Diagnosis of Flatulence
Flatulence Diagnosis: Book Excerpts
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FLATULENCE:
Ask the Following Questions:
(Algorithmic Diagnosis of Symptoms and Signs)
- 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.
» READ BOOK EXCERPT ONLINE »
Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
FLATULENCE AND BORBORYGMI:
Approach to the Diagnosis
(Differential Diagnosis in Primary Care)
If excessive food, beverages, or air swallowing from nervous tension or talking can be excluded, reflux esophagitis and diverticulitis must be considered. Upper GI series, esophagram, small-bowel series, and sigmoidoscopy with a barium enema should be done. A gallbladder series is also ordered. If these findings are questionable, a more definitive diagnosis may be made with endoscopy. Stools for ova, parasites, blood, and cultures should be done. When the outcome is still uncertain, evaluation of the adequacy of the intestinal digestive secretions is worthwhile. Gastric analysis with Histalog and duodenal analysis for bicarbonate, bile, and pancreatic enzymes is done. A lactose tolerance test should be done. If the digestive secretions are adequate, a small bowel biopsy may be necessary to exclude a malabsorption syndrome. Xylose absorption is a good screening test for this.
» READ BOOK EXCERPT ONLINE »
Source: Differential Diagnosis in Primary Care, 2007
Abdominal distention:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
If the patient’s abdominal distention isn’t acute, ask about its onset and duration and associated signs. A patient with localized distention may report a sensation of pressure, fullness, or tenderness in the affected area. A patient with generalized distention may report a bloated feeling, a pounding heart, and difficulty breathing deeply or when lying flat. (See Abdominal distention: Common causes and associated findings.)
The patient may also feel unable to bend at his waist. Make sure to ask about abdominal pain, fever, nausea, vomiting, anorexia, altered bowel habits, and weight gain or loss.
Obtain a medical history, noting GI or biliary disorders that may cause peritonitis or ascites, such as cirrhosis, hepatitis, or inflammatory bowel disease. (See Detecting ascites, page 4.) Also, note chronic constipation. Has the patient recently had abdominal surgery, which can lead to abdominal distention? Ask about recent accidents, even minor ones, such as falling off a stepladder.
Perform a complete physical examination. Don’t restrict the examination to the abdomen because you could miss important clues to the cause of abdominal distention. Next, stand at the foot of the bed and observe the recumbent patient for abdominal asymmetry to determine if distention is localized or generalized. Then assess abdominal contour by stooping at his side. Inspect for tense, taut skin and bulging flanks, which may indicate ascites. Observe the umbilicus. An everted umbilicus may indicate ascites or umbilical hernia. An inverted umbilicus may indicate distention from gas; it’s also common in obesity. Inspect the abdomen for signs of inguinal or femoral hernia and for incisions that may point to adhesions. Both may lead to intestinal obstruction. Then auscultate for bowel sounds, abdominal friction rubs (indicating peritoneal inflammation), and bruits (indicating an aneurysm). Listen for succussion splash — a splashing sound normally heard in the stomach when the patient moves or when palpation disturbs the viscera. However, an abnormally loud splash indicates fluid accumulation, suggesting gastric dilation or obstruction.
Next, percuss and palpate the abdomen to determine if distention results from air, fluid, or both. A tympanic note in the left lower quadrant suggests an air-filled descending or sigmoid colon. A tympanic note throughout a generally distended abdomen suggests an air-filled peritoneal cavity. A dull percussion note throughout a generally distended abdomen suggests a fluid-filled peritoneal cavity. Shifting of dullness laterally with the patient in the decubitus position also indicates a fluid-filled abdominal cavity. A pelvic or intra-abdominal mass causes local dullness upon percussion and should be palpable. Obesity causes a large abdomen without shifting dullness, prominent tympany, or palpable bowel or other masses, with generalized rather then localized dullness.
Palpate the abdomen for tenderness, noting whether it’s localized or generalized. Watch for peritoneal signs and symptoms, such as rebound tenderness, guarding, rigidity, McBurney’s point, obturator sign, and psoas sign. Female patients should undergo a pelvic examination; males, a genital examination. All patients who report abdominal pain should undergo a digital rectal examination with fecal occult blood testing. Finally, measure the patient’s abdominal girth for a baseline value. Mark the flanks with a felt-tipped pen as a reference for subsequent measurements.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Dyspepsia:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
If the patient complains of dyspepsia, begin by asking him to describe it in detail. How often and when does it occur, specifically in relation to meals? Do drugs or activities relieve or aggravate it? Has he had nausea, vomiting, melena, hematemesis, a cough, or chest pain? Ask if he's taking prescription drugs and if he has recently had surgery. Does he have a history of renal, cardiovascular, or pulmonary disease? Has he noticed a change in the amount or color of his urine?
Ask the patient if he's experiencing an unusual or overwhelming amount of emotional stress. Determine the patient's coping mechanisms and their effectiveness.
Focus the physical examination on the abdomen. Inspect for distention, ascites, scars, obvious hernias, jaundice, uremic frost, and bruising. Then auscultate for bowel sounds and characterize their motility. Palpate and percuss the abdomen, noting tenderness, pain, organ enlargement, or tympany.
Finally, examine other body systems. Ask about behavior changes, and evaluate the patient's level of consciousness. Auscultate for gallops and crackles. Percuss the lungs to detect consolidation. Note peripheral edema and any swelling of the lymph nodes.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Abdominal distention:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
If the patient’s abdominal distention isn’t acute, ask about its onset and duration and associated signs. A patient with localized distention may report a sensation of pressure, fullness, or tenderness in the affected area. A patient with generalized distention may report a bloated feeling, a pounding heartbeat, and difficulty breathing deeply or breathing when lying flat. The patient may also feel unable to bend at his waist. Be sure to ask about abdominal pain, fever, nausea, vomiting, anorexia, altered bowel habits, and weight gain or loss.
Obtain a medical history, noting GI or biliary disorders that may cause peritonitis or ascites, such as cirrhosis, hepatitis, or inflammatory bowel disease. (See Detecting ascites.) Also note chronic constipation. Has the patient recently had abdominal surgery, which can lead to abdominal distention? Ask about recent accidents, even minor ones, like falling off a stepladder.
Perform a complete physical examination. Don’t restrict the examination to the abdomen because you could miss important clues to the cause of abdominal distention. Next, stand at the foot of the bed and observe the recumbent patient for abdominal asymmetry to determine if distention is localized or generalized. Then assess abdominal contour by stooping at his side. Inspect for tense, glistening skin and bulging flanks, which may indicate ascites. Observe the umbilicus. An everted umbilicus may indicate ascites or an umbilical hernia. An inverted umbilicus may indicate distention from gas; it’s also common in obese individuals. Inspect the abdomen for signs of an inguinal or femoral hernia and for incisions that may point to adhesions; both may lead to intestinal obstruction. Then auscultate for bowel sounds, abdominal friction rubs (indicating peritoneal inflammation), and bruits (indicating an aneurysm). Listen for a succussion splash—a splashing sound normally heard in the stomach when the patient moves or when palpation disturbs the viscera. An abnormally loud splash indicates fluid accumulation, suggesting gastric dilation or obstruction.
Next, percuss and palpate the abdomen to determine if distention results from air, fluid, or both. A tympanic note in the left lower quadrant suggests an air-filled descending or sigmoid colon. A tympanic note throughout a generally distended abdomen suggests an air-filled peritoneal cavity. A dull percussion note throughout a generally distended abdomen suggests a fluid-filled peritoneal cavity. Shifting of dullness laterally when the patient is in the decubitus position also indicates a fluid-filled abdominal cavity. A pelvic or intra-abdominal mass causes local dullness upon percussion and should be palpable. Obesity causes a large abdomen with generalized rather then localized dullness and without shifting dullness, prominent tympany, or palpable bowel or other masses.
Palpate the abdomen for tenderness, noting whether it’s localized or generalized. Watch for peritoneal signs and symptoms, such as rebound tenderness, guarding, rigidity, McBurney’s point, obturator sign, and psoas sign. Female patients should undergo a pelvic examination; males, a genital examination. All patients who report abdominal pain should undergo a digital rectal examination with fecal occult blood testing. Finally, measure abdominal girth for a baseline value. Mark the flanks with a felt-tipped pen as a reference point for subsequent measurements. (See Abdominal distention: Causes and associated findings, pages 6 and 7.)
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Dyspepsia:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
If the patient complains of dyspepsia, begin by asking him to describe it in detail. How often and when does it occur, specifically in relation to meals? Do any drugs or activities relieve or aggravate it? Has the patient had nausea, vomiting, melena, hematemesis, cough, or chest pain? Ask if he’s taking any prescription drugs and if he has recently had surgery. Does he have a history of renal, cardiovascular, or pulmonary disease? Has he noticed any change in the amount or color of his urine?
Ask the patient if he’s experiencing an unusual or overwhelming amount of emotional stress. Determine the patient’s coping mechanisms and their effectiveness.
Focus the physical examination on the abdomen. Inspect it for distention, ascites, scars, obvious hernias, jaundice, uremic frost, and bruising. Then auscultate it for bowel sounds and characterize their motility. Palpate and percuss the abdomen, noting any tenderness, pain, organ enlargement, or tympany.
Finally, examine other body systems. Ask about behavior changes, and evaluate level of consciousness. Auscultate for gallops and crackles. Percuss the lungs to detect consolidation. Note peripheral edema and any swelling of lymph nodes.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Flatulence:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
Determine how long the patient has noticed the flatulence. Find out if he passes an excessive amount of flatus. Also, ask about frequent belching or snoring, and observe for overly rapid speech. These signs are all possible clues to aerophagia.
In addition, be sure to ask the patient if he’s undergoing unusual emotional stress because this can cause aerophagia or irritable bowel syndrome. Obtain a medical history, focusing on GI disorders and systemic illnesses such as scleroderma, which can cause malabsorption syndrome. Then inspect the patient’s abdomen for distention, and auscultate for abnormal bowel sounds. Percuss for increased tympany due to gas accumulation, and palpate for tenderness and masses.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Abdominal distention:
History
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
If the patient’s abdominal distention isn’t acute, ask about its onset and duration and associated signs. A patient with localized distention may report a sensation of pressure, fullness, or tenderness in the affected area. A patient with generalized distention may report a bloated feeling, a pounding heart, and difficulty breathing when lying flat or breathing deeply. The patient may also feel unable to bend at his waist. Be sure to ask about abdominal pain, fever, nausea, vomiting, anorexia, altered bowel habits, and weight gain or loss.
Obtain a medical history, noting GI or biliary disorders that may cause peritonitis or ascites, such as cirrhosis, hepatitis, and inflammatory bowel disease. (See Detecting ascites.) Also note chronic constipation. Has the patient recently had abdominal surgery, which can lead to abdominal distention? Ask about recent accidents, even minor ones, like falling off a stepladder.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Dyspepsia:
History
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
If the patient complains of dyspepsia, begin by asking him to describe it in detail. How often and when does it occur, specifically in relation to meals? Do any drugs or activities relieve or aggravate it? Has he had nausea, vomiting, melena, hematemesis, cough, or chest pain? Ask if he’s taking prescription drugs and if he has recently had surgery. Does he have a history of renal, cardiovascular, or pulmonary disease? Has he noticed any change in the amount or color of his urine?
Ask the patient if he’s experiencing an unusual or overwhelming amount of emotional stress. Determine the patient’s coping mechanisms and their effectiveness.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Flatulence:
History
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Determine how long the patient has noticed the flatulence. Find out if he passes an excessive amount of flatus. Also, ask about frequent belching or snoring, and observe for overly rapid speech. These signs are all possible clues to aerophagia.
In addition, be sure to ask the patient if he’s undergoing unusual emotional stress because this can cause aerophagia or irritable bowel syndrome. Obtain a medical history, focusing on GI disorders and systemic illnesses such as scleroderma. These can cause malabsorption syndrome.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Abdominal distention:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
If the patient's abdominal distention isn't acute, ask about its onset and duration and associated signs. A patient with localized distention may report a sensation of pressure, fullness, or tenderness in the affected area. A patient with generalized distention may report a bloated feeling, a pounding heart, and difficulty breathing deeply or when lying flat.
The patient may be unable to bend at the waist. Make sure to ask about abdominal pain, fever, nausea, vomiting, anorexia, altered bowel habits, and weight gain or loss.
Obtain a medical history, noting GI or biliary disorders that may cause peritonitis or ascites, such as cirrhosis, hepatitis, or inflammatory bowel disease. (See Detecting ascites.) When did the patient last have a bowel movement? Note chronic constipation. Has the patient recently had abdominal surgery, which can lead to abdominal distention? Ask about recent accidents, even minor ones such as falling off a stepladder.
Perform a complete physical examination. Don't restrict the examination to the abdomen because you could miss important clues to the cause of abdominal distention. Next, stand at the foot of the bed and observe the recumbent patient for abdominal asymmetry to determine if distention is localized or generalized. Then assess abdominal contour by stooping at his side. Inspect for tense, taut skin and bulging flanks, which may indicate ascites. Observe the umbilicus. An everted umbilicus may indicate ascites or umbilical hernia. An inverted umbilicus may indicate distention from gas; it's also common in obesity and pregnancy. Inspect the abdomen for signs of inguinal or femoral hernia and for healed incisions that may point to adhesions. Both may lead to intestinal obstruction. Auscultate for bowel sounds, abdominal friction rubs (indicating peritoneal inflammation), and bruits (indicating an aneurysm). Listen for succussion splash—a splashing sound normally heard in the stomach when the patient moves or when palpation disturbs the viscera. An abnormally loud splash indicates fluid accumulation, suggesting gastric dilation or obstruction.
Next, percuss and palpate the abdomen to determine if distention results from air, fluid, or both. A tympanic note in the left lower quadrant suggests an air-filled descending or sigmoid colon. A tympanic note throughout a generally distended abdomen suggests an air-filled peritoneal cavity. A dull percussion note throughout a generally distended abdomen suggests a fluid-filled peritoneal cavity. Shifting of dullness laterally with the patient in the decubitus position also indicates a fluid-filled abdominal cavity. A pelvic or intra-abdominal mass causes local dullness upon percussion and should be palpable. Obesity causes a large abdomen without shifting dullness, prominent tympany, or palpable bowel or other masses, with generalized rather then localized dullness.
Palpate the abdomen for tenderness, noting whether it's localized or generalized. Watch for peritoneal signs and symptoms, such as rebound tenderness, guarding, rigidity, McBurney's point, obturator sign, and psoas sign. Female patients should undergo a pelvic examination; males, a genital examination. All patients who report abdominal pain should undergo a digital rectal examination with fecal occult blood testing. Finally, measure the patient's abdominal girth for a baseline value. Mark the flanks with a felt-tipped pen as a reference for subsequent measurements.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Dyspepsia:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
If the patient complains of dyspepsia, begin by asking him to describe it in detail. How often and when does it occur, specifically in relation to meals? Do drugs or activities relieve or aggravate it? Has he had nausea, vomiting, melena, hematemesis, a cough, or chest pain? Ask if he's taking prescription drugs and if he has recently had surgery. Does he have a history of renal, cardiovascular, or pulmonary disease? Has he noticed a change in the amount or color of his urine?
Ask the patient if he's experiencing an unusual or overwhelming amount of emotional stress. Determine the patient's coping mechanisms and their effectiveness.
Focus the physical examination on the abdomen. Inspect for distention, ascites, scars, obvious hernias, jaundice, uremic frost, and bruising. Then auscultate for bowel sounds and characterize their motility. Palpate and percuss the abdomen, noting tenderness, pain, organ enlargement, or tympany.
Finally, examine other body systems. Ask about behavior changes, and evaluate the patient's level of consciousness. Auscultate for gallops and crackles. Percuss the lungs to detect consolidation. Note peripheral edema and any swelling of the lymph nodes.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
FLATULENCE AND BORBORYGMI:
Approach to the Diagnosis
(Differential Diagnosis in Primary Care)
If excessive food, beverages, or air swallowing from nervous tension or
talking can be excluded, reflux esophagitis and diverticulitis must be
considered. Upper gastrointestinal (GI) series, esophagram, small-bowel
series, and sigmoidoscopy with a barium enema should be done. A gallbladder
series is also ordered. If these findings are questionable, a more
definitive diagnosis may be made with endoscopy. Stools for ova, parasites,
blood, and cultures should be done. When the outcome is still uncertain,
evaluation of the adequacy of the intestinal digestive secretions is
worthwhile. Gastric analysis with Histalog and duodenal analysis for
bicarbonate, bile, and pancreatic enzymes is done. A lactose tolerance test
should be done. If the digestive secretions are adequate, a small-bowel
biopsy may be necessary to exclude a malabsorption syndrome. Xylose
absorption is a good screening test for this.
» READ BOOK EXCERPT ONLINE »
Source: Differential Diagnosis in Primary Care, 2007
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