How I Healed my Flatulence

Ultimate Flatulence Cure

Ultimate Flatulence Cure is a new program developed by Joseph Arnold, who has many years of experience in the health industry. The program provides people with natural remedies, techniques, tips, and detailed instructions on how to reduce flatulence, smelly gas, bloating and burps effectively. With this 55-page eBook, you learn how to eliminate your matter step by step from the comfort of your home. Ultimate Flatulence Cure has treated for thousands of people in over 75 countries. Purchasing the program, individuals will get a lot of coaching publications like the Flatulence Cure book, the Natural Organic Remedies And Remedies reserve, the Detoxify Your Body How To Detoxification Fast And Simple Way At Home book, the How To Manage Irritable Intestinal Syndrome reserve, as well as the Acid Reflux Remedies reserve. Read more...

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Enteral and parenteral nutrition

The GI tract remains an appropriate and important route for nutritional support in if the gut is working adequately (inadequate function being manifest by abdominal distension, vomiting and large volume nasoenteral aspirates). Small intestine digestive and absorptive function is maintained in the postoperative period after abdominal surgery (the main sites of 'ileus' being the stomach and colon). EN may therefore be administered safely into the small bowel immediately after abdominal surgery (including major aortic reconstruction). It is often suggested that bowel anastomosis is a contraindication to EN in the early postoperative period, but studies have confirmed its safety. EN should be considered the first choice for feeding patients with severe head injuries and should be commenced early as aggressive nutritional support confers benefit on outcome.

Concurrent Surgical Disease Intestinal Obstruction

Patients with intestinal obstruction often have electrolyte disturbances due to vomiting or, if incomplete obstruction, diarrhoea. They may have been ill at home for several days and not been able to take their usual medication for any concurrent medical condition. These patients may be dehydrated and possibly hypovolaemic due to gastro-intestinal losses or to third space losses into their gut. Inappropriate intravenous fluid therapy on a surgical ward may have exacerbated the problems. Abdominal distension splints the diaphragm and decreases respiratory reserves. If long standing, a chest infection may have developed. Fluid and electrolyte disturbances should be corrected before theatre and pre-operative chest physiotherapy may be useful. A nasogastric tube should be inserted before induction of anaesthesia in an attempt to empty the stomach and decrease the risk of peri-operative regurgitation and aspiration.

Mode Of Abdominal Expansion

Woolley et al examined the effect of gasless abdominal distension, CO2 pneumoperitoneum and positive end expiratory pressure (PEEP) on hemodynamic and blood gas alterations in six anesthetized swine.7 Control animals were monitored with pulmonary artery and arterial line catheters. Animals were then assigned a course of variable PEEP with either CO2 pneumoperitoneum or abdominal wall lifting. Baseline values without PEEP were obtained for both groups. Abdominal wall lifting was associated with increased PaO2 and decreased central venous pressure (CVP), pulmonary aretry pressure, pulmonary wedge pressure (PCWP) and PaCO2 compared to CO2 pneumoperitoneum. Similarly, abdominal wall lifting abolished the adverse hemodynamic effects (increased CVP, PAP and PCWP) associated with PEEP that were seen with CO2 pneumoperitoneum. However, abdominal wall lifting was associated with increased systemic vascular resistance compared to baseline and CO2 pneumoperitoneum. Cardiac function significantly...

Clinical Description

FDCM DCM is a leading cause of heart failure and arrhythmia. Symptoms of congestive heart failure are dyspnea on exertion, decreased exercise tolerance, orthopnea, paroxysmal nocturnal dyspnea, fatigue, edema, and abdominal distension. Chest pain results from limited coronary vessel reserve. Ventricular arrhythmia leads to palpitations, syncope, and sudden cardiac death (SCD). Severe LV dilatation and dysfunction result in thrombo-embolic complications.

Irritable bowel syndrome

Irritable bowel syndrome (IBS) is a widespread functional gastrointestinal disorder that affects 10-20 of the Western population (Drossman et al., 2002). The main clinical features of IBS include abdominal pain, bloating, flatulence and variable bowel habit. Current treatments for IBS are regarded as relatively ineffective. The pathophysiology of IBS remains unknown, but there is evidence that at least in part of the patients an imbalanced intestinal microbiota is associated with the onset of disease. The effect of Lactobacillus plantarum 299v on IBS symptoms has been investigated in three randomized placebo-controlled trials. In a four-week trial, Nobaek and colleagues (2000) demonstrated L. plantarum 299v to be significantly more efficient than placebo in reducing flatulence and abdominal pain. A second study with the same probiotic also found a reduction in abdominal pain (Niedzielin et al., 2001), whereas a third study including only 12 patients was not able to confirm any...

Small Bowel Obstruction

Small bowel obstruction presents with abdominal distention and crampy abdominal pain. Proximal small bowel obstruction can often present with nausea and vomiting. Patients may also have nausea and vomiting with distal small bowel and colonic obstruction, but it presents later in the course of the obstruction. Patients will report minimal flatus, and will describe a history of no bowel movements over a prolonged period of time. Patients will occasionally report small watery or mucus predominant bowel movements. There are functional and mechanical obstructions. A mechanical obstruction is when there is a physical blockage in the bowel. In the small bowel, this is most commonly due to adhesions from a prior surgery, but it can also be due to an intraluminal foreign body, incarcerated hernia, or intraluminal source such as intussusception or malignancy. In the large bowel, obstructions should be considered malignant until proven otherwise. Once this has been eliminated, less common causes...

Changes in the alveolar capillary membrane and gas exchange

The failing heart challenges the integrity of the lung capillaries by at least two factors increased pressure and increased volume within the alveolar vasculature. The thickness of the alveolar capillary membrane is significantly increased in chronic heart failure mainly due to the deposition of collagen.19'20 Similar findings have been reported in patients with mitral stenosis21 and pulmonary venous hypertension.22 Overall the anatomic changes that take place in the alveolar capillary unit lead to an increase resistance across the membrane and impaired gas transfer23 that is inversely related to its diffusing capacity for carbon monoxide (DLCO). A reduction in DLCO may arise from a decrease in capillary blood volume or haemoglobin, or from an increase in the resistance of the alveolar capillary membrane to such diffusion. DLCO is commonly reduced in patients with severe heart failure and is unrelated to lung volume or the duration of heart failure.24-27 A crucial question is whether...

Clinical Presentation

Celiac disease may present in a wide variety of ways (Table 1). In children, the onset of celiac disease is classically described as occurring within the first to seventh year of life with the introduction of cereals to the diet. Symptoms may vary with the age of the child at onset of disease. Young children may develop chronic diarrhea, failure to thrive, muscle wasting, abdominal distension, vomiting, and abdominal pain. Older children may present with anemia, rickets, behavioral disturbances, or poor performance in school. In some children constipation, pseudo-obstruction, and intussusception may be seen. It has been estimated that 2-8 of children with unexplained short stature may have celiac disease. Dental enamel defects involving secondary dentition as well as

Differential Diagnosis

Symptoms of irritable bowel syndrome include diffuse crampy or colicky abdominal pain, brought on by meals or emotional upset. The patients may also describe a bloated or distended sensation in the abdomen. The symptoms are usually intermittent and chronic. The passage of flatus or a bowel movement may bring relief. The disease is characterized by alternating bouts of constipation and diarrhea. On physical examination, the patient is afebrile and a cordlike mass may be appreciated in the left lower quadrant corresponding to the sigmoid colon. Signs of localized or generalized peritonitis are not seen. Laboratory studies are normal.

The Alimentary System

The bolus of food is propelled forward by rhythmic contractions of the entire intestinal system. These peristaltic waves move the food from the mouth, through the esophagus, and into the stomach. Certain individuals, especially nervous people, tend to swallow air when eating. When part of the air is expelled through the mouth, belching results the remaining air is expelled as flatus. If too much air is swallowed, there will be abdominal discomfort.

H 12332 Visceral Ischemia

Patients with peritonitis and suspected intestinal ischemia do not need work-up and should be taken to the operation room immediately for diagnostic and therapeutic laparotomy. Those with suspected renal or mesenteric artery occlusion, on the other hand, require angiography for an accurate diagnosis. In these segments duplex is obscured by intestinal gas. A very good alternative is CT angio-graphy, which enables identification of renal infarction as well as vascular segments filled with thrombus.

Stenosis of the Small Intestine Description

Endoscopic investigation of stenotic lesions, as well as bleeding in the small intestine, is an indication for which the double-balloon endoscope offers the greatest advantage. Stenosis of the small intestine often interferes with the passage of intestinal contents and thereby causes bowel obstruction symptoms, such as abdominal pain, abdominal distension, and vomiting. Particularly in the distal small intestine, however, stenosis is less symptomatic unless severe narrowing occurs because intestinal contents are usually well-digested liquids. It is difficult to delineate stenosis of the small intestine by modalities other than contrast-enhanced studies, and the diagnosis is difficult to make particularly when symptoms chronically persist. Consequently, patients often suffer from symptoms due to stenosis of the small intestine for a long time. Accurate diagnosis of the cause of stenosis of the small intestine and selection of appropriate treatment often relieve years of distress and...

Hostparasite relationships

Weakness, whirling, listlessness, abdominal distension, anaemia, faecal pseudocasts, pale stringy faeces, a red vent, exophthalmia and dark coloration (Moore, 1922 Allison, 1963 Becker, 1977 Ferguson and Moccia, 1980 Post, 1987 Andrews et al., 1988 Gratzek, 1988 Mo et al., 1990 Buchmann and Uldal, 1996).

AGlucosidase Inhibitors

Acarbose acts to decrease postprandial glucose concentrations by decreasing gastrointestinal absorption of carbohydrates. Acarbose inhibits the brush-border enzyme a-glucosidase, thereby preventing the metabolism of polysaccharides into smaller units for absorption. By itself, acarbose does not cause hypoglycemia. To date, experience with acarbose overdose is limited. However, flatulence, bloating, and malabsorption can complicate use of this medication and should be expected in overdose.

Pathophysiology and Symptoms

Malabsorption can occur when any of the several steps in nutrient digestion, absorption, and or assimilation are interrupted see Table 1 for a list of congenital defects in nutrient assimilation. Carbohydrate malabsorption can occur, for instance, when intestinal disaccharidases are reduced in concentration at the enterocyte. The brush border membrane produces four disaccharidases that are important in carbohydrate digestion. These enzymes are sucrase-isomaltase, maltase-glucoamylase, trehalase, and lactase-phlorizin hydrolase. Worldwide, lactase deficiency is the most common type of acquired disaccharidase deficiency since much of the world's population exhibits a noticeable reduction in intestinal lactase concentration after the age of 2 years. In addition, infants and children with diarrheal disease may suffer from acquired lactase deficiency due to intestinal villous damage that is often temporary. With either congenital or acquired lactase deficiency, malabsorbed carbohydrate...

Aortic Graft Infection

The first investigation done to reveal signs of aortic graft infection is CT. The question to be answered is whether there is fluid or gas around the graft and inside the aneurysm sac. The normal postoperative course is that fluid and gas should be absorbed within 3-6 weeks. Accordingly, gas bubbles around the graft after 20 days postopera-tively suggest that infection is a possible diagnosis. Unfortunately, it is not always easy to differentiate from intestinal gas. Magnetic resonance imaging (MRI) is an alternative for the work-up. It is better for differentiating between fluid collections, old thrombi, and inflammatory changes in tissue. Unless the diagnosis is obvious after the initial investigation, most patients with suspected aortic graft infections are examined with both CT and MRI. Our recommendation is that CT is ordered first when aortoduodenal fistula is suspected, and MRI is ordered for all other patients. Other methods such as a leukocyte scintigram can be helpful when...

Carbohydrate Malabsorption

Lactose intolerance Lactose intolerance is defined by the occurrence of symptoms due to the inability to digest lactose, the main carbohydrate in milk. These symptoms may include abdominal pain, bloating, diarrhea, or flatulence. Lactose malabsorption is attributed to a relative deficiency of the di-saccharidase lactase. Primary lactase deficiency is a condition in which lactase activity declines after weaning. Secondary lactose intolerance is usually due to mucosal injury associated with a condition or disease such as infectious diarrhea, Crohn's disease, or short bowel syndrome.

Loss of Appetite Anorexia

Loss of appetite is a common feature in many illnesses and not only those involving the gastrointestinal tract. It is now thought that much of the appetite loss in disease is mediated by one or more cytokines released by lymphocytes as part of the body's response to tissue damage or invasion. Additionally, however, parasitized individuals often complain of symptoms such as nausea, abdominal pain, flatulence, and distension and discomfort, while the protozoal infections are associated with vomiting, diarrhea, or dysentery, all of which can be expected to reduce appetite.

Physical Examination

In the acute setting, the important features of examination are those that argue for or against incarceration, with or without strangulation. Inspection may reveal erythematous skin changes overlying the hernia, which should raise concern for possible strangulation. The position of the hernia is typically similar to that seen in the chronic setting. Palpation is essential, with its purpose being evaluation for incarceration and possible strangulation. Incarcerated hernias are often tender to palpation, particularly when strangulation has occurred. However, the diagnosis of incarceration centers on the palpatory findings of irreducibility and to a lesser extent, immobility. Auscultation over the hernia may reveal obstructive or even absent bowel sounds when incarceration of bowel has occurred. Finally, the remainder of the abdominal and groin examinations should be performed to evaluate for other processes that may present similarly, and equally importantly, to evaluate for...

Effects of salmonid cryptobiosis on fish production

There were serious outbreaks of the disease in juvenile salmon in hatcheries (fresh water) in Washington State, USA. These include three separate outbreaks in chinook salmon in three localities in 1972 and 1973 (Wood, 1979). The fish had massive numbers of Cryptobia in their blood, they were anaemic and lethargic and some had abdominal distension and generalized oedema. Parasites were on the body surface and in abdominal fluid in fish with acute disease. There was a substantial loss of juvenile chinook salmon, while coho salmon of the same age in the same or adjacent ponds were unaffected. More recently,

Intestinal Pseudoobstruction

Intestinal pseudo-obstruction encompasses several intestinal motor disorders characterized by episodes that suggest intestinal obstruction because defecation stops and abdominal distension, pain, and vomiting occur, but in which no mechanical obstruction is found. It may be due to primary abnormalities of the visceral muscle or nerves or be secondary to chronic renal failure, hypothyroidism, diabetes mellitus, amyloidosis, scleroderma, or muscular dystrophy. There is no effective treatment that is specific for intestinal pseudo-obstruction. If the patient has bacterial overgrowth, this should be treated with antibiotics. If nutrition is impaired, administration of liquid, low-residue feeds enterally is required rarely, parenteral (intravenous) feeding is necessary.

FishC bullocki relationships

The disease develops slowly in summer flounders and clinical signs include anaemia, splenomegaly, exophthalmia, sluggishness and abdominal distension with ascites (Fig. 3.32) (Burreson, 1982b Burreson and Zwerner, 1984). Clinical disease is evident in experimentally infected juvenile summer flounders at 5 wpi and fish are normally dead at 11 wpi.

Early Postoperative Bowel Obstruction

Early postoperative bowel obstruction refers to mechanical bowel obstruction, primarily involving the small bowel, which occurs in the first 30 days following abdominal surgery. The clinical picture may frequently be mistaken for ileus, and these clinical conditions can overlap. The clinical presentation of early postoperative bowel obstruction is similar to bowel obstruction arising de novo crampy abdominal pain, vomiting, abdominal distension, and obstipation. The incidence of early postoperative bowel obstruction has been variable in published series, due to difficulty in differentiating ileus from early postoperative bowel obstruction, but the reported range is from 7 to 9.5 of abdominal operations.

Rationale for Enteral Nutrition

Initiation of enteral nutrition should occur immediately after adequate resuscitation, most readily determined by adequate urine output. The presence of bowel sounds and the passage of flatus or stool are not absolute requisites for initiating enteral nutrition, but feedings in the setting of gastropar-esis should be administered distal to the pylorus. Gastric residuals > 200 ml in 4-6 h or abdominal distention will require cessation of feeding and adjustment of infusion rate. Concomitant gastric decompression with distal small bowel feedings may be appropriate in certain patients, such as closed-head injury patients with gastroparesis. There is no evidence to support withholding enteric feedings for patients following bowel resection or in those with low-output enterocutaneous fistulas of < 500 ml day, but low-residue formulations may be preferred. Enteral feeding should also be offered to patients with short bowel syndrome or clinical malabsorption, but caloric needs, essential...

History and Physical Examination

Flank ecchymoses and or abrasions, fractured ribs, abdominal distension or tenderness, and palpable mass. The clinical presentation of renal vein thrombosis depends on the balance achieved between the rapidity and degree of venous occlusion, as well as the development of collateral veins. Thus, patients may be asymptomatic, have no specific symptoms such as nausea or vomiting, or have more specific symptoms such as hematuria or flank pain (Berkovich et al. 2001).

Bile acid sequestering agents resins

The biggest proportional reduction in lipid levels occurs at low doses and in those who have moderately elevated levels of cholesterol.54 Careful selection of the vehicle and logistics used in resin administration will promote long-term patient adherence. Premixing with cold water (taking advantage of the resin's hygroscopic nature) and drinking the preparation slowing is by far the most frequent and successful method of administration. Still, some patients prefer mixing with a heavily textured juice. Pre-existing gastrointestinal symptoms should be addressed before resin therapy is started. Bloating, belching and increased flatus are related to rapid ingestion. Dyspepsia and increased stool consistency or frank constipation can be managed with increases in fluids or dietary fiber intake.

Clinical Features

Once a physician determines that a patient truly is constipated, the physician must attempt to determine the cause. Ihe differential diagnosis is broad ( Iab e Z9.-3). Determining the onset of the constipation helps narrow the differential diagnosis. Acute constipation represents intestinal obstruction until proven otherwise. Iumors, strictures, and volvuli can all present as acute constipation. Physicians often mistake subacute for chronic constipation. Ihe important distinction here is to determine exactly when bowel habits changed. Generally, acute and subacute conditions have the same differential diagnosis. Chronic constipation, that is, a lifelong or persistent habit, is usually less ominous and, if uncomplicated, can often be managed on an outpatient basis. Ihe presence or absence of associated symptoms may help guide decision making. Vomiting rarely accompanies benign constipation. Inability to pass flatus also raises concern about obstruction. A history of gradually...

Principal Mechanisms and Pathophysiology of Food Intolerance

Lactase deficiency An example of an enzyme defect causing food intolerance is lactase deficiency. In this condition, which is primarily a disorder that affects infants and young children, there is a reduced or absent concentration of the enzyme lactase in the small intestinal mucosa. Affected individuals are unable to break down ingested lactose, the main sugar found in milk, and which if unabsorbed passes into the large intestine, where there are two consequences. One is an osmotic diarrhea. The other is that some of the unabsorbed lactose is broken down by intestinal bacteria, accompanied by the production of gas (hydrogen) leading to abdominal distension and flatus and the production of organic acids that cause perianal soreness or excoriation. The production of hydrogen, its absorption into the bloodstream, and its excretion in the breath lead to a very simple and elegant test for sugar intolerance the breath hydrogen test. In this test, the subject swallows a portion of the sugar...

Hasan Aziz and Zarin Mogal

In developing countries epilepsy still remains in the shadows of myths, superstitions and stigma. Fear, shame and mysticism surrounds epilepsy even today. Families of patients with epilepsy often make references to black magic, witchcraft, voodoo or evil ancestral spirit possession, a divine punishment, and poisoning.26,27,36,37 The mysterious stormy events of an epileptic seizure have compelled many to associate it with a supernatural cause.36-39 In Pakistan, only 3.1 population surveyed associated epilepsy to a supernatural cause as against 71 in Turkey.40 In traditional Africa epilepsy is linked to the evil eye. The curative rituals range from complete shaving of entire body with glass and affliction of burns to banishment of the person causing the evil influence.38,41 The saliva, flatus, breath, and other secretions of the patient are thought to be highly contagious.38,42 Epileptic seizure is thought to signify escaping of a demon or an evil spirit and hence one is not allowed to...

Bacterial interactions

The best and first recognised effect of probiotics is the alleviation of lactose intolerance by lactic acid bacteria, mainly Streptococcus thermophilus and Lactobacillus bulgaricus used as yoghurt starters. The genetically programmed drop in human enterocyte lactase activity in childhood (Wang et al., 1998), as well disorders leading to small intestinal mucosa damages or increase of the gastrointestinal transit time (Labayen et al., 2001), trigger lactose malabsorption responsible for gastrointestinal symptoms such as bloating, flatulence, abdominal pain and diarrhoea (Shaw and Davies, 1999). Lactic acid bacteria have proved useful in this context to improve lactose

Types Of Map Packages

Gases that contribute to product life in MAP are C02 and 02, and their relative rates of transmission depend on the film. As well as appropriately low gas transmission characteristics, films used for MAP packaging should have good sealing qualities. Although clipping or crimping is used in some systems for closing MAP packs, such closures are unreliable in that channels allowing excessive gas exchange may traverse the seals. To maintain a modified atmosphere, packaging materials that can be reliably sealed by heating are required. Tray and package design must consider film thickness at the thinnest points. An accordion-fold design meant to improve physical strength of a tray could result in thinning of gas barrier walls if the quantity of film material is limited.

Normal Bowel Rectosphincteric Reflex

The final effects of stress on colonic motility vary greatly from individual to individual. Most students are familiar with diarrhea previous to an important examination. The severity of the problem is usually related inversely to how well the student knows the material to be covered by the test. Prolonged, extreme responses of anger, anxiety, hostility, or resentment may result in irritable bowel syndrome. In these individuals constipation may alternate with diarrhea, and abdominal pain or cramping and flatulence are often present as well.

Superior Mesenteric Artery Syndrome

Superior mesenteric artery (SMA) syndrome is a condition in which the third portion of the duodenum is intermittently compressed by the overlying SMA, resulting in gastrointestinal obstruction. Symptoms include recurrent vomiting, abdominal distension, weight loss, and postprandial distress. People with CP are at high risk for several of the reported causes of SMA syndrome, including body cast compression, severe weight loss, prolonged supine positioning, and scoliosis surgery. Consequently, it is important to recognize the symptoms and know the appropriate treatments for this syndrome. Most people can be treated nonsurgically with gastric aspiration and nasojejunal or gastroje-junal feedings distal to the obstruction. One study also found that turning to the left from a supine position displaces the SMA from the right to the left side of the aorta in scoliosis cases. Thus, positioning can help alleviate symptoms and special

Absorption of Fructose

Dietary fructose is ingested as the simple monosac-charide and also as part of the disaccharide sucrose. Sucrose is hydrolyzed by sucrase at the intestinal brush border to yield one molecule of glucose and one of fructose. Glucose is rapidly absorbed via a sodium-coupled cotransporter and arrives at the liver via the portal circulation. Fructose absorption is accomplished primarily by a fructose-specific hex-ose transporter, GLUT-5. This transporter is found in the jejunum on both the brush border and the baso-lateral membranes. Expression of GLUT-5 increases within hours of exposure to a fructose-enriched diet, indicating that the transporter is regulated by luminal signals. However, consumption of a large amount of pure fructose can exceed the capacity of intestinal fructose absorption, resulting in diarrhea. Several studies have shown that when a single dose of 50 g of fructose is consumed by healthy adults, more than half experience malabsorption, and in some studies malabsorption...

Imaging

Although less useful, plain abdominal films (KUB) include information about the size and position of the kidneys, of the psoas shadow (poor identification may be a manifestation of retroperitoneal hematoma from a ruptured aortic aneurysm), and of intestinal gas distribution (e.g., postoperative ileus) and can aid the search for calculi and organ calcification, free intraabdominal gas, and bone pathology. For more than half a century, the plain abdominal film was the only tool available to detect urolithiasis. However, because of its limited accuracy for the direct detection of stones (Haddad et al. 1992 Levine et al. 1997 Mutgi et al. 1991), it is indicated only in follow-up of conservatively managed urolithiasis, of fragmentation results after lithotripsy (in combination with sonography), and for missed calculi after ureterorenoscopy (Grosse et al. 2005). Its advantages include availability, rapidity, and the ease of image evaluation even by a nonradiologist. Its only secondary...

The Large Intestine

The other major breakdown products of carbohydrate fermentation are hydrogen, methane, and carbon dioxide, which together comprise flatus gas. Excess gas production can cause distension and pain in some individuals, especially if they attempt to increase their fiber consumption too abruptly. In most cases, however, extreme flatus is probably caused more by fermentation of oligosaccharides such as stachyose and verbascose, which are found principally in legume seeds, rather than the cell wall polysaccharides themselves.

Abdominal Distention

Abdominal distention is normal in neonates and is usually due to lax abdominal musculature and relatively large intraabdominal organs. It may also be accentuated by excessive gas within the bowel. If the infant is comfortable and feeding well and the abdomen is soft, there is no need for concern. Abdominal distention may also occur in association with bowel obstruction, constipation, or ileus due to sepsis or gastroenteritis. Congenital organomegaly (e.g., hepatomegaly, splenomegaly, or renal enlargement) undetected in the perinatal period may also present as abdominal distention. 426

Diagnosis

Clinically, patients usually present with crampy abdominal pain, nausea, vomiting, and either decreased or absent stool and flatus. SBO is often characterized as being either complete when there is no stool or flatus or partial when stool may be decreased, normal, or increased (diarrhea). Emesis is often bilious or even feculent, indicating stasis in long-standing SBO. The degree of distention on abdominal examination is greater in patients with distal obstruction. The presence of hyperactive bowel sounds, resulting from

Volvulus

Although the incidence of sigmoid volvulus is rare in Western countries, it is one of the most common causes of emergency large-bowel surgery in other countries, particularly in Africa. In the UK, sigmoid volvulus often occurs in elderly and frail patients. The clinical symptoms and signs are those of colonic obstruction, often the abdomen is hugely distended and 'drum-like' and the rectum is empty on digital examination. The diagnosis is supported by a typical X-ray appearance. In the absence of signs of peritonitis, detorsion of the volvulus can be attempted by use of a rigid sigmoido-scope and a flatus tube however, flexible sigmoidoscopy may be more effective. If colonic ischaemia is suspected, then prompt laparotomy is indicated. Recurrence rates after

Giardia

Symptoms depend on the duration of infection at the time of presentation. Patients may complain of explosive, watery, or foul-smelling diarrhea, flatus, abdominal distention, fatigue, and fever or chronic diarrhea with weight loss or general debilitation. Stools should be examined for cysts and trophozoites with routine and concentration techniques. Giardia antigen can be detected in the stool with immunofluorescence or ELISA technique. Occasionally, duodenal aspiration, the string test (Entero-test), or small-bowel biopsy is necessary to make the diagnosis. The drug of choice for treatment is metronidazole.

Yoghurt

Yoghurt is often added nuts, honey, preserved or dried fruit, containing sucrose and is a source of yeast infections. Yeast spoilage of yoghurt is seen as excessive gas production followed by swelling of the package, unpleasant yeasty odor and taste, changes in texture and color, and formation of visible yeast colonies (Caggia et al. 2001 Fleet and Yeasts 1998).

Biology

Seventeen Peruvian patients positive for Cyclospora organisms were surveyed and underwent endoscopy, and their symptoms were recorded. Patients presented with gastrointestinal symptoms, including diarrhea, flatulence, weight loss, abdominal discomfort, and nausea. Jejunal biopsies showed an altered mucosal architecture with shortening and widening of the intestinal villi due to diffuse edema and infiltration by a mixed inflammatory cell infiltrate. There was reactive hyperemia with vascular dilatation and congestion of villous capillaries. Parasitophorous vacuoles contained sexual and asexual forms. Type I and II meronts, with 8-12 and 4 fully differentiated merozoites, respectively, were found at the luminal end of epithelial cells. These findings demonstrated the complete developmental cycle associated with host changes due to C. cayetanensis (Ortega et al., 1997a).

Effects in the Colon

Carbon dioxide and hydrogen are produced in this process contributing to disagreeable side effects when given in high doses. Abdominal cramping, increased flatulence, and bloating have been shown to occur significantly more in studies where adults received 15 g day-1 or more of fructooligosaccharide and inulin as compared to a placebo group. However, in a limited number of controlled pediatric studies these symptoms were not seen at doses of up to 3 gday-1.

General surgery

Diverticular disease of the sigmoid colon may cause abscess formation that perforates into the bladder producing a colovesical fistula. Symptoms include recurrent urine infections and air bubbles in the urine passed down from flatus in the colon (pneumaturia). It is uncommon for a carcinoma of either the bladder or colon to cause a similar fistula.

Black Beans

Beans do cause flatulence in many persons who eat them. The gassiness is the result of fermentation of the seeds' complex sugars, or oligosaccharides, by bacteria in the large intestine. Persons who eat beans frequently find that they do not develop gas as much. To reduce the flatulence effect, try these strategies The flatulence-producing effect of beans can be further reduced by changing the water several times during soaking and during cooking and by simmering the beans slowly until they are tender.

Glucose Metabolism

Some of the increase in hepatic gluconeogenesis in late-pregnant ruminants is due to increased voluntary feed intake. 1 However, intake is often constrained by physical factors such as diet quality and abdominal distension, as well as endocrine factors such as the surge in estrogen secretion in late pregnancy. 2 Under these or more controlled conditions of feed restriction, an increase in glucose production is sustained by increased peripheral mobilization and hepatic uptake of endogenous substrates such as amino acids from skeletal muscle and glycerol from the lipolysis of adipose triglycerides.1-1'3-1

Sugar Malabsorption

The disaccharidases are localized to the apical cell membrane of the villous absorptive gut epithelial cell. Lactase, the disaccharidase that digests lactose, is the most important. Deficiencies of these enzymes may be due to a primary inherited enzyme disorder (permanent) or secondary to disorders resulting from mucosal damage or bacterial overgrowth. Dis-accharidase deficiency results in an osmotic diarrhea, because the undigested sugar has a large osmotic pull, and abdominal distension.

Respiration

The mechanisms controlling respiration are inadequately developed in infants. Preterm infants are particularly at risk of developing apnoea and need close monitoring for at least 24 h after even relatively minor surgical procedures such as inguinal hernia repair. The presence of hyaline membrane disease in low birth weight babies demands expert neonatal care. Abdominal distension, shock and sepsis can compromise the fragile respiratory status of a neonate, and trigger the need for mechanical ventilation.

Clinical Aspects

The incubation period for trichinellosis lasts from 2 to 50 days, depending on the number of infective larvae ingested (a greater number of larvae correspond to a shorter incubation period). 7 The acute stage of trichinellosis corresponds to the phase in which the newborn larvae migrate from the lymphatic vessels and invade the muscle cells. The acute stage can be preceded by loose stools or diarrhea, with flatulence, moderately intense abdominal pain, loss of appetite, and vomiting. 7

Colostomy

A colostomy placed in the descending or sigmoid colon will have a faecal output that is generally formed and is easier for the patient to cope with. The appliance will be closed at the bottom and there will be a flatus patch at the top of the appliance that also has charcoal in it. This patch allows gas to

Info

Fat absorption, water absorption, texture, dough formation, adhesion, cohesion, elasticity, film formation, and aeration. The use of some oilseed proteins in foods is limited by flavor, color, and flatus problems. Raw soybeans, for example, taste grassy, beany, and bitter. Even after processing, residues of these flavors may limit the amounts of soybean proteins that can be added to a given food. Flatus production by defatted soy flours has been attributed to raffinose and stachyose. These sugars are removed by processing the defatted flours into concentrates and isolates.

Nematodes Roundworms

TRICHURIS TRICHIURA (WHIPWORM) Like Ascaris, Trichuris trichiura is found in rural communities in the southern United States. The infection is most often acquired in childhood because the ova are deposited in the soil where children play and defecate freely. The adult worm resides in the cecum. Patients complain of anorexia, insomnia, abdominal pain (including pain in the right upper quadrant), fever, flatulence, bloody diarrhea, weight loss, and pruritus and may have eosinophilia and microcytic hypochromic anemia. Trichuris can result in colitis or rectal prolapse in children. The diagnosis is made with the finding of ova in the stool. Mebendazole or albendazole is the treatment of choice.

Postoperative Ileus

Clinically, ileus can be recognized from clinical signs. Abdominal distension, nausea, and the absence of bowel sounds and flatus should prompt the diagnosis. Abdominal X-ray imaging typically shows dilated loops of small bowel and colon. Bowel obstruction must also be considered with these clinical findings, however, and CT or other contrast imaging may be required to confirm or rule out obstruction. In the expected course of uncomplicated abdominal surgery, the stomach is frequently drained by a nasogastric tube for the first 24 h after surgery, and the patient is not allowed oral intake until there is evidence that colonic motility has returned, usually best evidenced by the passage of flatus. Earlier feeding, and no gastric drainage after bowel surgery can be attempted for healthy patients undergoing elective abdominal surgery, with a high rate of success, provided clinical symptoms of ileus are not present. In such patients, the use of effective preventive strategies is highly...

Bowel Disorders

Diverticular disease of the colon, characterized by the development of protrusions of mucosa through the bowel wall, is common and usually asymptomatic. It has been shown to be less likely to develop in those following a high-fiber diet, and once acquired can be managed, in many cases, by ensuring an adequate amount of fiber in the diet. Experimentally, various fiber supplements and 'bulking agents' have been shown to reduce the abnormally high peak intracolonic pressures that are characteristic of diverticular disease. Sometimes 10-20 g of coarse wheat bran as a supplement is all that is required, but some patients develop flatulence and distension at least initially. Other fiber supplements such as ispaghula husk (psyllium) may be as effective, without the initial adverse side effects. Sometimes, simple dietary changes to achieve an adequate total daily intake of dietary fiber particularly from wheat-based foods are effective. Diverticulitis (inflammation of the diverticula) is a...

Fibre in the Diet

Although diverticular disease of the colon is viewed as a disease of western civilization and ascribed to inadequate dietary fibre intake, there is a strong clinical impression by the medical profession that increased dietary fibre intake will relieve the symptoms of diverticular disease (Ornstein et al., 1981). In a controlled clinical study, 58 patients with uncomplicated diverticular disease of the colon ingested a bran crispbread, an ispaghula drink (Psyllium) and a placebo for 4 months each in a randomized, cross-over, double-masked, controlled trial. Subjective assessments were made monthly using a self-administered questionnaire. Objective studies were made by examination of a 7-day stool collection from each patient at the end of each treatment period. Using a pain and lower bowel symptom score, which included incomplete sensation of emptying the bowel, straining, stool consistency, aperients taken and nausea, and a total symptom score, which included nausea, belching,...

Rett Syndrome

These girls may present to the ED with a variety of symptoms, including fainting due to apnea or hyperventilation or with severe abdominal distension due to air swallowing. Apnea has been known to last 30 to 40 s and may involve cyanosis. Screaming attacks may occur in puberty. Children need to be assessed for possible pain due to an acute abdomen, dental pain, kidney stones, or other medical causes. If no source of medical concern is identified, the child may be suffering from a screaming attack.

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