS: family history of IBS, stress, previous gut infections • Symptoms can also include bloating, gas, abdom- and an imbalance in gut bacteria are a few inal distension, intermittent indigestion, nausea, potential causes. and feeling full or uncomfortable after eating. • Some people may have symptoms in their The diagnostic criteria for IBS is defined as throat/upper stomach area, including burping, recurrent abdominal pain or discomfort for at reflux-type symptoms, chest pain and feeling a least 3 days per month for the last 3 months, lump in the throat or stomach. These symptoms with at least two of the following: may indicate functional dyspepsia, which is a functional gut disorder of the upper digestive tract related to IBS. • Improvement of symptoms with Talk to your doctor about differentiating between defecation the two based on your symptoms. • Symptom onset associated with a change in the frequency of stool Did you know? • Symptom onset associated with a IBS is the most common functional digestive change in the form/appearance of stool disorder, affecting between 13-20% of Canadians. -
Irritable Bowel Syndrome (IBS) Primary Care Pathway
Irritable Bowel Syndrome (IBS) Primary Care Pathway Quick links: Pathway primer Expanded details Advice options Patient pathway 1. Suspected IBS Recurrent abdominal pain at least one day per week (on average) in the last 3 months, with two or more of the following: • Related to defecation (either increasing or improving pain) • Associated with a change in frequency of stool • Associated with a change in form (appearance) of stool Typical Features of IBS • Intestinal: bloating, flatulence, nausea, burping, early satiety, dyspepsia • Extra intestinal: dysuria, frequent/urgent urination, widespread musculoskeletal pain, dysmenorrhea, dyspareunia, fatigue, anxiety, depression Positive 2. Initial workup for celiac • Medical history, physical exam, assess secondary causes of symptoms • Serological screening to exclude celiac • CBC, Ferritin 6. Refer for consultation and/or endoscopy 3. Alarm features Yes • Family history of IBD or colorectal cancer (first degree) • GI bleeding/anemia • Nocturnal symptoms • Onset after age 50 • Unintended weight loss (>5% over 6-12 months) No Presumed Diagnosis of IBS 4. Potential approaches to IBS treament (all subtypes) • Dietary modifications: assess common food triggers, psyllium supplementation (soluble fibre), ensure adequate fluids • Physical activity: 20+ minutes of exercise almost daily; aiming for 150 min/week • Psychological treatment: patient counselling and reassurance, Cognitive Behavioural Therapy, hypnotherapy, screen and treat any underlying sleep or mood disorder where relevant • Pharmacologic therapy: antispasmodics (hyoscine butylbromide, dicyclomine hydrochloride, pinaverium bromide), enteric coated peppermint oil 5. Specific approaches based on IBS subtypes IBS-D IBS-M/U IBS-C (diarrhea predominant) (mixed/undefined) (constipation predominant) Further testing for patients • Loperamide • Pay particular attention to • Adequate fibre and water with high clinical suspicion of • Tricyclic antidepressants lifestyle & dietary principles intake IBD. -
Today's Topic: Bloating
Issue 1; August 2017 Dr. Rajiv Sharma attended medical school at Daya- nand Medical College, Punjab, India. He received his Undernourished, intelligence Internal Medicine training from Loma Linda Univer- sity, Loma Linda, California and received his Gastro- becomes like the bloated belly enterology Fellowship training from University of Rochester, Rochester, New York. Dr. Sharma trained of a starving child: swollen, under the mentorship of Dr. Richard G. Farmer, who is world renowned for his work on Inflammatory Bowel Disease. filled with nothing the body Rajiv Sharma, MD Dr. Sharma’s special interests include GERD, NERD, can use.” Inflammatory Bowel Disease (Crohn’s & Ulcerative Colitis), IBS, Acute and Chronic Pancreatitis, Gastro- intestinal Malignancies and Familial Cancer Syn- - Andrea Dworkin dromes. In an effort to share his extensive knowledge with the public, Dr. Sharma re- leased his first book, Pursuit of Gut Happiness: A Guide for Using Probiotics to Inside this issue Achieve Optimal Health, in 2014. In Dr. Sharma’s free time, he enjoys medical writing, watching movies, exercis- Differential Diagnosis 2 ing and spending time with his family. He believes in “whole person care” and the effect of mind, body and spirit on “wellness”. He has a special interest in nu- trition, exercise and healthy eating. He prides himself on being a “fact doctor” as Signs of a More Serious 2 he backs his opinions and works with solid scientific research while aiming to deliver a simple and clear message. Problem Lab Workup 2 Non-Pathological Bloating 2 Today’s Topic: Bloating Bloating may seem an odd topic to choose for our first newsletter. -
Travelers' Diarrhea
Travelers’ Diarrhea What is it and who gets it? Travelers’ diarrhea (TD) is the most common illness affecting travelers. Each year between 20%-50% of international travelers, an estimated 10 million persons, develop diarrhea. The onset of TD usually occurs within the first week of travel but may occur at any time while traveling and even after returning home. The primary source of infection is ingestion of fecally contaminated food or water. You can get TD whenever you travel from countries with a high level of hygiene to countries that have a low level of hygiene. Poor sanitation, the presence of stool in the environment, and the absence of safe restaurant practices lead to widespread risk of diarrhea from eating a wide variety of foods in restaurants, and elsewhere. Your destination is the most important determinant of risk. Developing countries in Latin America, Africa, the Middle East, and Asia are considered high risk. Most countries in Southern Europe and a few Caribbean islands are deemed intermediate risk. Low risk areas include the United States, Canada, Northern Europe, Australia, New Zealand, and several of the Caribbean islands. Anyone can get TD, but persons at particular high-risk include young adults , immunosuppressed persons, persons with inflammatory-bowel disease or diabetes, and persons taking H-2 blockers or antacids. Attack rates are similar for men and women. TD is caused by bacteria, protozoa or viruses that are ingested by eating contaminated food or beverages. For short-term travelers in most areas, bacteria are the cause of the majority of diarrhea episodes. What are common symptoms of travelers’ diarrhea? Most TD cases begin abruptly. -
Symptomatic Approach to Gas, Belching and Bloating 21
20 Osteopathic Family Physician (2019) 20 - 25 Osteopathic Family Physician | Volume 11, No. 2 | March/April, 2019 Gennaro, Larsen Symptomatic Approach to Gas, Belching and Bloating 21 Review ARTICLE to escape. This mechanism prevents the stomach from becoming IRRITABLE BOWEL SYNDROME (IBS) Symptomatic Approach to Gas, Belching and Bloating damaged by excessive dilation.2 IBS is abdominal pain or discomfort associated with altered with OMT Treatment Options Many patients with GERD report increased belching. Transient bowel habits. It is the most commonly diagnosed GI disorder lower esophageal sphincter (LES) relaxation is the major and accounts for about 30% of all GI referrals.7 Criteria for IBS is recurrent abdominal pain at least one day per week in the Carly Gennaro, DO1; Helaine Larsen, DO1 mechanism for both belching and GERD. Recent studies have shown that the number of belches is related to the number of last three months associated with at least two of the following: times someone swallows air. These studies have concluded that 1) association with defecation, 2) change in stool frequency, 1 Good Samaritan Hospital Medical Center, West Islip, NY patients with GERD swallow more air in response to heartburn and 3) change in stool form. Diagnosis should be made using these therefore belch more frequently.3 There is no specific treatment clinical criteria and limited testing. Common symptoms are for belching in GERD patients, so for now, physicians continue to abdominal pain, bloating, alternating diarrhea and constipation, treat GERD with proton pump inhibitors (PPIs) and histamine-2 and pain relief after defecation. Pain can be present anywhere receptor antagonists with the goal of suppressing heartburn and in the abdomen, but the lower abdomen is the most common KEYWORDS: ABSTRACT: Intestinal gas production is a normal physiologic progress. -
2019 FMX Gastrointestinal Handouts
2019 FMX Gastrointestinal Handouts Colorectal Cancer Update: Butt Seriously (CME064‐065) Diverticulitis Update (CME066‐067) Gallbladder Disease (CME068‐069) Gastroesophageal Reflux Disease: Evidence‐Based Approach (CME070‐071) Colorectal Cancer Update: Butt Seriously Jason Domagalski, MD, FAAFP ACTIVITY DISCLAIMER The material presented here is being made available by the American Academy of Family Physicians for educational purposes only. Please note that medical information is constantly changing; the information contained in this activity was accurate at the time of publication. This material is not intended to represent the only, nor necessarily best, methods or procedures appropriate for the medical situations discussed. Rather, it is intended to present an approach, view, statement, or opinion of the faculty, which may be helpful to others who face similar situations. The AAFP disclaims any and all liability for injury or other damages resulting to any individual using this material and for all claims that might arise out of the use of the techniques demonstrated therein by such individuals, whether these claims shall be asserted by a physician or any other person. Physicians may care to check specific details such as drug doses and contraindications, etc., in standard sources prior to clinical application. This material might contain recommendations/guidelines developed by other organizations. Please note that although these guidelines might be included, this does not necessarily imply the endorsement by the AAFP. 1 DISCLOSURE It is the policy of the AAFP that all individuals in a position to control content disclose any relationships with commercial interests upon nomination/invitation of participation. Disclosure documents are reviewed for potential conflict of interest (COI), and if identified, conflicts are resolved prior to confirmation of participation. -
Abdominal Complaints
Abdominal Complaints EMD CE May 2016 Silver Cross EMSS Introduction to Abdominal Emergencies • Abdominopelvic pain has many causes, and can be an indication of serious underlying conditions. • Abdominal pain results from these mechanisms: – Stretching – Inflammation – Ischemia (insufficient blood supply to an organ) • Care includes managing life threats, making the patient comfortable, and transport. What’s Acute Abdomen? Acute Abdomen – Caused by irritation of the abdominal wall – May result from infection or the presence of blood in the abdominal cavity – Pain can be referred to other parts of the body. – The abdomen may feel as hard as a board. – Patients may have nausea and vomiting, fever, and diarrhea as well as pain. Some patients will vomit or pass blood because they are bleeding from the esophagus or stomach. Ask about bowel and bladder problems • Vomiting/diarrhea/constipation – Associated with many acute abdominal disorders – Can cause abdominal pain – Dehydration serious enough to cause shock may occur. Have they been eating and drinking normally? • Urination problems often accompany kidney or bladder problems. Abdominal/Pelvic Pain Considerations: Onset? What were they doing when it started? Provocation/Palliation? Anything make it worse or better? What have they done for pain relief? Quality? (Type of pain) Ache, cramping or sharp pain? Radiation/Region/Referred? Where is the pain? Does it travel anywhere? Severity? 1-10 Scale rating Time? How long has it been going on? Ever happen before? Acute Abdomen • The abdominal cavity extends from the diaphragm to the pelvis and contains organs of digestion, reproduction and excretion. • The parietal peritoneum lines the abdominal cavity, and the visceral peritoneum is in contact with the organs. -
Bloating and Abdominal Distension: Clinical Approach and Management
Adv Ther https://doi.org/10.1007/s12325-019-00924-7 REVIEW Bloating and Abdominal Distension: Clinical Approach and Management Amir Mari . Fadi Abu Backer . Mahmud Mahamid . Hana Amara . Dan Carter . Doron Boltin . Ram Dickman Received: February 5, 2019 Ó The Author(s) 2019 ABSTRACT complaint) or may overlap with other func- tional gastrointestinal disorders such as func- Functional abdominal bloating and distension tional constipation, irritable bowel syndrome, (FABD) are common gastrointestinal com- and functional dyspepsia. The pathophysiology plaints, encountered on a daily basis by gas- of FABD is not completely understood. Pro- troenterologists and healthcare providers. posed underlying mechanisms include visceral Functional abdominal bloating is a subjective hypersensitivity, behavioral induced abnormal sensation that is commonly associated with an abdominal wall-phrenic reflexes, the effect of objective abdominal distension. FABD may be poorly absorbed fermentable carbohydrates, diagnosed as a single entity (the sole or cardinal and microbiome alterations. Management includes behavioral therapy, dietary interven- Enhanced Digital Features To view enhanced digital tions, microbiome modulation, and medical features for this article go to https://doi.org/10.6084/ m9.figshare.7776143. therapy. This review presents the current knowledge on the pathophysiology, evaluation, and management of FABD. A. Mari Á F. Abu Backer Gastroenterology Institute, Hillel Yaffe Medical Center, Hadera, Israel A. Mari Á M. Mahamid Á H. Amara Keywords: Distension; Functional abdominal Gastroenterology Institute, Nazareth EMMS bloating; Functional constipation; Functional Hospital, Nazareth, Israel dyspepsia; Irritable bowel syndrome A. Mari Á M. Mahamid Faculty of Medicine in the Galilee, Bar-Ilan University, Ramat Gan, Israel DEFINITION D. Carter In 2016, the Rome IV working team revised the Department of Gastroenterology, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel Rome III diagnostic criteria and updated the clinical evaluation and treatment for functional & D.