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Chronic digestive diseases

Posted by on Wednesday, September 8, 2010, 4:15
This news item was posted in C, Digestive category and has 2 Comments so far.

A condition or disorder the causes continual digestive problems. Celiac disease, Crohn’s disease, diverticulitis and ulcers are some examples of stomach disorders to provide ongoing digestive complaints.

Chronic digestive diseases Causes:

Differential Diagnosis:

Central nausea/vomiting

Chronic digestive diseases

Chronic digestive diseases

–Pregnancy (hyperemesis gravidarum)
–Uremia
–Hypercalcemia
–Drugs (e.g., chemotherapy agents)
–Carbon monoxide poisoning
Gastrointestinal disease
–Infection (e.g., gastroenteritis, appendicitis, cholecystitis)
–Obstruction (e.g., pyloric stenosis, small bowel obstruction, large bowel obstruction, gastroparesis, Ogilvie’s syndrome)
–Inflammation (e.g., pancreatitis, peptic ulcer disease)
–Food poisoning
Toxic ingestions
–Syrup of ipecac
–Alcohol
–Salicylates: Result in tachypnea, tinnitus,
and metabolic acidosis/respiratory alkalosis
–Iron: Causes profound gastritis
–Arsenic
Middle ear disease (e.g., Ménie’re’s disease, labyrinthitis, benign positional vertigo)
Post-tussive emesis (especially in children)
Motion sickness
CNS disease
–Increased intracranial pressure due to brain tumor, CNS infection (e.g., meningitis, abscess), head trauma, hydrocephalus, subarachnoid hemorrhage, vestibular neuritis, or intracerebral hemorrhage
–Migraine headache
Acute myocardial infarction (especially inferior MI)
Ovarian torsion
Testicular torsion
Malingering: Relatively common, but should be a diagnosis of exclusion until more serious causes are excluded
Intussusception: Classically causes colicky abdominal pain, vomiting, and currant jelly stools
Pyelonephritis or other abdominal process
Workup and Diagnosis

Complete history and physical examination is the most useful diagnostic aid
–Neurologic examination looking for clues to CNS lesions
–Ear examination to evaluate for middle ear disease
–Ophthalmologic examination to evaluate for nystagmus in labyrinthitis or benign positional vertigo
–Abdominal examination including stool guaiac to evaluate for GI pathology
Labs may include CBC, electrolytes, liver function tests, amylase, lipase, urinalysis, calcium, magnesium, salicylate level, hepatitis serologies, toxicology screen, and CSF analysis (for meningitis or bleeding)
ECG and cardiac enzymes may be indicated to evaluate for cardiac ischemia
Abdominal CT scan with oral and IV contrast if history and physical examination suggest abdominal pathology
Plain KUB X-rays may be indicated to evaluate for bowel obstruction or perforation
Abdomen/pelvic ultrasound is especially helpful in cases of lower abdominal pain in female patients or in suspected gallbladder disease
Endoscopy is indicated for suspected peptic ulcer disease
Head CT with and without contrast if CNS lesion is suspected

Treatment:
Fluid resuscitation is a mainstay of therapy, because vomiting may cause significant dehydration
Antiemetics (e.g., metoclopramide, ondansetron, prochlorperazine) may be administered to control symptoms
Treat reversible causes as necessary (e.g., uremia, hypercalcemia, CNS infections, toxic exposures)
Treatment of underlying etiologies generally eliminates vomiting
Inner ear causes of vomiting may respond to treatment with anticholinergics (e.g., meclizine)
Endoscopy/colonoscopy may be used diagnostically and therapeutically in cases of peptic ulcer disease or large bowel obstruction


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