FLATULENCE
FLATULENCE: Excerpt from Algorithmic Diagnosis of Symptoms and Signs
Ask the Following Questions:
- Is the flatulence associated with heartburn or regurgitation? The presence of flatulence with heartburn or regurgitation should suggest reflux esophagitis, gastric or duodenal ulcer, or chronic cholecystitis.
- Is there a history of a gastrectomy? History of a gastrectomy may indicate that there is gastric dilatation due to the fact that the stomach fails to drain adequately.
- Is there abdominal pain or distention? The presence of abdominal pain or distention would indicate the possibility of partial intestinal obstruction, steatorrhea, or diverticulitis.
- Are there other signs of a nervous disorder? If there is a history of emotional trauma or there is hyperkinesis, increased sweating, insomnia, loss of appetite, or other signs of a nervous disorder, aerophagia should be considered.
DIAGNOSTIC WORKUP
If the gas is eructated, stools for occult blood and an upper GI series and esophagogram should be ordered. These may disclose a hiatal hernia and esophagitis, a gastric or duodenal ulcer, and other upper intestinal disorders. A gallbladder series may be done if the upper GI series is unremarkable. Gastroscopy and esophagoscopy may be necessary, as well as a gastric analysis.
If the excessive gas is passed rectally, stools for occult blood, stools for ovum and parasite, and stool cultures should be done. A flat plate of the abdomen may disclose evidence of intestinal obstruction. If these are negative, a barium enema may be done and that may be followed with a small bowel series. Colonoscopy may be indicated. Analysis of flatus for volume and composition of intestinal gases may be helpful. A quantitative stool-fat analysis should be done to determine if there is steatorrhea, and if so, the workup would proceed. A lactose tolerance test can be done in cases suspected of lactase deficiency. Hydrogen breath testing is useful in detecting lactase deficiency and other carbohydrate intolerance and bacterial overgrowth. When extensive testing is negative, a psychiatrist may need to be consulted.
Book Source Details
- Book Title: Algorithmic Diagnosis of Symptoms and Signs
- Author(s): R. Douglas Collins
- Year of Publication: 2003
- Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
» Next page: FLATULENCE AND BORBORYGMI (Differential Diagnosis in Primary Care)
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