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Eliminating Avoidance
Published in Melissa G. Hunt, Aaron T. Beck, Reclaim Your Life From IBS, 2022
Melissa G. Hunt, Aaron T. Beck
Most people with gut problems are both hypersensitive to visceral (or gut) sensations and hypervigilant about them. Because they fear the onset of GI symptoms, they monitor their bodies for signs of an impending attack. People with IBS often go to great lengths to avoid experiencing those sensations, if at all possible. They view abdominal discomfort as intolerable – painful, debilitating, incapacitating – and something to be avoided by whatever means necessary. This leads to avoidance of lots of other things (tight clothing that presses on the belly, possible “trigger” foods, and stressful situations), and to the use of medications (like antidiarrheal drugs), in a futile attempt to fend off any and all abdominal discomfort. It also leads to retreating from life experiences, opportunities, and challenges (in favor of, say, curling up in bed with a heating pad pressed to the tummy).
Primaquine
Published in M. Lindsay Grayson, Sara E. Cosgrove, Suzanne M. Crowe, M. Lindsay Grayson, William Hope, James S. McCarthy, John Mills, Johan W. Mouton, David L. Paterson, Kucers’ The Use of Antibiotics, 2017
Michael D. Edstein, G. Dennis Shanks
Gastrointestinal disturbances typically associated with primaquine therapy include nausea, abdominal cramps, anorexia, epigastric distress, and vomiting. The severity and frequency of these adverse effects is related to the amount of primaquine ingested (Clayman et al., 1952; Clyde, 1981). Abdominal pain is usually the first symptom to appear. After ingestion of a 15-mg dose, gastrointestinal discomfort is uncommon (~ 3%). At 30 mg daily, mild to moderate abdominal cramps can occur, particularly if the drug is taken on an empty stomach (Clayman et al., 1952). With a dose of 60 mg, the frequency of gastrointestinal disturbance is ~ 33%. Larger doses up to 240 mg base daily may cause severe and persistent abdominal cramps, nausea, and vomiting. Even at high doses, abdominal discomfort due to the drug can be mitigated by taking the drug with food (Clayman et al., 1952). Krudsood et al. (2008) reported that primaquine given in a regimen of 30 mg twice a day for 7 days to Thai subjects was well tolerated with no significant adverse events including gastrointestinal discomfort.
Bowel perforation
Published in Alexander Trevatt, Richard Boulton, Daren Francis, Nishanthan Mahesan, Take Charge! General Surgery and Urology, 2020
The specific details to elicit are: Take a very detailed pain history. What was the site of the pain?Did the pain start suddenly?Is the pain constant? Does it radiate anywhere?What is the character of the pain and are there any associated symptoms?How severe is the pain?Severe, constant upper abdominal pain that is worse on movement and breathing suggests perforation. The severe pain is usually of sudden onset but can be preceded by abdominal discomfort. A background of less severe upper abdominal pain suggests underlying pathology such an ulcer or malignancy.Has the patient ever had this pain before?Does the patient have any risk factors for perforation? These include: DiverticulitisPeptic ulcer diseaseUse of NSAIDs (nonsteroidal anti-inflammatory drugs) or steroidsMalignancy (not just GI)Any recent surgery or invasive procedureTraumaAny constitutional symptoms that might suggest malignancy (weight loss, change in bowel habit, rectal bleeding and abdominal mass)?Ask about systemic symptoms that can give you an idea of how unwell the patient is. Have they been having fevers, chills or rigors?Any nausea, vomiting or distension? These may suggest outflow obstruction or volvulus.
Potential clinical value of catheters impregnated with antimicrobials for the prevention of infections associated with peritoneal dialysis
Published in Expert Review of Medical Devices, 2023
Hari Dukka, Maarten W. Taal, Roger Bayston
Though PD is a very effective treatment, there are some complications and risks to patient health. These can be classified as noninfectious and infectious complications. Noninfectious complications include dialysis fluid drainage problems, pericatheter fluid leaks, abdominal discomfort, dialysis fluid leak into the pleura and electrolyte imbalances [12]. Dialysis fluid drainage problems are often due to constipation, which can be diagnosed with an abdominal X-ray and treated with laxatives. Other drainage issues may be due to deposition of fibrin and thrombi within the catheter, which can be treated with heparin or urokinase. Catheter kinks, which can also lead to drainage problems, require replacement of the PD catheter. Abdominal discomfort may be due to increased intra-abdominal pressure and volume, and some patients develop associated gastroesophageal reflux disease. Dialysis fluid leak into the pleura can occur due to the presence of a pleuroperitoneal fistula. This usually requires discontinuation of PD and transfer to HD treatment. Hypokalaemia is very common in PD patients and requires dietary advice and potassium supplementation.
Fabry disease – a multisystemic disease with gastrointestinal manifestations
Published in Gut Microbes, 2022
FD is a multisystemic disorder (Figure 1). GI symptoms belong to the first manifestations already in affected pediatric FD patients.19 Abdominal pain and diarrhea are the most common symptoms, followed by constipation, nausea, and vomiting.13,20–23 In detail, registry data from the Fabry Outcome Survey (FOS) based on 1,453 patients reported a prevalence of 51% for GI symptoms24 mainly due to abdominal pain and diarrhea.20 Abdominal pain is the most frequently reported symptom in affected patients and includes the appearance of colic with pain in the mid- or lower abdomen, bloating, cramping, or mid-abdominal discomfort.25,26 Since these symptoms may increase during or after meals or are triggered by stress, it is conceivable that many FD patients are reluctant to food intake, which may result in lower body weight. However, this seems to be limited to patients with very severe symptoms, since most studies and reports did not show differences in body mass index between patients with and without GI symptoms.2 Frequency and severity of diarrhea as the second most GI symptom is more diverse. According to the FOS registry, 20% of FD patients reported diarrhea, which was more common in males (26%) than in females (17%), and very frequent in children (25%).20,27 However, the real frequency in classical FD patients seems to be much higher, since the reported frequency in females with FD manifestations justifying ERT from the Fabry Registry is reported as 39%.23
The safety of available treatment options for short bowel syndrome and unmet needs
Published in Expert Opinion on Drug Safety, 2021
Loris Pironi, Emanuel Raschi, Anna Simona Sasdelli
Gastrointestinal disorders, including abdominal pain, abdominal distension, vomiting, and abdominal discomfort, tended to be reported more frequently in patients earlier during treatment, suggesting development of tolerance. Treatment discontinuation due to TEAEs peaked to 19.7% in the RCT/extension group exposed to teduglutide, due especially to abdominal pain. However, it should be acknowledged that use of both prokinetics and antipropulsives to manage intestinal motility may be associated with abdominal complaints independent of teduglutide use [49]. The AE grouping of central-line associated blood stream infections (CLABSI) events was the most commonly reported serious TEAE in the study, especially in long-term treatment (24.9% in patients in the RCT/extension teduglutide group treated for up to 2.5 years). This highlighted the importance of best practices for catheter maintenance and patient monitoring. The rates of CLABSI, albeit within the ranges reported in the literature for standard of care, might have been underestimated because the methodology assumed that no interruptions in catheter placement occurred during the study period [49].