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Bowel disorders
Published in Henry J. Woodford, Essential Geriatrics, 2022
Culture of the organism is difficult (and hence its name), is more expensive and takes longer (up to three days). Sigmoidoscopy may detect the pseudomembranes of PMC but the disease sometimes only affects the more proximal large bowel. Therefore, a colonoscopy would be required to adequately exclude all such changes. Given the frailty of this population and the increased risk of colonic perforation in the presence of inflammation, this procedure is rarely justified. A plain abdominal X-ray should be performed if megacolon is suspected. Abdominal CT scanning can show changes consistent with colitis. Repeat stool testing to look for clearance of toxins following symptom resolution is not appropriate as it may remain positive for several weeks even when the infection has resolved. Stool type and frequency should be monitored using the Bristol Stool Scale.
Management of Conditions and Symptoms
Published in Amy J. Litterini, Christopher M. Wilson, Physical Activity and Rehabilitation in Life-threatening Illness, 2021
Amy J. Litterini, Christopher M. Wilson
Diarrhea, or loose watery stools, can occur for a variety of reasons, including medications, disease processes, and infection (viral or bacterial). Diarrhea is classified in severity by grades from 1 (an increase of up to four stools per day beyond a person’s baseline), to 4 (life-threatening, requiring urgent medical care). Stool consistency and the descriptions of diarrhea have been outlined in the Bristol Stool Scale (see Figure 17.4).77 Diarrhea has been found to be highly prevalent among individuals with AIDS (90%), when compared to cancer survivors (29%) and patients with renal disease (21%).70
Pelvic Pain
Published in S Paige Hertweck, Maggie L Dwiggins, Clinical Protocols in Pediatric and Adolescent Gynecology, 2022
Systemic illnessHistoryWhen was pain first noticedLocalize pain: Groin, back, abdomen (right, left, upper, and/or lower quadrants, vaginal, umbilical, buttock, leg), abdominal wallRadiation (does or does not?)Relation to menstrual cycles (cyclic or noncyclic?)Characterize pain: (Burning, sharp, stabbing, aching, squeezing, throbbing, steady, or intermittent)Pain is worse at what timePain is worse with what position, activityPain is better with what position, activityDoes the pain awaken you from sleep? Can you sleep if you are in pain?Does pain interfere with your normal activity? (school, sports)Any associated symptoms (nausea, vomiting, dysuria, diarrhea, constipation), what pain medicines or treatments have been used, and did they help?GI: How often do you have a bowel movement? Do you sit on the toilet for a long time? Diarrhea alternating with constipation? Blood in the stool? (Bristol Stool Scale – see Bibliography)Urologic: History of urinary tract infections, dysuria, frequency, incontinence, hematuriaSubstance usePsychologic: Depression or anxietySexual/physical/psychological abuse or trauma historyInjuryFamily history (endometriosis, congenital anomaly, systemic illness)
Recommendations for the management of diarrhea with trofinetide use in Rett syndrome
Published in Expert Opinion on Orphan Drugs, 2023
Eric D. Marsh, Arthur Beisang, Timothy Buie, Timothy A. Benke, Brian Gaucher, Kathleen J. Motil
Obtain a 7- day baseline of bowel activity (stool frequency and consistency, presence of blood) and provide caregiver education on diarrhea management before initiation of trofinetide. A 7- day daily bowel record should be sufficient to document a typical elimination pattern. Stool consistency may be subject to the interpretation of the caregiver or family. While the Bristol stool scale [14] is appropriate for research and possibly caregivers, practical comparisons may be helpful for describing stool texture. For example, it may help to ask caregivers whether the stool is shaped like a ball or pebble, stringy, or formed like a log. Blood in stool should be evaluated to rule out a side infection or fissures from constipation and should prompt a general pediatric or gastroenterology consultation.
Tenapanor for the treatment of irritable bowel syndrome with constipation
Published in Expert Review of Clinical Pharmacology, 2020
Emanuele Sinagra, Francesca Rossi, Dario Raimondo, Giuseppe Conoscenti, Andrea Anderloni, Valentina Guarnotta, Marcello Maida
According to Rome Ⅳ criteria, IBS is defined on the basis of the presence of: recurrent abdominal pain, on average, at least 1 day per week in the last 3 months, associated with 2 or more of the following criteria: (1) related to defecation; (2) associated with a change in frequency of stool; and (3) associated with a change in form (appearance) of stool. These criteria should be fulfilled for the last 3 months with symptom onset at least 6 months before diagnosis [14]. According to the Rome Ⅳ criteria, IBS is subtyped according to the predominant bowel habit as follows: IBS with constipation (IBS-C), IBS with diarrhea (IBS-D), mixed type (IBS-M), and unclassified (IBS-U) [13]. The definition of bowel habit type is based on the patient’s description of the stool form by referring to the Bristol Stool Scale [15]. Furthermore, IBS patients can be grouped into sporadic (nonspecific) and postinfectious (PI-IBS)/inflammatory bowel disease (IBD) associated (IBD-IBS) [16,17].
Clinical response to fecal microbiota transplantation in patients with diarrhea-predominant irritable bowel syndrome is associated with normalization of fecal microbiota composition and short-chain fatty acid levels
Published in Scandinavian Journal of Gastroenterology, 2019
Tarek Mazzawi, Trygve Hausken, Johannes R. Hov, Jørgen Valeur, Dag André Sangnes, Magdy El-Salhy, Odd Helge Gilja, Jan Gunnar Hatlebakk, Gülen Arslan Lied
IBS-SSS score (mean ± SEM) for the asymptomatic donors was 18 ± 8.9 and the scores for the total group of IBS patients at baseline (week 0) and at the last week of the study were 328.8 ± 20.7 and 250.8 ± 35.9, respectively. According to clinical response at week 20/28, eights patients were considered responders (IBS-SSS reduction >50 from baseline) and five nonresponders. The IBS-SSS scores for the responders and nonresponders’ groups were similar at baseline and control visit 1, but was significantly reduced compared to baseline only for the responders’ group from control visit 2 and onwards (Figure 1). Significant differences were noted in IBS-SSS scores between the responders and nonresponders’ groups at control visit 3 and 4 (Figure 1). Clinical responses before and during the first 20 days after FMT as assessed by the different domains of IBS-SQ questionnaire in responders and nonresponders’ groups are shown in Supplementary material 1. The responders’ group showed improved quality of life scores as measured by SF-NDI at control visits 2 and 4 compared to baseline (p = .036 and .0095, respectively), while no improvement was shown in the nonresponders’ group, Supplementary material 2. Stool consistency also improved from watery to normal in the responders’ group (Bristol stool scale scores changing from 5.4 ± 0.6 at baseline to 3.6 ± 0.6 at control visit 4), while it remained unchanged for the nonresponders’ group.