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Alterations in GI Function (CONSTIPATION (Causes (Chronic (Irritable bowel…
Alterations in GI Function
DIARRHEA
ACUTE
TREATMENT
Causes
Infectious Agents
Other
APPROACH
Likely infectious
if not--> Antidiarrheal agents + (hydration); if persists--> stool exam; if nothing found-->empirical therapy
if Fever>38.5°C, bloody stools, fecal WBCs,
immunocompromised or elderly host--> antibiotic + stool exam; if not available, empirical
Likely noninfectious: Evaluate and
treat accordingly
CHRONIC
Causes
Secretory
Osmotic
Steatorrheal
Inflammatory
Dysmotile
Factitial
Iatrogenic
APPROACH
colonoscopy for approx. all (if blood present in stool, must);
if normal; features of malabsorption--> small bowel examined; if no features in stool-->search for IBS
TREATMENT
CONSTIPATION
Causes
Recent Onset
Anal sphincter spasm
Medications
Colonic obstruction
Chronic
Irritable bowel syndrome
Medications
Colonic pseudoobstruction
Disorders of rectal evacuation
Endocrinopathies
Psychiatric disorders
Neurologic disease
Generalized muscle disease
APPROACH
INVESTIGATION OF SEVERE CONSTIPATION
Measurement of Colonic Transit
Anorectal and Pelvic Floor Tests
TREATMENT
NAUSEA AND VOMITING
DIFFERENTIAL DIAGNOSIS (Causes)
Extraperitoneal
Medications/
Metabolic Disorders
Intraperitoneal
APPROACH
MECHANISMS
TREATMENT