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

Natures Quick Constipation Cure Summary


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Constipation and Diverticulitis

Constipation is a disorder characterized by the need to strain to pass hard stools and decreased frequency of stools (two to three times a week). Chronic constipation can lead to diverticulosis, in which multiple small sacs of the colonic mucosa are pushed out through the muscular wall of the colon. Diverticulosis occurs because chronic straining to pass feces produces increased pressure inside the colon. Inflammation often develops within the small sacs (diverticula) producing diverticulitis, with abdominal pain and bleeding. Constipation and diverticulitis are so-called diseases of civilization. They occur in near epidemic proportions in the industrialized countries, where one-fifth of the adult population suffers from chronic constipation and diverticu-losis occurs in about one-third of people older than 65 years.

Micronutrients Constipation

Pulls water into the colon and softens stools. Start with 250 mg and increase gradually until constipation improves. Take as single dose on arising in the morning Deficiency can aggravate constipation High-dose calcium supplements (more than 2 g day) may worsen constipation. Chronic use of laxatives should be avoided. Most interfere with normal colonic function and reduce absorption of nutrients. They can also precipitate development of irritable bowel syndrome.

Treatment of Symptoms and Constipation as Causes for Secondary Anorexia Cachexia

In patients with advanced, progressive, incurable disease, the causes of anorexia, decreased oral intake and loss of weight are complex. Besides the primary (paraneoplastic) catabolic processes, a number of important causes for loss of appetite or weight may occur, such as severe symptoms (i.e. pain, shortness of breath, depression), syndromes (i.e. constipation, mucositis, bowel obstruction) or prolonged bed rest 12 . Poor assessment of interfering symptoms (see Chp. 9.11) by not acknowledging risk factors for symptom expression and insufficient symptom management (i.e. pain, depression, social distress), or negligence of the syndromes constipation 13 or sedation 14 can lead to sub-standard management.

Diet Constipation

The primary cause of both constipation and diverticulosis are highly refined and processed diets that are low in dietary fiber. Dietary fiber passes into the colon intact and absorbs water - increasing the bulk of the stool and softening it.1 This stimulates peristalsis in the colon, pushing the stool forward more rapidly. Dietary fiber is found in large amounts in whole grains, corn, vegetables, fruits (dried prunes, apples, raisins, and figs), seeds, and legumes. Increasing intake of these foods will soften the stool, and often eliminate constipation. Supplements of fiber, such as corn or wheat bran and psyllium-seed preparations, can also be beneficial. However, because large amounts of fiber can produce gas and abdominal discomfort, fiber intake should be increased gradually as tolerated overa period of several weeks. Ample fluid intake (8-10 large glasses per day) should accompany increases in dietary fiber.2

Stimulant Laxatives

The anthraquinone group of laxatives includes senna, danthron, cascara, rhubarb5 and aloes. In the small intestine soluble anthraquinone derivates are liberated and absorbed. These are excreted into the colon and act there, along with those that have escaped absorption, probably after being chemically changed by bacterial action. Senna, available as a biologically standardised preparation, is widely used to relieve constipation and to empty the bowel for investigative procedures and surgery. It acts in 8-12 h. 5 In the late 18th century Britain made approaches to trade with China which were met with indifference it seems that the mandarins held the belief that the British feared death from constipation if deprived of rhubarb (Rheum palmatum), one of China's exports. Misuse of laxatives the bowels are only incompletely opened by nature, and so indulge in regular purgation. This effectively prevents the easy return of normal habits because the more powerful stimulant purges empty the...

Osmotic Laxatives

Some inorganic salts retain water in the intestinal lumen or, if given as hypertonic solution, withdraw it from the body. When constipation is mild, magnesium hydroxide will suffice but magnesium sulphate (Epsom4 salts) is used when a more powerful effect is needed. Both magnesium salts act in 2-4 h. The small amount of magnesium absorbed when the sulphate is frequently used can be enough to cause magnesium poisoning in patients with renal impairment, the central nervous effects of which somewhat resemble those of uraemia. Magnesium sulphate 50 (hypertonic) is available as a single dose retention enema to reduce cerebrospinal fluid pressure in neurosurgery. Osmotic laxatives are frequently used to clear the colon for diagnostic procedures or surgery. Enemas containing phosphate or citrate effectively evacuate the distal colon and can be useful for treating obstinate constipation in elderly or debilitated patients. Oral preparations containing magnesium sulphate and citric acid...

Cereals Bread Wheat Bran and Wheat Germ

Whole grains are the best natural sources of complex carbohydrates and fiber. Populations eating large amounts of whole-grain products (e.g., Africa and Asia) have far fewer intestinal and bowel problems-such as constipation, hemorrhoids, diverticulitis, and colon cancer-compared to Western populations consuming mainly refined carbohydrates.30

Cannabis And North America

In 1860, a committee of the Ohio State Medical Society published a report on the medical uses of cannabis. Information was provided on its use to treat puerperal psychosis, various pains (inflammatory, neuralgic, abdominal), gonorrhoea, cough and so forth. One of the contributors, Dr Fronmueller, compared cannabis favourably to opium as an analgesic. He suggested that although cannabis was a less reliable and less potent analgesic, the side effect profile was better. Unlike opium, cannabis did not reduce appetite, produce constipation, cause nausea or vomiting, affect lung function and the nervous system is also not so much affected (McMeens, 1860).

Irritable Bowel Syndrome

IBS can be subclassified into three groups based on altered bowel habit constipation predominant, diarrhea-predominant, and alternating (5,8-11). Another subclass has now been added, postinfectious IBS (12). However, despite this heterogeneous population of patients, enhanced colonic mechanosensation is a hallmark of all subtypes of IBS and as such increased perception of mechanical distension of the distal colon rectum has become the best-characterized clinical manifestation of IBS (1,13,14). The extent of this enhanced colonic sensation is considerable, as a colorectal distending volume of approximately 60 mL evokes pain in less than 10 of normal subjects compared with greater than 50 of IBS patients. Therefore there is leftward shift in the psychophysical function of IBS patients suggesting the presence of hyperalgesia in IBS (13). There is a general agreement that this visceral hyper-sensitivity and hyperalgesia correlates well with the overall severity of the disease (1,15),...

Xanthinecontaining Drinks

Excessive prolonged consumption of caffeine causes anxiety, restlessness, tremors, insomnia headache, cardiac extrasystoles and confusion diarrhoea may occur with coffee and constipation with tea. The cause can easily be overlooked if specific enquiry into habits is not made including children regarding cola drinks. Of coffee drinkers, up to 25 who complain of anxiety may benefit from reduction of caffeine intake. An adult heavy user may be defined as one who takes more than 300 mg caffeine day, i.e. 4 cups of 150 ml of brewed coffee, each containing 80 20 mg caffeine per cup or 5 cups (60 20) of instant coffee. The equivalent for tea would be 10 cups at approximately 30 mg caffeine per cup and of cola drinks about 2.01. Plainly, caffeine drinks brewed to personal taste of consumer or vendor must have an extremely variable concentration according to source of coffee or tea, amount used, method and duration of brewing. There is also great individual variation in the...

Clinical Features

Ataxia of gait is usually the presenting cerebellar symptom, followed by ataxia of limbs, dysarthria, and ocular signs such as nystagmus, ocular dysmetria, fixation instability, and jerky pursuit movements. The parkinsonian features include rigidity, bradykinesia-akinesia, postural instability, hypokinetic dysarthria, and tremor. The autonomic failure consists of orthostatic hypotension, bladder dysfunction (urinary frequency, urgency, retention), bowel dysfunction (constipation), and sexual (male erectile) dysfunction. Spasticity, hyper-reflexia, sleep disorder, respiratory stridor, and hypoventilation add to the syndrome. The course averages from 6 to 10 years. MRI demonstrates cerebellar atrophy and

General Symptom Data on Children at the End of Life

A retrospective chart review examined the signs and symptoms occurring at the end of life in 28 children dying from cancer in Japan. All children experienced anorexia, 82.1 had dyspnea, and 75 had pain. Other symptoms included fatigue (71.4 ), nausea vomiting (57.1 ), constipation (46.4 ), and diarrhea (21.4 ) (4). This symptom profile parallels that of the North American reviews of the symptoms of dying children (2,5,6).

Gastrointestinal system

The higher tonus and the uninhibited activity in the anal sphincter after cervical and thoracic lesions might give rise to severe pain that seems to originate from the anal sphincter. The pain is made worse by anal fissures and hemorrhoids, and this pain, as well as anal incontinence and constipation, might later lead to colostomy. However, the pain problem is not always resolved even though the rectum and anal region are bypassed.

Evidence for Alterations in Descending Pain Modulation

Demonstrate the activation of brain stem regions in the context of central sensitization in healthy human volunteers (68). Using 3T fMRI, they compared whole brain responses, including the brain stem, to punctuate mechanical stimulation in an area of secondary hyperalgesia (induced by heat capsaicin sensitization model) or in a control area. They found greater activation during stimulation of the hyperalgesic region in several cortical regions, including posterior insula and anterior and posterior cingulate cortex, as well as the thalamus and pons. The brain stem activation was localized to the NCF and the PAG, two regions that receive inputs from corticolimbic networks (including the rostral ACC), send projections to the rostro-ventral medulla, and are part of a corticolimbic pontine pain modulation circuit (69,70). These intriguing findings correlate nicely with recent findings in rodents demonstrating the upregu-lation of spino bulbo spinal loops, which play a role in the...

Sex Differences in Brain Responses to Visceral Stimuli

Berman et al. reported the first study of brain responses in two samples of a total of 30 IBS patients (13 females 6 with constipation-predominant bowel habit) with H215O-PET in response to rectal distension (18). Despite similar subjective stimulus ratings by male and female patients, regional brain activations were stronger in males. In males, but not females, rectal distension was associated with activation of regions within the central pain matrix (including anterior insula and dACC). Insula activation correlated most strongly with the objective intensity of the stimulus (rectal pressure), whereas ACC activation correlated most strongly with the subjective discomfort rating of the stimulus. The authors interpreted their

Stages Of Diverticulitis

Patients usually present with visceral pain that localizes later to the left lower quadrant and that is associated with fever, nausea, vomiting, or constipation. A right lower quadrant presentation would not exclude this diagnosis because ascending colon or cecal diverticulitis can occur. If a colovesical fistula is present, the patient may present with pneumaturia or fecaluria (a virtually pathognomic finding). On examination, the patient may have localized left lower quadrant tenderness or more diffuse abdominal tenderness with peritoneal irritation signs, such as guarding or rebound tenderness. The differential diagnosis includes painful diverticular disease without diverticulitis, acute appendicitis, Crohn disease, colon carcinoma, ischemic colitis, irritable bowel syndrome, and gynecologic disorders such as ruptured ovarian cyst, endometriosis, ectopic pregnancy, and pelvic inflammatory disease.

Diseases with Akinetic Rigidity Idiopathic Parkinsons Disease

Lewy Body Pathology

Combinations of extrapyramidal disorders and auto-nomic dysfunctions, frequently accompanied by neuro-psychiatric symptoms, define the disease. The cardinal motor symptoms are cogwheel rigidity of muscle tone, bradykinesia akinesia, postural instability, and pill-rolling tremor at rest. A stooped posture, shuffling and festinating gait, lack of facial expression, micrographia, weak monotonous speech, and dysphagia are additional characteristic features. In some patients, akinetic-rigidity predominates in others, resting tremor. Characteristic autonomic dysfunctions include orthostatic hypotension, seborrhea, sialorrhea, hyperhydrosis, constipation, bladder disorder, sleep disorder, and, rarely, sexual dysfunction. Anxiety, depression, psychosis, hallucination, and cognitive decline may emerge at any time during the course of the disease, which ranges from 10 to 20 years. No specific diagnostic tests are available. PET and SPECT show diminished striatal dopamine uptake.

Anionexchange resins bile acid sequestrants

About half the patients who take Colestyramine experience constipation and some complain of anorexia, abdominal fullness and occasionally of diarrhoea these effects are dose-related but may limit or prevent its use. Because the drug binds anions, drugs such as warfarin, digoxin, thiazide diuretics, phenobarbitone and thyroid hormones should be taken 1 h before or 4 h after Colestyramine to avoid impairment of their absorption.

Assessment Instruments for Eating Related Distress

Traditional instruments, such as the FAACT (Functional Assessment of Anorexia Cachexia Therapy) for anorexia cachexia, or widely used quality-of-life instruments, such as the EORTC-QlQ-c30, carry some items related to distress, but they were not specifically developed for the purpose of assessing distress. The FAACT 19 , as an example, asks at least three distress-related questions 'I am worried about my weight' (item 3), 'I am concerned how thin I look' (item 5), and 'my family or friends are pressuring me to eat' (item 8). In the general section of the FACT, there is a question regarding the impact of physical function on social contacts (item 3). In the EORTC-QlQ-c30, questions assessing interference with (physical) function (items 6, 7) or social contacts (items 26, 27) may depict issues related to cachexia and weakness, but not directly to eating. As a solitary symptom, only the impact of pain on daily life (item 19) is included in the EORTC-QLQ-C30, but there are no items...

Evidence for Autonomic Nervous System Dysfunction

Increased sympathetic activity has been demonstrated in patients with IBS. Heitkemper et al. studied urinary catecholamine (NE and epinephrine) and cortisol levels in women diagnosed with IBS against women who reported similar symptoms but did not seek health care services and asymptomatic control women (122). Women with IBS had significantly higher urinary levels of all of these neuroendocrine indicators of arousal suggesting heightened sympathetic nervous system activation. Whether greater symptom distress in the IBS women resulted in increased sympathetic activation and health care seeking or the higher sympathetic activation increased pain perception leading to health care seeking is unclear. These investigators later demonstrated significantly lower parasympathetic tone and higher ANS balance in constipation-predominant compared to diarrhea-predominant subgroups of IBS but only when symptom severity scores were high. No difference was seen between IBS and control women, and...

Morphine On Smooth Muscle

Morphine activates receptors on the smooth muscle of the stomach (antrum) and of both large and small bowel, causing it to contract. Peristalsis (propulsion) is reduced and segmentation increased. Thus, although morphine 'stimulates' smooth muscle, delayed gastric emptying and constipation occur, with gut muscle in a state of tonic contraction. Delay in the passage of the intestinal contents results in greater absorption of water and increased viscosity of faeces, which contribute to the constipation. The management of such opioid- induced constipation is an important aspect of palliative care.

Social Causes of Weight Loss

Hospitalised AIDS patients, who take in only 70 of resting energy expenditure (REE) needs and 65 of protein needs, excluding the extra needs resulting from the hypermetabolism associated with fever, acute infections, and physical activity. Dietetic deficits in protein and calorie consumption interfere with the natural course of the main disease, emphasising subjective symptoms such as sickness, asthenia, anorexia, emesis, and constipation, which in turn interfere with feeding. A close relationship exists between susceptibility to infectious diseases and nutritional status regular nutrition and general good health make individuals more resistant to infections. Similarly, anergy to cutaneous tests (PPD, candidin, DNCB, etc.) is closely related to body-weight insufficiency and hypoalbuminaemia. The pre-surgical correction of denutrition reduces the incidence of post-surgical infectious complications, favouring the healing of the wounds and a quicker return to health 18-20 .

Ida J Llewellyn Smith1 Lynne C Weaver2 and Janet R Keast3

And severity of these problems is dependent on the level and completeness of the injury. Two cardiovascular consequences of spinal cord injury are resting or postural hypotension and autonomic dysreflexia, a condition in which strokes or death can occur when noxious or innocuous sensory stimuli entering the cord below the injury reflexly induce episodes of hypertension. Spinal cord injury can also produce a variety of difficulties that impair the voiding of urine, including detrusor hyperreflexia, detrusor sphincter dyssy-nergia and detrusor areflexia. Fecal incontinence and constipation are also outcomes of spinal cord injury and inability to achieve psychogenic and

Molecular Basis For The Side Effects Of Anticholinergics

The untoward effects associated with the use of anticholinergics are manifestations of their pharmacological actions, and usually occur on excessive dosage. The effects include dryness of mouth, blurred vision, difficulty in urination, increased intraocular tension, tachycardia, and constipation. Most of these side effects are lessened when the quaternary anticholinergics are administered orally in the treatment of peptic ulcer because of low absorption into the systemic circulation. In the case of tertiary amines the central side effects

Palliative Nutritional Endpoints and Decision Making

About the goals of an intervention is important to avoid both extremes neglect and overactivity. The focus on amount of intake, optimisation of nutrients or weight is curative in nature, since it does not aim to relieve primarily suffering. Treatment of the sensation of loss of appetite, decreasing the distress related to social interactions associated with meals, is palliative in nature. However, the optimal management of constipation leading to (almost) complete reversal of anorexia, or stenting the colon to improve bowel obstruction, aim to relieve suffering but are curative in nature. In both cases a pure palliative approach to relieve anorexia, visceral pain, and nausea in constipation and bowel obstruction would probably be of minor quality in many patients.

Prevention Of Further Absorption Ofthe Poison

Activated charcoal, although unpalatable, appears to be relatively safe but constipation or mechanical bowel obstruction may be caused by repeated use. Aspiration of charcoal into the lungs can cause hypoxia through obstruction and arteriovenous shunting. Charcoal adsorbs and thus inactivates

Palliative Symptom and Syndrome Management

Constipation often causes symptoms such as anorexia, early satiety or nausea before it is perceived as a symptom (feeling of incomplete evacuation, fullness of the bowel, etc.). It needs to be diagnosed as a syndrome (history, X-ray abdomen, rectal examination), not as a symptom.

The Diagnosis of Cancer Cachexia and its Implications

Pre-treatment weight loss has long been identified as an important prognostic factor in oncology 6 and the objective clinical consequences of cachexia are profound - reduced survival, impaired response to anti-cancer therapy, impaired immunity, lower performance status, increased symptomatology, reduced physical activity, impaired quality of life. It is important to identify potentially reversible conditions that can exacerbate cachexia (e.g. mechanical causes of inadequate nutritional intake, malabsorption, metabolic disorders such as hyper-calcaemia, and depression) and to manage adequately other problems that may confront cancer patients (e.g. pain, nausea, constipation and infection). Common treatment-related side-effects (e.g. gastrointestinal sequelae of chemotherapy or radiotherapy such as nausea, mucositis, diarrhoea, food aversion) should also be anticipated. In addition, there is a suggestion that some cytotoxic drugs may themselves generate cachexia-like side-effects 7 .

Nutritional Therapy Background

Patients with advanced cancer may have an inadequate nutritional intake and fail to increase appropriately their intake in response to increased resting energy demands 18 . Intake may be reduced by 'primary' mechanisms induced by the cachexia syndrome (and manifesting as anorexia or early satiety) or may be 'secondary' to problems such as mechanical gut obstruction or impaired swallowing, nausea, constipation, depression, gastrointestinal fungal infection and treatment side-effects (e.g. opiates, antibiotics, chemotherapy, radiotherapy). Such secondary problems should be proac-tively sought and appropriately managed. In addition, the medical team should also be alert to the risk of deteriorating nutritional status when patients are hospitalised 19,20 .

Immunomodulatory Analogs Of Thalidomide

The efficacy of thalidomide has been limited by adverse effects, which include sedation, neuropathy, constipation, and deep vein thrombosis. This spurred the development of thalidomide-derived immunomodulatory analogs, known as immunomodulatory drugs (ImiDs). Like thalidomide, IMiDs inhibit angiogenesis and act directly on MM cells to induce both apoptosis and growth arrest in resistant cells. They also block the adhesion of myeloma cells to bone marrow stromal cells and the associated protection against apoptosis, and thus affect myeloma cell growth, survival, and migratory factors such as IL-6, tumor necrosis factor a (TNFa), and VEGF. In addition, they expand natural killer cell and T-cell numbers, and improve function against human myeloma cells and enhance their susceptibility to antibody-dependent cell-mediated cyto-toxicity in vivo.54-56 The addition of an amino group at position 4 of the phthaloyl ring in thalidomide structure led to the generation of CC-4047, and with the...

Changing Therapeutics in the Management of Intractable Pain in Children at the End of Life 19952005

Children do not necessarily report opioid side effects voluntarily (e.g., constipation, pruritus, dreams, etc.) and should be asked specifically about these problems. An assessment of opioid side effects is included in an assessment of analgesic effectiveness. All opioids can potentially cause the same constellation of side effects. If opioid side effects limit opioid dose escalation, then consideration should be given to an opioid switch. Tolerance to some opioid side effects (e.g., sedation, nausea and vomiting, pruritus) often develops within the first week of starting opioids. Children do not develop tolerance to constipation, and concurrent treatment with laxatives should be provided.

Proton pump inhibitors PPIs

Adverse effects include nausea, headache, diarrhoea, constipation and rash but are uncommon. Omeprazole inhibits the 2C family of the cytochrome P450 system, decreasing the metabolism of warfarin, diazepam, carbamazepine and phenytoin, and enhancing the action of these drugs (but inhibition is less than with cimetidine).

Therapeutic Applications of ASBT

These agents is poor compliance of patients stemming from adverse side effects, such as high dosages of 10-30 g per day, constipation, maldigestion, and malabsorption syndromes. As an alternative method to bile acid s questrants, any reagent that can inhibit the bile acid active transport system could block the reabsorption of bile acids and consequently reduce the serum cholesterol level. So far, several molecules have been found to possess this effect in animal studies (108-110,295).

Bile Salt Malabsorption

This condition affects 20 of the population and is the commonest reason for referral to a gastroenterologist. It is manifested by a variety of gastrointestinal symptoms including disordered bowel habit (constipation, diarrhoea or both), abdominal pain and bloating. Upper gastrointestinal symptoms manifest as nonulcer dyspepsia (see Chapter 31). All these symptoms occur in the absence of demonstrable pathology in the gastrointestinal tract, although patients with IBS often have abnormalities of gut motility. Another feature of the condition is visceral hypersensitivity patients with IBS have lower thresholds for pain from colonic distension induced by inflating balloons placed in the bowel. A proportion of patients develop their IBS symptoms after an episode of gastroenteritis and in many emotional stress is an important precipitating factor. Associated psychopathology, with anxiety and sometimes depression, are common. The mainstay of treatment, after investigation when appropriate,...

Changing Contours Of The Primigravid Abdomen

Hegar Sign

Heartburn, constipation Relaxation of the lower esophageal sphincter allows stomach contents to back up into the lower esophagus. The decreased GI motility caused by pregnancy hormones slows peristalsis and causes constipation. Constipation may cause or aggravate existing hemorrhoids.

Symptoms And Management

Most patients with cancer actually have several pains. Most have chronic pain with transient flares of acute pain.17 In approximately one-third, neuropathic pain will be prominent, though many will have a mixed pattern of neuropathic and nociceptive pain.18 Both the type of pain, pain intensity, and the temporal nature of pain govern the analgesic dosing strategy. Therapy needs to be individualized.19 20 Opioids should be used for moderate to severe pain.1920 Eighty percent of patients with severe pain will have pain controlled by morphine or other potent opioids. Opioid titration to response is a cardinal principle of treatment. An effective drug will be ineffective if underdosed potent opi-oids do not have a ceiling dose. Twenty percent of patients will require a complex approach to pain management of opioid (route) conversion, opioid rotation to an alternative opioid, opioid sparing (by adding an adjuvant analgesic), or maintenance of opioid dosing with simultaneous treatment of...

Managing The Actively Dying

Dying patients require symptom management, physical expressions of love, the presence of significant others, truth telling, and dignity through meticulous maintenance of personal hygiene.98,99 Patients should not be subject to venipuncture and procedures for curiosity sake when the goals of care are comfort. Family education, frequent visits, and intensive low-technology care are other elements to good end of life care. Symptoms change during the course of illness. At the end, pain, delirium, nausea, vomiting, and secretions are the important symptoms to control.99-101 Opioids should be maintained despite changing mentation. Families often mistake the dying process for drug toxic-ity and need to understand the difference. Terminal agitation or restlessness may arise from a full rectum or bladder, poorly controlled pain, or delirium. Patients should be examined for fecal impaction and a distended bladder, and measures should be taken to relieve either one if present. As patients become...

The Standard of Care in Cachexia Trials

When designing an intervention trial it is important to bear in mind the hypothesis that the trial is attempting to prove. Most commonly, an intervention is compared with a placebo the two cohorts of patient subjects should otherwise receive the same standard of care. However, the standard of care pertaining to the general management of cachexia remains currently undefined. The issue of standardisation of care in cancer cachexia is a complex field that can be divided into general medical issues and specific issues. General medical issues include patients' pain, constipation, depression, fatigue, malabsorption and diabetes, to name but a few. All must be adequately controlled if any

Comprehension Questions

17.1 A 60-year-old male comes into your office with the complaint of fatigue and constipation. He has had no dietary changes recently. A history reveals that he has hypertension, treated with medications, and an inguinal hernia that was repaired 10 years earlier without complications. The examination was nonspecific. You decide to obtain an electrolyte panel and find that the calcium level is elevated at 11.5 mg dL (normal 8.5-10.2). Other labs were normal. What is the next step

Pheochromocytoma and Weight Loss

Gastrointestinal symptoms can also contribute to weight loss. They include nausea, vomiting, abdominal pain, and, occasionally, constipation or diarrhoea. Constipation may reflect direct inhibitory effects of catecholamines on gut smooth-muscle contraction. The so-called watery diarrhoea, hypokalaemia, achlorydria syndrome ( WDHA , also known as Verner-Morrison syndrome) in patients with PCC is secondary to the ectopic production of vasoactive intestinal polypeptide (VIP) 35 . These symptoms, including weight loss, resolve after the tumour is removed 26,35 .

Physical Examination Multiple Choice

A 68-year-old homemaker presents to your clinic complaining of difficulty swallowing. It began several months ago when she would attempt to eat steak. Over time, it has progressed to the point that she can only sip on soups and broths. She has sometimes had to regurgitate her food back up to get relief from the pain in her chest when she attempts to eat. Her past medical history is significant for diet controlled, type-2 diabetes. She had a 60-pack-year smoking history but quit smoking 15 years ago. She denies any drug or alcohol abuse. On review of systems, she has lost approximately 15 lbs in the past 3 months. She denies any heartburn, constipation, or diarrhea. On exam, you find a pleasant elderly woman in no acute distress. Her cardiac, pulmonary, and abdominal exams are all normal. What disorder of dysphagia is the most likely cause for her symptoms 5. A 26-year-old woman follows up at your office for her 6-week postpartum visit. She complains of severe constipation problems...

The Anus Rectum and Prostate Multiple Choice

A 24-year-old housewife and mother presents to the clinic for evaluation of rectal bleeding. She has intermittent constipation and frequently has to use a laxative to have a bowel movement. On examination of the anus, you see a reddish, moist, protruding mass located at the 5 o'clock position. What is your most likely diagnosis

Current Drugs on the Market

Opioid antagonists (Table 7.4), predominantly naloxone, are used clinically to reverse the effects of opiates in overdose or postoperative sedation. Naltrexone, which has oral bioavailability, is used for the treatment of narcotic addiction and alcohol dependence. As discussed below (Section, peripherally selective antagonists are being evaluated for treatment of constipation and other gastrointestinal side effects associated with opioid agonist use.

Principles of Pediatric Pain Management

Stool stimulants are to be considered when extended use of an opioid is projected. Stool softeners may be inadequate because they do not cause propulsion of feces. Stool stimulants are warranted when defecation is absent after 3 days of opioid administration because tolerance of side effects, such as constipation, can take 1 week or more to occur (50).

Answers To Case 40 Irritable Bowel Syndrome

Summary A 28-year-old female presents with a several-year history of abdominal pain and constipation. She denies any fever, weight loss, heartburn, or bloody stools. Her past medical history and family history are otherwise unremarkable. The physical examination, including abdominal and pelvic examination, are grossly within normal limits.

Other Electrolyte Disturbances Resulting From Gastrointestinal Disturbances

This condition is characterized by recurrent episodes of binge eating followed by self-induced vomiting, use of laxatives and or diuretics, and vigorous dieting or fasting to overcome the effects of excessive eating. It is associated with adolescent and young adult females more than any other group, even though it can occur at any age. Bulimia can cause several ill effects, including electrolyte imbalance, especially potassium depletion from vomiting and laxatives. Life-threatening consequences can arise from the hypokalemia and metabolic alkalosis, with resulting cardiac arrhythmia and shock. Fluid and electrolyte replacement can reverse the acute hypokalemia if administered early. The psychological aspects of the illness require long-term treatment in order to prevent relapses.28

Approach To Suspected Irritable Bowel Syndrome

Patients with IBS complain of constipation, diarrhea, alternating constipation with diarrhea, and periods of normal bowel habits that alternate with either constipation and or diarrhea. The abdominal pain associated with IBS is frequently in the lower part of the abdomen, with the left lower quadrant being the most common location. However, both the location and the nature of the pain in IBS is subject to great variability. The pain is described as a cramping sensation of intermittent frequency and variable intensity, often improved or relieved with defecation. Other gastrointestinal symptoms seen in IBS include the passage of mucus with stool, bowel urgency, bloating, dyspepsia, gastroesophageal reflux, and the sensation of incomplete stool evacuation. For constipation-predominant IBS, increasing fiber intake, either via dietary fiber, synthetic fiber, or natural fiber, is recommended. For diarrhea-predominant IBS. loperamide may reduce the frequency of loose stools, as well as...

Presenting Signs and Symptoms

The most common presenting signs and symptoms of an ovarian tumor are abdominal pain, palpable abdominal mass, increasing abdominal girth, urinary frequency, constipation and dysuria 10, 28 . Some tumors, however, are asymptomatic and only discovered during routine examinations. Abdominal pain is most often chronic, but torsion of the ovary can be associated with acute pain. Since normal sex cord-stromal cells are involved in steroid hormone produc

H2 receptor antagonists

Adverse effects and interactions are few in short-term use. Minor complaints include headache, dizziness, constipation, diarrhoea, tiredness and muscular pain. Bradycardia and cardiac conduction defects may also occur. Cimetidine is a weak antiandrogen, and may cause gynaecomastia and sexual dysfunction in males. In the elderly particularly, it may cause CNS disturbances including lethargy, confusion and hallucinations. Cimetidine inhibits cytochromes P450, in particular CYP 1A2 and CYP 3A4 and there is potential for The drugs are well tolerated but headache, dizziness, reversible confusion, constipation and diarrhoea may occur. In addition, urticaria, sweating and somnolence are reported with nizatidine. The drugs do not inhibit hepatic microsomal enzymes and do not block androgen receptors.

Burning with urination

Many questions concerning symptoms related to the anorectal area and the prostate have been addressed in other chapters. For example, you will need to ask if there has been any change in the pattern of bowel function or the size or caliber of the stools. What about diarrhea or constipation You will See Table 9- , Black and Bloody Stools, and Table 9- , Constipation.

Modulation of Brain Responses by Pharmacological Treatments

Morgan et al. studied 22 females with pain-predominant IBS (Rome II positive, 11 with diarrhea, 7 with constipation, and 4 with alternating bowel habit) (75). No patients had significantly elevated symptoms for depression, anxiety, and general psychological distress on the Symptom Check List-90 (SCL-90) instrument. The study was designed as a randomized, placebo-controlled, double-blind crossover trial. Patients initially took 25 mg (one week), and later 50 mg, of amitriptyline at bedtime for three weeks, followed by a three-week washout before switching over to the alternate treatment. Cerebral activation during controlled rectal distension (15, 30, and 50 mmHg distension pressure) was compared between placebo and amitriptyline groups by fMRI. Distensions were performed alternately during auditory stress (babies crying) and relaxing music (stress reduction tape), and a total number of nine distensions in random order were given during each condition. Subjective ratings of rectal pain...

The Gastrointestinal Tract

Nutrients that are not absorbed through the small intestine mucosa pass into the large intestine. This undigested material consists of mainly of water and cellulose. Resident bacteria of the large intestine complete the degradation process. The chief function of the large intestine is the reabsorption of water from the undigested material. Failure to reabsorb water causes watery diarrhea, while absorption of too much water may produce constipation.

Clinical Correlation

Hypokalemia is caused by renal loss such as renal tubular acidosis, hyperaldos-teronism, hypercortisolism, and certain diuretics. Potassium can also be decreased due to gastrointestinal dietary deficit or loss from severe vomiting, diarrhea, nasogastric suctioning, laxatives, and malabsorption. A cellular shift in cases of insulin overdose and alkalosis can also cause hypokalemia.23

Medicinal Use of Basil

Traditionally basil has been used as a medicinal plant for various ailments, such as headaches, coughs, diarrhea, constipation, warts, worms and kidney malfunction. It is also thought to be an antispasmodic, stomachicum, carminative, antimalarial, febrifuge and stimulant (Wome 1982, Giron et al., 1991). Ethnobotanical surveys report the traditional utilization of basil as a veterinary medicinal plant as well (Baerts and

Thalidomide And Dexamethasone

Thalidomide 100-200 mg daily with dose increase to 400 mg day allowed (median maximum dose achieved was 200 mg day), and dexamethasone 20 mg m2 on the same schedule as in the Mayo trial.69 As would be predicted from trials involving patients with relapsed refractory MM,65' 66 thalidomide therapy caused neuropathy, sedation, and constipation. Thrombotic complications occurred in 12 and 15 of patients treated in these two induction trials. In the MDACC study, a 25 thrombosis rate was observed in the first 24 patients treated, despite prophylaxis with 1 mg of coumadin daily. The next 16 patients received therapeutic doses of coumadin or low-molecular-weight heparin and no thrombotic events occurred.69 Based on the results of these Phase II trials, a randomized study comparing TD to dexamethasone alone was undertaken by ECOG. In this study, after four cycles of randomized therapy, patients with at least stable disease were given the option of proceeding to HDC ASCS. Although a...

Lenalidomide Cc5013 Revlimid

Is very different than that of thalidomide, with thrombocytopenia and neutropenia predominating, and essentially no sedation, constipation, or neuropathy. The response rate among 34 patients with newly diagnosed MM treated with lenalidomide 25 mg daily for 21 out of every 28 days with pulse dexamethasone (40 mg day on days 1-4, 9-12, 17-20) was 91 (CR 6 ).122 ECOG has completed accrual to a large randomized study of lenalidomide with two different doses of dexamethasone, and the Southwest Oncology Group is currently conducting a 500-person randomized, double-blinded study comparing dexamethasone to dexamethasone plus lenalidomide (LD). The results of these two studies will establish whether LD could be an appropriate front-line regimen for patients with MM.

Hydroxytryptamine Receptors

In terms of drug development, 5-HT3 and 5-HT4 receptors have been in the focus of interest, because their pharmacologic manipulation may correct both the functional disturbances in the gut and the pain associated with FBDs (12). This is particularly true for 5-HT3 receptors, which are present on vagal afferent neurons originating in the nodose ganglia, spinal afferents originating in the DRG, enteric neurons, and other cells of the gut. 5-HT-evoked excitation of extrinsic sensory neurons is primarily mediated by 5-HT3 receptors (10,12,18). Antagonism of 5-HT3 receptor-mediated stimulation of vagal afferents inhibits emesis induced by release of 5-HT from enterochromaffin cells (10), and blockade of 5-HT3 receptor-mediated activation of spinal afferents by alosetron depresses the afferent signaling of colorectal distension in the rat (19). Accordingly, alosetron has been found to reduce the discomfort and pain in female patients suffering from functional dyspepsia or...

Vegetarian Diets

What are the health benefits of a vegetarian or semivegetarian diet Vegetarians are less at risk for heart attack and diabetes.41 The risk of vegetarians suffering a heart attack is around two-thirds lower than that of meat eaters.42 High blood pressure, obesity, and high blood cholesterol are also less likely in vegetarians. Vegetarians suffer less from many digestive disorders, including gallbladder disease, constipation, and colon cancer.4143 Studies in


Patients with hypothyroidism can present with a wide range of symptoms, including lethargy, weight gain, hair loss, dry skin, slowed mentation or for-getfulness, constipation, intolerance to cold, and a depressed affect. In older patients, hypothyroidism can be confused with Alzheimer disease and other conditions that cause dementia. In women, it is often confused with depression. Physical findings that can present in hypothyroid patients include low blood pressure, bradycardia, nonpitting edema, hair thinning or loss, dry skin, and a diminished relaxation phase of reflexes.


Item 12 of the Hamilton depression rating scale records appetite disturbances and considers different gastrointestinal symptoms, such as constipation, diarrhoea, or a heavy feeling in the abdomen, as a whole. Nonetheless, simple selection according to this item leads to a subgroup of untreated depressed patients with or without gastrointestinal symptoms. In a recent study 7 , the authors compared platelet 5-HT concentration and apparent kinetic parameters of 5-HT uptake in these two subgroups in order to test the hypothesis that platelet serotonergic parameters are affected by certain somatic symptoms of major depression. The results could provide important information, because 5-HT in the gut seems to be a mucosal transmitter that stimulates sensory nerves and initiates peristaltic and secretory reflexes 8 . Based on findings that 5HT knock-out mice (lack of serotonin transporter) show an increase in intestinal motility (diarrhoea) along with episodes of decreased motility...

Anorexia Nervosa

In the restricting type of AN, the affected person has not regularly engaged in binge eating or purging behaviour during his or her active episode of the disease (i.e. self-induced vomiting or the misuse of laxatives, diuretics, or enemas). By contrast, in the binge-eating purging type of AN, the affected person has regularly engaged in binge eating or purging behaviour (i.e. self-induced vomiting or the misuse of laxatives, diuretics, or enemas).

The Uterus

Endometriosis, while not exclusively an uterine phenomenon, is a common clinical disorder that is often accompanied by severe dysmenorrhea (painful menstruation), painful defecation, chronic pelvic pain, and dyspareunia (pain during sexual intercourse), and thus is relevant to this discussion. It is characterized by the growth of uterine tissue outside of the uterus and has been modeled in both the rat (100) and the mouse (101), although behavioral data is only currently available in the rat (102). One uterine horn is removed surgically from animals and placed in culture medium at 37 C, where it is cut into equal-sized fragments (three to six, depending upon species and laboratory), each of which is then sutured to a blood vessel in the mesentery of the small intestine, lower abdominal wall, ovary, or all three (note that autotransplants to the abdominal wall rarely produce cysts, and only small ones when they do). Following wound closure, the animal is allowed to recover. In all...


As with alcohol and heroin use, prolonged use of nicotine leads to neuroadaptation in the brain, caused by pharmacological, contextual, and behavioral factors. This neuroadaptation is responsible for the tolerance and physical withdrawal symptoms. Physical withdrawal symptoms of nicotine include a decrease in the heart rate, increased appetite, constipation, and hyperreactivity of the bronchial tubes. Some of the mental withdrawal symptoms are bad mood or depression, insomnia, irritability, anxiety, restlessness, and aggravation of psychiatric co-morbidity.


Chronic use of morphine and other opioids is marked by acquired tolerance to the depressant agonist effects, e.g. analgesic action and respiratory depression (the fatal dose becomes higher), but not to some stimulant agonist effects, e.g. constipation and miosis, which persist.

Clinical Care

Another survey of pain practices conducted across Canada heard from 26 organizations that provide pediatric cancer care, including care in the context of palliative and end-of-life management. There were no protocols in 21 of the centers to manage the most common problems related to this aspect of care, including seizures, excessive secretions, constipation, respiratory distress, and nausea and vomiting. The difficulties in providing adequate care within the home was noted by several respondents.

Drug Therapy

Antimuscarinic drugs are suitable only for younger patients predominantly troubled with tremor and rigidity. They do not benefit bradykinesia, the main disabling symptom. The unwanted effects of acute angle glaucoma, retention of urine, constipation and psychiatric disturbance are general contraindications to the use of antimuscarinics in the elderly.

Digestive System

Liver function also declines in older adults, decreasing clearance of many drugs and increasing the potential for adverse drug-nutrient interactions (see appendix I). Constipation is a common complaint in older adults. Immobility, dehydration, and foods low in fiber contribute to this problem. Increasing physical activity, consuming more dietary fiber - eating whole-grain products, legumes, fruits, and vegetables - and drinking from six to eight glasses of water per day is beneficial. Additional vitamin C (0.5 g-1.0 g) per day may also help soften and ease passage of the stool.

False Transmitter

Methyldopa is reliably absorbed from the gastrointestinal tract and readily enters the CNS. The t is 1.5 h. Adverse effects, largely expected from its mode of action, include sedation (frequent), nightmares, depression, involuntary movements, nausea, flatulence, constipation, score or black


Clinically, hypercalcemia is associated with lethargy, confusion, polydypsia, polyuria, constipation, and nausea.11 Untreated hypercalcemia will lead to renal insufficiency, a problem to which patients with MM are already prone. Therefore, prompt treatment once recognized is essential.

Stool Bulking Agents

Dietary fibre comprises the cell walls and supporting structures of vegetables and fruits. Most of the fibre in our diet is in the form of nonstarch polysaccharides (NSP),1 which are not digestible by human enzymes. Fibre may be soluble (pectins, guar, ispaghula) or insoluble (cellulose, hemicelluloses, lignin). Insoluble fibre has less effect than soluble fibre on the viscosity of gut contents but is a stronger laxative because it resists digestion in the small bowel and so enters the colon intact. In addition it has a vast capacity for retaining water thus one gram of carrot fibre can hold 23 grams of water.2 It has been proposed that as humans have refined the carbohydrates in their diet over the centuries, so they have deprived themselves of fibre, the ensuing under-filling of the colon being an important cause of constipation, haemorrhoids and diverticular disease. Stool bulking agents, which add fibre to the diet, are the treatment of choice for simple constipation. They act by...


Adverse effects include constipation, dry mouth and insomnia which occur in 10 of users. Less commonly, nausea, tachycardia, palpitations, raised blood pressure, anxiety, sweating and altered taste may occur. Blood pressure should be monitored closely throughout its use (twice weekly in the first 3 months). Contraindications include severe hypertension, peripheral occlusive arterial or coronary heart disease, cardiac arrhythmia, prostatic hypertrophy and those with severe hepatic or renal impairment. It should not be used to treat obesity of endocrine origin or those with a history of major eating disorder or psychiatric disease. Concomitant use with tricyclic antidepressants should be avoided (CNS toxicity).


Thalidomide also decreases TNF-a production by increasing degradation of TNF-a mRNA 146 . It reduces serum C-reactive protein and IL-6 147 . Reyes-Teran et al. 148 carried out a double-blind, placebo-controlled study with 23 HIV-infected wasting patients and found a significant weight gain and improved Karnofsky scores in the thalidomide-treated group. There was no significant change in viral load and absolute CD4+ cells count. However, 29 of the treatment group developed a rash. Other well-known side effects are peripheral neuropathy, somnolence, and constipation. Vivid memories of thalidomide-induced ter-atogenicity several decades ago make it very difficult to revive this medication for general use. The


Virtually all patients experience some degree of vitamin A toxicity, including headache, fever, weakness, and fatigue.42 These adverse effects are seldom permanent or irreversible, nor do they usually require interruption of therapy. Other common adverse drug reactions include flushing, hypotension, increase in serum cholesterol and triglycerides, and gastrointestinal toxicity such as abdominal pain, constipation, and diarrhea.42

Bisphosphonates bone

Symptoms of overdose are due mainly to excessive rise in plasma calcium. General effects include malaise, drowsiness, nausea, abdominal pain, thirst, constipation and loss of appetite. Other long-term effects include ectopic calcification almost anywhere in the body, renal damage and an increased calcium output in the urine renal calculi may be formed. It is dangerous to exceed 10 000 units daily of vitamin D in an adult for more than about 12 weeks.

Things To Come

Pounds that do not cross the blood-brain barrier, but that are still orally bioavailable. The peripherally selective antagonists methylnal-trexone and alvimopan are currently undergoing clinical trials for treatment of opioid-in-duced constipation and related GI side effects.

Phase Iii Studies

Intraoperative doses of HBOC-201 (up to a maximum of 245 g) were well tolerated. There were no patient deaths or withdrawals during the study. Adverse events were similar in both treatment groups in type of event and frequency of occurrence most were not associated with either treatment. Nausea, hypertension, oliguria, skin discoloration after large doses, and rash occurred somewhat more frequently in the HBOC-201 group fever, hypotension, constipation, insomnia, gastrointestinal disorder and hypomagnesemia occurred somewhat more frequently in the RL group. Administration of HBOC-201 was associated with a dose-dependent increase in methemoglobin concentrations (3.7 per cent 3.2 per cent). Systolic blood pressure was approximately 12 per cent higher in the HBOC-201 treated patients than controls following recovery room discharge other vital signs were not different. Isolated transient increases in aspartate aminotransferase and or lipase activities (that returned to normal levels prior...

Vinca Alkaloids

Toxicity Although vincas are structurally similar, their spectra of activity and adverse effects differ significantly. The dose-limiting toxicity of vincristine is neurotoxicity, likely due to inhibition of microtubule effects related to neuronal transmission.65 This can manifest as sensory and or motor neuropathy and is characterized by paresthesias, palsies, and pain. Autonomic complications, such as abdominal pain, orthostatic hypotension, constipation, and paralytic ileus, may also occur. For this reason, vincristine doses have traditionally been limited to 2 mg, although recent protocols are challenging this maximum dose. Other adverse effects associated with vincristine include SIADH and alopecia. Fatal cases of intrathecal administration have been reported.66 While the potential for myelosuppression exists with vincristine, it is uncommon at standard doses. Conversely, the dose-limiting toxicity for vinblastine and vinorelbine is myelosuppression. Anemia and thrombocytopenia...


The symptoms and signs that occur are unique and characteristic of the alterations to the normal physiologic function. Symptoms of right-sided heart failure include venous congestion, nausea vomiting, distension bloating, constipation, abdominal pain, and decreased appetite. Common signs of right-sided heart failure are fluid retention, weight gain, peripheral edema, JVD. hepatojugular reflux, hepatic ascites, and splenomegaly.

Other Side Effects

The most common side effect of long-term narcotic analgesia is constipation plus other gastrointestinal (GI) effects collectively referred to as opioid bowel dysfunction. The frequency of these side effects is very high 40-50 or more in patients receiving opioids (34-36) and can become the limiting factor in opioid use. These effects are mediated predominantly by jit receptors in the bowel (23).The effects begin with delayed food Patients are generally started prophylacti-cally on a regimen including a laxative such as bisacodyl or senna that increases bowel motility plus a stool softener like docusate (20, 22). In patients refractory to laxatives, oral naloxone (22) has been successfully used as a therapeutic alternative for constipation without loss of analgesia (37). Because of its central activity, however, higher doses of naloxone can decrease the analgesic effectiveness of the opiate and precipitate opioid withdrawal in some patients (37). Peripherally...

Mode Of

Are believed to result from a shift in favour of cholinergic rather than dopaminergic neurotransmission in the nigrostriatal pathway (see p. 422). Anticholinergic agents, e.g. procyclidine, orphe-nadrine or benztropine, restore the balance in favour of dopaminergic transmission but are liable to provoke antimuscarinic effects (dry mouth, urine retention, constipation, exacerbation of glaucoma and confusion) and they offer no relief for tardive dyskinesia, which may even worsen. They should be used only in response to clear dystonic or parkinsonian symptoms rather than for prophylaxis. Benzodiazepines, with their general inhibitory effects, are an alternative. Thioridazine and related Type 2 phenothiazines are less likely to provoke extrapyramidal effects as they also block cholinergic transmission (but patients may suffer antimuscarinic effects). Note that confusion from anticholinergic effects may mimic or complicate schizophrenic thought disorder.

Yvonne Holm

Ocimum basilicum is known under the following local names in the Rift Valley in central Kenya (area in brackets) Chemishwa (Tugen), Chenekom Sipko (Pokot), Embuke Emboa (Bukusu), Lemurran (Samburu), Mwenye (Luhya), Mutaa (Kamba) and Rigorio (Marakwet). The vapour of boiling leaves is inhaled for nasal or bron-chial catarrh and colds. The leaves may be rubbed between the palms and sniffed for colds. It cures stomachache and constipation. The leaves are crushed and the juice is used as vermifuge. It is further used to repel mosquitoes and as a broom to sweep chicken house in order to get rid of fleas.

Energy Intake

Resting Energy Expendature

Several factors may contribute to the decreased intake of food in cancer patients. Anorexia, due to the disease itself or its treatment, is commonly recognised. Cancer patients may frequently suffer from symptoms affecting the gastrointestinal tract, for instance due to physical obstruction, constipation, or malabsorption. The effects or consequences of treatment by opiates, radiotherapy, or chemotherapy may all explain decreased food intake in the palliative care of cancer patients. However, reports on the degree of anorexia do not always indicate low intakes. Cohn et al. assessed energy and protein intake in relation to lean body mass in 22 oncology patients and found no difference from normal subjects, unless weight loss was present 4 . Parkinson et al., in a study of the effects of oral protein and energy supplements in 30 cancer patients, reported a mean intake of 1515 Kcal day, corresponding to 25 Kcal kg day 5 . Simons et al. studied the effects of medroxyprog-esterone acetate...

Ketogenic Diet

Vitamin deficiency, hypocalcemia, and carnitine deficiency due to inadequate consumption of these agents have been reported in epilepsy studies (Levy and Cooper 2003). Other reported side effects include dehydration, constipation, and sometimes complications from kidney stones or gall stones (Levy and Cooper 2003). Adult women on the diet may have menstrual irregularities, pancreatitis, and decreased bone density (Levy and Cooper 2003). Excessive bruising and increase in minor bleeding in patients after institution of KD is probably associated with diet-induced changes in platelet function (Berry-Kravis et al. 2001). Recent studies have shown that the KD can also have some detrimental effects on cognitive ability (Zhao et al. 2004).

Adverse Effects

Adverse effects include postural hypotension (especially in the elderly) and dizziness. Less common are headache, irritability, apathy, insomnia, fatigue, ataxia, gastrointestinal disturbances including dry mouth and constipation, sexual dysfunction (especially anorgasmia), blurred vision, difficult micturition, sweating, peripheral oedema, tremu-lousness, restlessness and hyperthermia. Appetite may increase inappropriately, causing weight gain.


Vinorelbine is a semisynthetic derivative of vinblastine that also inhibits tubulin polymerization and disrupts spindle assembly in the M phase. This compound has a higher specificity for mitotic microtubules and a lower affinity for axonal microtu-bules, reducing neuropathy. Vinorelbine is indicated in the treatment of lung cancer, breast cancer, and ovarian cancer. Adverse reactions are similar to those produced by vinblastine include myelosuppression, nausea, vomiting, and constipation altered liver function, requiring more frequent liver function tests alopecia neurotoxicity hypersensitivity and syndrome of inappropriate antidiuretic hormone secretion (SIADH).

Case Study

G. is a 42-year-old housewife who makes an appointment at your clinic because she has been experiencing pain in her upper abdomen for the past 3 months. She describes the pain as an ache that sometimes radiates into her right upper back and right shoulder. The pain gets worse after eating fatty or greasy foods, so she has eliminated these foods from her diet. She feels nauseated when the pain occurs and sometimes vomits. She denies fever or chills, weight loss, chest pain, diarrhea, constipation, melena, rectal bleeding, or dysuria. She has not been exposed to anyone who has been sick.


Diverticulitis results from inflammation of a colonic diverticulum, with subsequent microperforation. The most common symptoms include left lower quadrant abdominal pain, which may be cramping in nature initially, but then becomes steady, and fever. Associated symptoms may include nausea, vomiting, constipation, diarrhea, dysuria, and urinary frequency. The most common physical sign is tenderness in the left lower quadrant. There may be other signs of localized peritoneal inflammation, such as involuntary guarding, and percussion tenderness in a localized area. Occasionally, a tender mass, which represents a phlegmon, can be palpated. There will be some tenderness in the pelvis with rectal examination.

First Visit

Abnormal bleeding tendencies such as nosebleeds, prolonged bleeding from minor cuts, spontaneous ec-chvmoses, tendency toward excessive bruising, and excessive menstrual bleeding should be cited. 7. History of allergy should be taken, including hay fever, asthma, sensitivity to foods, or sensitivity to drugs such as aspirin, codeine, barbiturates, sulfonamides, antibiotics, procaine, and laxatives, to dental materials such as eugenol or acrylic resins.

Case Scenario

A mother brings her active 2-year-old son to the pediatrician for a routine visit. The physician orders a CBC. When the laboratory returns the test results, she notices that the child's hemoglobin is 10.2 g dL, a slight decrease from the normal range of 11 to 14 g dL. The mother reports her son has been healthy for the most part, but has had some constipation and what appears to be abdominal pain. He does eat well, and she gives him a vitamin supplement that includes iron. Upon further questioning, the mother discloses that they live in an older home that hasn't been repainted in a long time, and the woodwork especially is not in good shape.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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