...
Is the stool volume small or large? A small volume of stool should suggest anal fissure; hemorrhoids, diarrhea, or postoperative ... DIAGNOSTIC WORKUP
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Is the volume of urine large or small? If the volume of urine released is small, stress incontinence and vesicovaginal fistula should be considered. If the amounts released are large, one ... DIAGNOSTIC WORKUP
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... Stress incontinence occurs most commonly in women who have had many pregnancies or who are in menopause. The patient loses control of the bladder when he or she coughs, laughs, or sneezes... DIAGNOSTIC WORKUP
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Is there blood in the stool? From the algorithm, blood in the stool should indicate that there is
Salmonella
,
Shigella
,
Campylobacter jejuni ... DIAGNOSTIC WORKUP
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...
Is there a positive drug or alcohol history? It is well known that alcohol can cause diarrhea, as do drugs in common use, such as digitalis, diuretics, ... DIAGNOSTIC WORKUP
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Incontinence, defined as the involuntary loss of urine, is one of the ten most common medical problems in the U.S. However, most patients do not seek treatment despite the significant effects on self-esteem and social... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Decreased bowel sounds can be as innocent as a hungry patient anticipating a next meal or as ominous as an impending abdominal catastrophe necessitating emergent laparotomy. However, the sensitivity and... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Despite extensive efforts to evaluate and classify the sounds of the bowel using advanced technology, correlation of sounds to physiology using manometry and/or auscultation, ... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Diarrhea is defined as an increase in the volume of bowel movements. Acute diarrhea is designated as being of less than 4 weeks’ duration. Many patients describe increased frequency or decreased... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Chronic diarrhea is defined as increased volume bowel movements persisting for more than 4 weeks. Mechanisms of diarrhea are categorized as increased secretion, decreased absorption, osmotic diarrhea, or... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Decreased bowel sounds can be as innocent as a hungry patient anticipating his or her next meal or as ominous as an impending abdominal catastrophe necessitating emergent laparotomy. However, the sensitivity and... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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...
Normal bowel sounds (BS) are intermittent low-to-medium-pitched gurgles interspersed with occasional high-pitched, tinkling metallic sounds heard every 10–30 seconds. In acute intestinal... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Chronic diarrhea (nonbloody, without weight loss) is defined as increased total daily stool output (greater than 10 g/kg/day), associated with increased stool water content; diarrhea is classified as chronic when it... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Diarrhea is considered chronic when it last longer than 14 days. Weight loss with diarrhea should always be concerning and deserves thorough investigation. Collectively the malabsorption... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Acute diarrhea is an abrupt onset of increased fluid content of stool above about 10 mL/kg/day and increased frequency from 4–5 to more than 20 times daily. It is a major problem worldwide because of excessive loss of fluid and... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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... The differential diagnosis of diarrhea may be approached from either an anatomic or a physiologic basis. The anatomic approach is used in Table 22. In the stomach and duodenum, pernicious anemia and Zollinger–
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... Incontinence may be due to loss of voluntary control of urination, in which case neurologic disorders are usually the cause, or it may result from overflow of a distended bladder (overflow
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... Usually a chief sign of an intestinal disorder, diarrhea is an increase in the volume of stools compared with the patient's normal bowel habits. It varies in severity and may be acute or chronic. Acute diarrhea may result... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pictures
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... Fecal incontinence, the involuntary passage of feces, follows a loss or an impairment of external anal sphincter control. It can result from many GI, neurologic, and psychological... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Pictures
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... Absent bowel sounds refers to an inability to hear any bowel sounds with a stethoscope in any quadrant after listening for at least 5 minutes. Bowel sounds cease when mechanical or vascular obstruction or... Emergency interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pictures
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... Sometimes audible without a stethoscope, hyperactive bowel sounds reflect increased intestinal motility (peristalsis). They're commonly characterized as rapid, rushing, gurgling waves of sounds. (See Characteristics of bowel... Emergency interventions ... History and physical examination ... Medical causes ... Special considerations ... Pictures
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... Hypoactive bowel sounds, detected by auscultation, are diminished in regularity, tone, and loudness from normal bowel sounds. In themselves, hypoactive bowel sounds don't... History and physical examination ... Medical causes ... Other causes ... Special considerations
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... Incontinence, the uncontrollable passage of urine, can result from a bladder abnormality, a neurologic disorder, or an alteration in pelvic muscle strength. A common urologic... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Pictures
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... Acute Diarrhea
Infections
Viral gastroenteritis (adenovirus, Norwalk agent, rotavirus, etc.)
Bacterial
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... Irritable bowel syndrome (IBS), also called spastic colon and spastic colitis, is a common condition marked by chronic or periodic diarrhea, alternating with constipation, and accompanied by straining and... Causes and incidence ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations
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Diarrhea
(Professional Guide to Signs & Symptoms (Fifth Edition))
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... Usually a chief sign of an intestinal disorder, diarrhea is an increase in the volume of stools compared with the patient’s normal bowel elimination habits. It varies in severity and may be acute or chronic. Acute diarrhea may... Emergency interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
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... Fecal incontinence, the involuntary passage of feces, follows any loss or impairment of external anal sphincter control. It can result from various GI, neurologic, and psychological disorders; the effects of... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Pictures
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... Absent bowel sounds refers to an inability to hear any bowel sounds through a stethoscope after listening for at least 5 minutes in each abdominal quadrant. Bowel sounds cease when mechanical or vascular... Emergency interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Pictures
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... Sometimes audible without a stethoscope, hyperactive bowel sounds reflect increased intestinal motility (peristalsis). They’re commonly characterized as rapid, rushing, gurgling waves of sounds. (See ... Emergency interventions ... History and physical examination ... Medical causes ... Special considerations ... Pediatric pointers ... Patient counseling ... Pictures
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... Hypoactive bowel sounds, detected by auscultation, are diminished in regularity, tone, and loudness from normal bowel sounds. In themselves, hypoactive bowel sounds don’t herald an emergency; in fact, they’re considered normal... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers
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... Incontinence, the uncontrollable passage of urine, can result from a bladder abnormality, a neurologic disorder, or an alteration in pelvic muscle strength. A common urologic sign, incontinence may be transient or permanent... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Pictures
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Diarrhea
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
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... Francis G. O’Connor
Diarrhea is one of the most common clinical complaints encountered by primary care providers. Although diarrhea infrequently... Approach ... History ... Physical examination ... Testing (5) ... Diagnostic assessment ... Pictures
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Urinary Incontinence
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
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... Richard Rathe
Urinary incontinence (UI) in adults is one of the most prevalent and underdiagnosed afflictions in the United States (>25 million effected individuals, >50% of nursing home residents).... Approach ... History ... Physical examination ... Testing ... Diagnostic assessment ... Pictures
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... Differential Overview
❑ Cystitis
❑ Benign prostatic hypertrophy
❑ Pelvic floor relaxation
❑ Drugs ... Diagnostic Approach ... Clinical Findings
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... Differential Overview
❑ Viral gastroenteritis
❑ Staphylococcal enterotoxin
❑ E. coli
❑ Salmonella ... Diagnostic Approach ... Clinical Findings ... Pictures
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... Differential Overview
Altered Intestinal Motility
❑ Irritable bowel syndrome
❑ Diabetic... Diagnostic Approach ... Clinical Findings
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... Also referred to as spastic colon or spastic colitis, irritable bowel syndrome is marked by chronic abdominal pain, alternating constipation and diarrhea, and abdominal distention. This disorder is... Causes ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations
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Diarrhea
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
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... Usually a chief sign of an intestinal disorder, diarrhea is an increase in the volume of stools compared with the patient’s normal bowel habits. It varies in severity and may be acute or chronic.... Assessment ... History ... Physical examination ... Pediatric pointers ... Geriatric pointers ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
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Bowel sounds, absent
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
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... Absent bowel sounds refers to an inability to hear bowel sounds through a stethoscope after listening for at least 5 minutes in each abdominal quadrant. Bowel sounds cease when mechanical or vascular obstruction or... Assessment ... History ... Physical examination ... Pediatric pointers ... Geriatric pointers ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
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... Sometimes audible without a stethoscope, hyperactive bowel sounds reflect increased intestinal motility (peristalsis). They’re commonly characterized as rapid, rushing, gurgling... Assessment ... History ... Physical examination ... Pediatric pointers ... Geriatric pointers ... Medical causes ... Nursing considerations ... Patient teaching ... Pictures
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... Usually a chief sign of an intestinal disorder, diarrhea is an increase in the volume of stools compared with the patient’s normal bowel habits. It varies in severity and may be acute or chronic. Acute diarrhea may result from... Emergency Actions ... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
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... Absent bowel sounds, or silent abdomen, refers to an inability to hear any bowel sounds through a stethoscope after listening for at least 5 minutes in each abdominal quadrant.... Emergency Actions ... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
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... Sometimes audible without a stethoscope, hyperactive bowel sounds reflect increased intestinal motility (peristalsis). They’re commonly characterized as rapid, rushing, gurgling waves of sounds. (See Characterizing bowel sounds, ... Emergency Actions ... History ... Physical assessment ... Medical causes ... Special considerations ... Pediatric pointers ... Patient counseling ... Pictures
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... Hypoactive bowel sounds, detected by auscultation, are diminished in regularity, tone, and loudness from normal bowel sounds. They may portend absent bowel sounds, which can indicate a life-threatening... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Patient counseling ... Pictures
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... Incontinence, the uncontrollable passage of urine, can result from a bladder abnormality, a neurologic disorder, or an alteration in pelvic muscle strength. A common urologic sign, incontinence may be transient or permanent and... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
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Diarrhea
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)
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... Definedas stools that are more fluid and frequent than normal. Can be acute or chronic (>2–3wks in duration). Acute diarrhea is discussed in first section ofthis chapter, and chronic... Principle Causes of Acute Diarrhea ... Clinical Features and Diagnosis: Acute Diarrhea ... Diagnostic Approach: Acute Diarrhea ... Principle Causes of Chronic Diarrhea ... Clinical Features and Diagnosis: Chronic Diarrhea ... Diagnostic Approach: Chronic Diarrhea ... References
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... Definedas fecal soiling beyond 4 yrs of age. Until this age, children arelearning normal bowel control and bowel habits. Primary fecal incontinence exists whenchild has never achieved adequate bowel control; secondary... Principal Causes of Fecal Incontinence ... Clinical Features and Diagnosis ... Diagnostic Approach ... References
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... Urinaryincontinence or enuresis refers to the involuntary passage of urine. Most children have achieved urine continenceduring the day by 4 yrs of age, and during the night by 6 yrs ofage. ... Principal Causes of Urinary Incontinence ... Clinical Features and Diagnosis ... Diagnostic Approach ... References
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... Usually a chief sign of an intestinal disorder, diarrhea is an increase in the volume of stools compared with the patient's normal bowel habits. It varies in severity and may be... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
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... Fecal incontinence, the involuntary passage of feces, follows a loss or an impairment of external anal sphincter control. It can result from many GI, neurologic, and psychological disorders; the effects of drugs; or surgery. In some... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
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... Absent bowel sounds refers to an inability to hear any bowel sounds with a stethoscope in any quadrant after listening for at least 5 minutes in each quadrant. Bowel sounds cease when mechanical or vascular obstruction or neurogenic... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
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... Sometimes audible without a stethoscope, hyperactive bowel sounds reflect increased intestinal motility (peristalsis). They're commonly characterized as rapid, rushing, gurgling waves of sounds. ... History and physical examination ... Medical causes ... Nursing considerations ... Patient teaching ... Pictures
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... Hypoactive bowel sounds, detected by auscultation, are diminished in regularity, tone, and loudness from normal bowel sounds. They don't herald an emergency; in fact, they're considered normal during sleep. Hypoactive bowel sounds may portend... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching
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... Urinary incontinence, the uncontrollable passage of urine, can result from a bladder abnormality, a neurologic disorder, or an alteration in pelvic muscle strength. A common... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
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...
Incontinence may be due to loss of voluntary control of urination, in
which case neurologic disorders are usually the cause, or it may result from
overflow of a distended bladder
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...
Anatomy will serve us well in recalling the various causes of
fecal incontinence. The pathway of voluntary control of this function begins
in the cerebrum and
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... Author: Craig DeWolfe, MD
What to Do - Take Action
Appropriate nutrition is vital to maintaining health and recovering from
disease and injury. Research in this... Suggested Readings
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