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wikidoc - User contributions [en]
2026-04-04T14:48:51Z
User contributions
MediaWiki 1.45.1
https://www.wikidoc.org/index.php?title=Gait_abnormality&diff=1702932
Gait abnormality
2021-06-03T19:29:55Z
<p>Usmanaliakbar: </p>
<hr />
<div>__NOTOC__ <br />
{| class="infobox" style="float:right;"<br />
|-<br />
|[[File:Siren.gif|30px|link= Gait Abnormality resident survival guide]]||<br>||<br><br />
|[[Gait Abnormality survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']]<br />
|}'''For patient information, click [[Gait Abnormality(patient information)|here]]'''<br />
{{SI}} <br />
{{CMG}} {{AE}} {{Usman Ali Akbar}}<br />
<br />
{{SK}} Gait disturbance<br />
<br />
<br />
==[[Gait Disturbances overview|Overview]]==<br />
<br />
==[[Gait Disturbances historical perspective|Historical Perspective]]==<br />
<br />
==[[Gait Disturbances classification|Classification]]==<br />
<br />
==[[Gait Disturbances pathophysiology|Pathophysiology]]==<br />
<br />
==[[Gait Disturbances causes|Causes]]==<br />
<br />
==[[Gait Disturbances differential diagnosis|Differentiating Any Disease from other Diseases]]==<br />
<br />
==[[Gait Disturbances epidemiology and demographics|Epidemiology and Demographics]]==<br />
<br />
==[[Gait Disturbances risk factors|Risk Factors]]== <br />
<br />
==[[Gait Disturbances screening|Screening]]== <br />
<br />
==[[Gait Disturbances natural history, complications and prognosis|Natural History, Complications and Prognosis]]==<br />
<br />
==Diagnosis==<br />
[[Type page name here history and symptoms|History and Symptoms]] | [[Type page name here physical examination|Physical Examination]] | [[Type page name here laboratory findings|Laboratory Findings]] | [[Type page name here electrocardiogram|Electrocardiogram]] | [[Type page name here chest x ray|Chest X Ray]] | [[Type page name here CT|CT]] | [[Type page name here MRI|MRI]] | [[Type page name here echocardiography or ultrasound|Echocardiography or Ultrasound]] | [[Type page name here other imaging findings|Other Imaging Findings]] | [[Type page name here other diagnostic studies|Other Diagnostic Studies]]<br />
<br />
==Treatment==<br />
[[Type page name here medical therapy|Medical Therapy]] | [[Type page name here surgery|Surgery]] | [[Type page name here primary prevention|Primary Prevention]] | [[Type page name here secondary prevention|Secondary Prevention]] | [[Type page name here cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Type page name here future or investigational therapies|Future or Investigational Therapies]]<br />
<br />
==Case Studies==<br />
[[Type page name here case study one|Case #1]]<br />
<br />
<br />
[[Category:Projects]]<br />
[[Category:Help]]<br />
<br />
{{WH}}<br />
{{WS}}<br />
<br />
<br />
==References==<br />
{{reflist|2}}<br />
<br />
==See also==<br />
<br />
*[[Ataxia]]<br />
*[[Limp]]<br />
*[[Foot drop]]<br />
*[[Gait Abnormality Rating Scale]]<br />
<br />
==External links==<br />
<br />
*[http://www.childrenshospital.org/az/Site932/printerfriendlypageS932P0.html Children's Hospital Boston]<br />
*[http://www.univie.ac.at/cga/faq/classification.html Classification]<br />
*[http://www.univie.ac.at/cga/archives/25-7-96/ Case Study]<br />
*[http://medstat.med.utah.edu/neurologicexam/html/gait_abnormal.html Utah]<br />
*{{GPNotebook|1376124935}}<br />
{{Symptoms and signs}}<br />
{{jb1}}<br />
{{WikiDoc Help Menu}}<br />
{{WikiDoc Sources}}<br />
<br />
[[Category:Disease]]<br />
[[Category:Neurology]]<br />
[[Category:Primary care]]</div>
Usmanaliakbar
https://www.wikidoc.org/index.php?title=Gait_abnormality&diff=1702930
Gait abnormality
2021-06-03T19:17:37Z
<p>Usmanaliakbar: /* Complete Differential Diagnosis */</p>
<hr />
<div>__NOTOC__ <br />
{| class="infobox" style="float:right;"<br />
|-<br />
|[[File:Siren.gif|30px|link= Gait Abnormality resident survival guide]]||<br>||<br><br />
|[[Gait Abnormality survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']]<br />
|}'''For patient information, click [[Gait Abnormality(patient information)|here]]'''<br />
{{SI}} <br />
{{CMG}} {{AE}} {{Usman Ali Akbar}}<br />
<br />
{{SK}} Gait disturbance<br />
<br />
==Overview==<br />
<br />
==Complete Differential Diagnosis==<br />
<br />
*<br />
<br />
{| class="wikitable"<br />
|+<br />
!Gait abnormalities due to Drugs<br />
!Organic Diseases<br />
!Electrolyte imbalances<br />
!Vitamin Deficiency<br />
!Pyschiatric<br />
|-<br />
|<br />
* Alcohol<br />
* Amiodarone<br />
* Antiepileptic drugs<br />
* Barbiturates<br />
* Benzodiazepines<br />
* Bismuth<br />
* Bromides<br />
* Carbon tetrachloride<br />
* Chemotherapeutic agents (particularly high-dose cytarabine, fluorouracil, and asparaginase)<br />
* Cyclosporine<br />
* Glucocorticoids (high-dose)<br />
* Heavy metals (particularly mercury and manganese)<br />
* Lithium<br />
* Metronidazole<br />
* Phencyclidine<br />
* Piperazine<br />
* Tacrolimus<br />
* Thallium<br />
* Toluene<br />
* Zidovudine<br />
<br />
*<br />
|<br />
*[[Appendicitis]]<br />
*Cerebellar lesions<br />
*[[Cerebral Palsy]]<br />
*[[Cerebrovascular disease]]<br />
*[[Chondrodystrophia]]<br />
*[[Chondromalacia Patellae]]<br />
*Damage of the [[symphysis]]<br />
*[[Degenerative joint disease]]<br />
*[[Discitis]]<br />
*[[Drugs]]<br />
**[[Artemether and lumefantrin]]<br />
**[[Interferon gamma]]<br />
**[[Perampanel]]<br />
*[[Dystonia]]<br />
*[[Encephalitis]]<br />
*Foreign body in shoe<br />
*[[Fredreich's Ataxia]]<br />
*[[Hemophilia]]<br />
*[[Hernia]]s<br />
*[[Hydrocephalus]]<br />
*Leg length discrepancy<br />
*[[Legg-Calve-Perthes Disease]]<br />
*Local [[neoplasm]]<br />
*[[Meningitis]]<br />
*[[Metastases]]<br />
*[[Multiple Sclerosis]]<br />
*[[Neuromuscular]] disorders<br />
*[[Osgood-Schlatter Disease]]<br />
*[[Osteomalacia]]<br />
*[[Osteochondritis Dissecans]]<br />
*[[Osteomyelitis]]<br />
*[[Parkinson's Disease|Parkinsonism]]<br />
*[[Periostitis]]<br />
*[[Poliomyelitis]]<br />
*[[Polyneuropathy]]<br />
*Poorly fitting shoes<br />
*[[Rickets]]<br />
*Sensory [[ataxia]]<br />
*[[Septic Arthritis]]<br />
*[[Sickle cell Disease]]<br />
*[[Somatization Syndrome]]<br />
*Splinter in foot<br />
*[[Tabes Dorsalis]]<br />
*[[Testicular torsion]]<br />
*[[Trauma]]<br />
*Viral [[arthritis]] <ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref> <ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X</ref><br />
|<br />
*Hyponatremia<br />
*Hypokalemia<br />
*Hypomagnesemia<br />
<br />
<br /><br />
|Vitamin B12 deficiency <br />
<br />
Vitamin E deficiency <br />
<br />
Copper Deficiency <br />
<br /><br />
|Anxiety <br />
Depression<br />
|-<br />
|<br />
|<br />
|<br />
|<br />
|<br />
|-<br />
|<br />
|<br />
|<br />
|<br />
|<br />
|}<br />
<br />
*<br />
<br />
Persons suffering from [[peripheral neuropathy]] experience [[numbness]] and [[tingling]] in their hands and feet. This can cause difficulty in walking, climbing stairs and maintaining [[balance]]. Gait abnormality that results from [[chemotherapy]] is generally temporary in nature, though recovery times of six months to a year are common.<br />
<br />
==Specific abnormalities and examples of causes==<br />
===Antalgic gait===<br />
''User favors certain motions to avoid acute pain. [http://www.gpnotebook.co.uk/simplepage.cfm?ID=671481857]''<br />
<br />
*[[Physical trauma|Trauma]]<br />
*[[Osteoarthritis]]<br />
*[[Pelvic girdle pain]]<br />
<br />
===Drunken gait/Cerebellar ataxia===<br />
''Reeling in a style like that of an intoxicated person. [http://www.gpnotebook.co.uk/simplepage.cfm?ID=-972685307&linkID=203&cook=yes]''<br />
<br />
*[[Ataxia]]<br />
*[[Cerebellar lesion]]s<br />
*[[Cerebellar degeneration]]<br />
*[[Intoxication]]s<br />
<br />
===Festinating gait/Parkinsonian gait===<br />
''Patient moves with short, jerky steps. Term derives from Latin "festino", or "to hurry". [http://www.medfriendly.com/festinatinggait.html] [http://physicaltherapy.about.com/od/abbreviationsandterms/g/Gait.htm] [http://www.gpnotebook.co.uk/simplepage.cfm?ID=610992140&linkID=206&cook=yes]''<br />
<br />
*[[Parkinson's disease]]<br />
<br />
===Pigeon gait===<br />
''Torsional abnormalities. [http://www.gpnotebook.co.uk/simplepage.cfm?ID=1590689848]''<br />
<br />
*[[Hip dysplasia]]<br />
<br />
===Propulsive gait===<br />
''Stiff, with head and neck bent. [http://www.nlm.nih.gov/medlineplus/ency/article/003199.htm] ''<br />
<br />
*[[Carbon monoxide poisoning]]<br />
*[[Parkinson's disease]]<br />
<br />
===Steppage gait/High stepping gait===<br />
''Toes point down. [http://www.nlm.nih.gov/medlineplus/ency/article/003199.htm] [http://www.medterms.com/script/main/art.asp?articlekey=22477] [http://www.gpnotebook.co.uk/simplepage.cfm?ID=1966407688&linkID=205&cook=yes]''<br />
<br />
*[[Polio]]<br />
*[[Multiple sclerosis]]<br />
<br />
===Scissor gait===<br />
Legs flexed slightly at the hips and knees, giving the appearance of crouching, with the knees and thighs hitting or crossing in a scissors-like movement. Often mixed with or accompanied by spastic gait, a stiff, foot-dragging walk caused by one-sided, long-term muscle contraction. Most common in patients with spastic cerebral palsy, usually [[spastic diplegia|diplegic]] and [[spastic paraplegia|paraplegic]] varieties. The individual is forced to walk on [[tiptoe]] unless the [[Tibialis anterior muscle|dorsiflexor]] muscles are released by an orthaepedic surgical procedure. Muscle contractures of the [[adductor]]s result in thighs and knees rubbing together and crossing in a manner analogous to scissors.<br />
<br />
These features are typical, and usually result in some form and to some degree regardless of the mildness or severity of the spastic CP condition.<br />
<br />
*rigidity and excessive adduction of the leg in swing<br />
*plantar flexion of the ankle<br />
*flexion at the knee<br />
*adduction and internal rotation at the hip<br />
*contractures of all spastic muscles<br />
*complicated assisting movements of the upper limbs when walking [http://www.nlm.nih.gov/medlineplus/ency/article/003199.htm].[http://www.gpnotebook.co.uk/simplepage.cfm?ID=-120586227&linkID=208&cook=yes]<br />
<br />
====See Also====<br />
<br />
*[[Spastic diplegia]]<br />
*[[Pernicious anemia]]<br />
*[[Spastic paraplegia]]<br />
<br />
===[[Sensory ataxia]] gait/Stomping gait===<br />
''Uncoordinated walking [http://medical.webends.com/kw/Gait%20Ataxia] [http://physicaltherapy.about.com/od/abbreviationsandterms/g/Gait.htm] [http://www.gpnotebook.co.uk/simplepage.cfm?ID=-1737818075&linkID=207&cook=yes] [http://www.diseasesdatabase.com/ddb29285.htm]'' <br />
<br />
*[[Friedreich's ataxia]]<br />
*[[Pernicious anemia]]<br /><br />
*Tabes Dorsalis (Syphilis)<br />
<br />
===Spastic gait===<br />
''Asymmetric foot dragging. [http://www.nlm.nih.gov/medlineplus/ency/article/003199.htm] [http://physicaltherapy.about.com/od/abbreviationsandterms/g/Gait.htm]''<br />
<br />
*[[Brain tumor]]<br />
*[[Sturge-Weber syndrome]]<br />
*[[Cerebral palsy]]<br />
<br />
===[[Trendelenburg gait]]===<br />
<br />
*weakness of the [[abductor]] muscles of the lower limb, principally [[gluteus medius]]<br />
<br />
===Waddling/Myopathic gait===<br />
''Walking like a duck. [http://www.nlm.nih.gov/medlineplus/ency/article/003199.htm] [http://www.gpnotebook.co.uk/simplepage.cfm?ID=147849232&linkID=209&cook=yes] ''<br />
<br />
*[[Pregnancy]]<br />
<br />
===Magnetic gait===<br />
Feet seem attached to floor as if by a magnet. In magnetic gait, each step is initiated in a "wresting" motion carrying feet upward and forward. Magnetic gait can be visualized in terms of a powerful magnet being forcefully pulled from a steel plate.<br />
<br />
*[[Normal pressure hydrocephalus]] (NPH)<br />
<br />
==References==<br />
{{reflist|2}}<br />
<br />
==See also==<br />
<br />
*[[Ataxia]]<br />
*[[Limp]]<br />
*[[Foot drop]]<br />
*[[Gait Abnormality Rating Scale]]<br />
<br />
==External links==<br />
<br />
*[http://www.childrenshospital.org/az/Site932/printerfriendlypageS932P0.html Children's Hospital Boston]<br />
*[http://www.univie.ac.at/cga/faq/classification.html Classification]<br />
*[http://www.univie.ac.at/cga/archives/25-7-96/ Case Study]<br />
*[http://medstat.med.utah.edu/neurologicexam/html/gait_abnormal.html Utah]<br />
*{{GPNotebook|1376124935}}<br />
{{Symptoms and signs}}<br />
{{jb1}}<br />
{{WikiDoc Help Menu}}<br />
{{WikiDoc Sources}}<br />
<br />
[[Category:Disease]]<br />
[[Category:Neurology]]<br />
[[Category:Primary care]]</div>
Usmanaliakbar
https://www.wikidoc.org/index.php?title=Gait_abnormality&diff=1702929
Gait abnormality
2021-06-03T19:16:04Z
<p>Usmanaliakbar: /* Complete Differential Diagnosis */</p>
<hr />
<div>__NOTOC__ <br />
{| class="infobox" style="float:right;"<br />
|-<br />
|[[File:Siren.gif|30px|link= Gait Abnormality resident survival guide]]||<br>||<br><br />
|[[Gait Abnormality survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']]<br />
|}'''For patient information, click [[Gait Abnormality(patient information)|here]]'''<br />
{{SI}} <br />
{{CMG}} {{AE}} {{Usman Ali Akbar}}<br />
<br />
{{SK}} Gait disturbance<br />
<br />
==Overview==<br />
<br />
==Complete Differential Diagnosis==<br />
<br />
*<br />
<br />
{| class="wikitable"<br />
|+<br />
!Gait abnormalities due to Drugs<br />
!Organic Diseases<br />
!Electrolyte imbalances <br />
!Vitamin Deficiency <br />
!Pyschiatric<br />
|-<br />
|<br />
*<br />
|<br />
*[[Appendicitis]]<br />
*Cerebellar lesions<br />
*[[Cerebral Palsy]]<br />
*[[Cerebrovascular disease]]<br />
*[[Chondrodystrophia]]<br />
*[[Chondromalacia Patellae]]<br />
*Damage of the [[symphysis]]<br />
*[[Degenerative joint disease]]<br />
*[[Discitis]]<br />
*[[Drugs]]<br />
**[[Artemether and lumefantrin]]<br />
**[[Interferon gamma]]<br />
**[[Perampanel]]<br />
*[[Dystonia]]<br />
*[[Encephalitis]]<br />
*Foreign body in shoe<br />
*[[Fredreich's Ataxia]]<br />
*[[Hemophilia]]<br />
*[[Hernia]]s<br />
*[[Hydrocephalus]]<br />
*Leg length discrepancy<br />
*[[Legg-Calve-Perthes Disease]]<br />
*Local [[neoplasm]]<br />
*[[Meningitis]]<br />
*[[Metastases]]<br />
*[[Multiple Sclerosis]]<br />
*[[Neuromuscular]] disorders<br />
*[[Osgood-Schlatter Disease]]<br />
*[[Osteomalacia]]<br />
*[[Osteochondritis Dissecans]]<br />
*[[Osteomyelitis]]<br />
*[[Parkinson's Disease|Parkinsonism]]<br />
*[[Periostitis]]<br />
*[[Poliomyelitis]]<br />
*[[Polyneuropathy]]<br />
*Poorly fitting shoes<br />
*[[Rickets]]<br />
*Sensory [[ataxia]]<br />
*[[Septic Arthritis]]<br />
*[[Sickle cell Disease]]<br />
*[[Somatization Syndrome]]<br />
*Splinter in foot<br />
*[[Tabes Dorsalis]]<br />
*[[Testicular torsion]]<br />
*[[Trauma]]<br />
*Viral [[arthritis]] <ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref> <ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X</ref><br />
|<br />
* Hyponatremia<br />
* Hypokalemia <br />
* Hypomagnesemia<br />
<br />
<br /><br />
|Vitamin B12 deficiency <br />
<br />
Vitamin E deficiency <br />
<br />
Copper Deficiency <br />
<br /><br />
|Anxiety <br />
Depression<br />
|-<br />
|<br />
|<br />
|<br />
|<br />
|<br />
|-<br />
|<br />
|<br />
|<br />
|<br />
|<br />
|}<br />
<br />
*<br />
<br />
Persons suffering from [[peripheral neuropathy]] experience [[numbness]] and [[tingling]] in their hands and feet. This can cause difficulty in walking, climbing stairs and maintaining [[balance]]. Gait abnormality that results from [[chemotherapy]] is generally temporary in nature, though recovery times of six months to a year are common.<br />
<br />
==Specific abnormalities and examples of causes==<br />
===Antalgic gait===<br />
''User favors certain motions to avoid acute pain. [http://www.gpnotebook.co.uk/simplepage.cfm?ID=671481857]''<br />
<br />
*[[Physical trauma|Trauma]]<br />
*[[Osteoarthritis]]<br />
*[[Pelvic girdle pain]]<br />
<br />
===Drunken gait/Cerebellar ataxia===<br />
''Reeling in a style like that of an intoxicated person. [http://www.gpnotebook.co.uk/simplepage.cfm?ID=-972685307&linkID=203&cook=yes]''<br />
<br />
*[[Ataxia]]<br />
*[[Cerebellar lesion]]s<br />
*[[Cerebellar degeneration]]<br />
*[[Intoxication]]s<br />
<br />
===Festinating gait/Parkinsonian gait===<br />
''Patient moves with short, jerky steps. Term derives from Latin "festino", or "to hurry". [http://www.medfriendly.com/festinatinggait.html] [http://physicaltherapy.about.com/od/abbreviationsandterms/g/Gait.htm] [http://www.gpnotebook.co.uk/simplepage.cfm?ID=610992140&linkID=206&cook=yes]''<br />
<br />
*[[Parkinson's disease]]<br />
<br />
===Pigeon gait===<br />
''Torsional abnormalities. [http://www.gpnotebook.co.uk/simplepage.cfm?ID=1590689848]''<br />
<br />
*[[Hip dysplasia]]<br />
<br />
===Propulsive gait===<br />
''Stiff, with head and neck bent. [http://www.nlm.nih.gov/medlineplus/ency/article/003199.htm] ''<br />
<br />
*[[Carbon monoxide poisoning]]<br />
*[[Parkinson's disease]]<br />
<br />
===Steppage gait/High stepping gait===<br />
''Toes point down. [http://www.nlm.nih.gov/medlineplus/ency/article/003199.htm] [http://www.medterms.com/script/main/art.asp?articlekey=22477] [http://www.gpnotebook.co.uk/simplepage.cfm?ID=1966407688&linkID=205&cook=yes]''<br />
<br />
*[[Polio]]<br />
*[[Multiple sclerosis]]<br />
<br />
===Scissor gait===<br />
Legs flexed slightly at the hips and knees, giving the appearance of crouching, with the knees and thighs hitting or crossing in a scissors-like movement. Often mixed with or accompanied by spastic gait, a stiff, foot-dragging walk caused by one-sided, long-term muscle contraction. Most common in patients with spastic cerebral palsy, usually [[spastic diplegia|diplegic]] and [[spastic paraplegia|paraplegic]] varieties. The individual is forced to walk on [[tiptoe]] unless the [[Tibialis anterior muscle|dorsiflexor]] muscles are released by an orthaepedic surgical procedure. Muscle contractures of the [[adductor]]s result in thighs and knees rubbing together and crossing in a manner analogous to scissors.<br />
<br />
These features are typical, and usually result in some form and to some degree regardless of the mildness or severity of the spastic CP condition.<br />
<br />
*rigidity and excessive adduction of the leg in swing<br />
*plantar flexion of the ankle<br />
*flexion at the knee<br />
*adduction and internal rotation at the hip<br />
*contractures of all spastic muscles<br />
*complicated assisting movements of the upper limbs when walking [http://www.nlm.nih.gov/medlineplus/ency/article/003199.htm].[http://www.gpnotebook.co.uk/simplepage.cfm?ID=-120586227&linkID=208&cook=yes]<br />
<br />
====See Also====<br />
<br />
*[[Spastic diplegia]]<br />
*[[Pernicious anemia]]<br />
*[[Spastic paraplegia]]<br />
<br />
===[[Sensory ataxia]] gait/Stomping gait===<br />
''Uncoordinated walking [http://medical.webends.com/kw/Gait%20Ataxia] [http://physicaltherapy.about.com/od/abbreviationsandterms/g/Gait.htm] [http://www.gpnotebook.co.uk/simplepage.cfm?ID=-1737818075&linkID=207&cook=yes] [http://www.diseasesdatabase.com/ddb29285.htm]'' <br />
<br />
*[[Friedreich's ataxia]]<br />
*[[Pernicious anemia]]<br /><br />
*Tabes Dorsalis (Syphilis)<br />
<br />
===Spastic gait===<br />
''Asymmetric foot dragging. [http://www.nlm.nih.gov/medlineplus/ency/article/003199.htm] [http://physicaltherapy.about.com/od/abbreviationsandterms/g/Gait.htm]''<br />
<br />
*[[Brain tumor]]<br />
*[[Sturge-Weber syndrome]]<br />
*[[Cerebral palsy]]<br />
<br />
===[[Trendelenburg gait]]===<br />
<br />
*weakness of the [[abductor]] muscles of the lower limb, principally [[gluteus medius]]<br />
<br />
===Waddling/Myopathic gait===<br />
''Walking like a duck. [http://www.nlm.nih.gov/medlineplus/ency/article/003199.htm] [http://www.gpnotebook.co.uk/simplepage.cfm?ID=147849232&linkID=209&cook=yes] ''<br />
<br />
*[[Pregnancy]]<br />
<br />
===Magnetic gait===<br />
Feet seem attached to floor as if by a magnet. In magnetic gait, each step is initiated in a "wresting" motion carrying feet upward and forward. Magnetic gait can be visualized in terms of a powerful magnet being forcefully pulled from a steel plate.<br />
<br />
*[[Normal pressure hydrocephalus]] (NPH)<br />
<br />
==References==<br />
{{reflist|2}}<br />
<br />
==See also==<br />
<br />
*[[Ataxia]]<br />
*[[Limp]]<br />
*[[Foot drop]]<br />
*[[Gait Abnormality Rating Scale]]<br />
<br />
==External links==<br />
<br />
*[http://www.childrenshospital.org/az/Site932/printerfriendlypageS932P0.html Children's Hospital Boston]<br />
*[http://www.univie.ac.at/cga/faq/classification.html Classification]<br />
*[http://www.univie.ac.at/cga/archives/25-7-96/ Case Study]<br />
*[http://medstat.med.utah.edu/neurologicexam/html/gait_abnormal.html Utah]<br />
*{{GPNotebook|1376124935}}<br />
{{Symptoms and signs}}<br />
{{jb1}}<br />
{{WikiDoc Help Menu}}<br />
{{WikiDoc Sources}}<br />
<br />
[[Category:Disease]]<br />
[[Category:Neurology]]<br />
[[Category:Primary care]]</div>
Usmanaliakbar
https://www.wikidoc.org/index.php?title=Gait_abnormality&diff=1695872
Gait abnormality
2021-04-01T02:14:55Z
<p>Usmanaliakbar: /* Complete Differential Diagnosis */</p>
<hr />
<div>__NOTOC__ <br />
{| class="infobox" style="float:right;"<br />
|-<br />
|[[File:Siren.gif|30px|link= Gait Abnormality resident survival guide]]||<br>||<br><br />
|[[Gait Abnormality survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']]<br />
|}'''For patient information, click [[Gait Abnormality(patient information)|here]]'''<br />
{{SI}} <br />
{{CMG}} {{AE}} {{Usman Ali Akbar}}<br />
<br />
{{SK}} Gait disturbance<br />
<br />
==Overview==<br />
<br />
==Complete Differential Diagnosis==<br />
<br />
*<br />
<br />
{| class="wikitable"<br />
|+<br />
!Gait abnormalities due to Drugs <br />
!<br />
!<br />
!<br />
|-<br />
|<br />
* Alcohol<br />
* Amiodarone<br />
* Antiepileptic drugs<br />
* Barbiturates<br />
* Benzodiazepines<br />
* Bismuth<br />
* Bromides<br />
* Carbon tetrachloride<br />
* Chemotherapeutic agents (particularly high-dose cytarabine, fluorouracil, and asparaginase)<br />
* Cyclosporine<br />
* Glucocorticoids (high-dose)<br />
* Heavy metals (particularly mercury and manganese)<br />
* Lithium<br />
* Metronidazole<br />
* Phencyclidine<br />
* Piperazine<br />
* Tacrolimus<br />
* Thallium<br />
* Toluene<br />
* Zidovudine<br />
|<br />
*[[Appendicitis]]<br />
*Cerebellar lesions<br />
*[[Cerebral Palsy]]<br />
*[[Cerebrovascular disease]]<br />
*[[Chondrodystrophia]]<br />
*[[Chondromalacia Patellae]]<br />
*Damage of the [[symphysis]]<br />
*[[Degenerative joint disease]]<br />
*[[Discitis]]<br />
*[[Drugs]]<br />
**[[Artemether and lumefantrin]]<br />
**[[Interferon gamma]]<br />
**[[Perampanel]]<br />
*[[Dystonia]]<br />
*[[Encephalitis]]<br />
*Foreign body in shoe<br />
*[[Fredreich's Ataxia]]<br />
*[[Hemophilia]]<br />
*[[Hernia]]s<br />
*[[Hydrocephalus]]<br />
*Leg length discrepancy<br />
*[[Legg-Calve-Perthes Disease]]<br />
*Local [[neoplasm]]<br />
*[[Meningitis]]<br />
*[[Metastases]]<br />
*[[Multiple Sclerosis]]<br />
*[[Neuromuscular]] disorders<br />
*[[Osgood-Schlatter Disease]]<br />
*[[Osteomalacia]]<br />
*[[Osteochondritis Dissecans]]<br />
*[[Osteomyelitis]]<br />
*[[Parkinson's Disease|Parkinsonism]]<br />
*[[Periostitis]]<br />
*[[Poliomyelitis]]<br />
*[[Polyneuropathy]]<br />
*Poorly fitting shoes<br />
*[[Rickets]]<br />
*Sensory [[ataxia]]<br />
*[[Septic Arthritis]]<br />
*[[Sickle cell Disease]]<br />
*[[Somatization Syndrome]]<br />
*Splinter in foot<br />
*[[Tabes Dorsalis]]<br />
*[[Testicular torsion]]<br />
*[[Trauma]]<br />
*Viral [[arthritis]] <ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref> <ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X</ref><br />
|<br />
|<br />
|-<br />
|<br />
|<br />
|<br />
|<br />
|-<br />
|<br />
|<br />
|<br />
|<br />
|}<br />
<br />
*<br />
<br />
Persons suffering from [[peripheral neuropathy]] experience [[numbness]] and [[tingling]] in their hands and feet. This can cause difficulty in walking, climbing stairs and maintaining [[balance]]. Gait abnormality that results from [[chemotherapy]] is generally temporary in nature, though recovery times of six months to a year are common.<br />
<br />
==Specific abnormalities and examples of causes==<br />
===Antalgic gait===<br />
''User favors certain motions to avoid acute pain. [http://www.gpnotebook.co.uk/simplepage.cfm?ID=671481857]''<br />
<br />
*[[Physical trauma|Trauma]]<br />
*[[Osteoarthritis]]<br />
*[[Pelvic girdle pain]]<br />
<br />
===Drunken gait/Cerebellar ataxia===<br />
''Reeling in a style like that of an intoxicated person. [http://www.gpnotebook.co.uk/simplepage.cfm?ID=-972685307&linkID=203&cook=yes]''<br />
<br />
*[[Ataxia]]<br />
*[[Cerebellar lesion]]s<br />
*[[Cerebellar degeneration]]<br />
*[[Intoxication]]s<br />
<br />
===Festinating gait/Parkinsonian gait===<br />
''Patient moves with short, jerky steps. Term derives from Latin "festino", or "to hurry". [http://www.medfriendly.com/festinatinggait.html] [http://physicaltherapy.about.com/od/abbreviationsandterms/g/Gait.htm] [http://www.gpnotebook.co.uk/simplepage.cfm?ID=610992140&linkID=206&cook=yes]''<br />
<br />
*[[Parkinson's disease]]<br />
<br />
===Pigeon gait===<br />
''Torsional abnormalities. [http://www.gpnotebook.co.uk/simplepage.cfm?ID=1590689848]''<br />
<br />
*[[Hip dysplasia]]<br />
<br />
===Propulsive gait===<br />
''Stiff, with head and neck bent. [http://www.nlm.nih.gov/medlineplus/ency/article/003199.htm] ''<br />
<br />
*[[Carbon monoxide poisoning]]<br />
*[[Parkinson's disease]]<br />
<br />
===Steppage gait/High stepping gait===<br />
''Toes point down. [http://www.nlm.nih.gov/medlineplus/ency/article/003199.htm] [http://www.medterms.com/script/main/art.asp?articlekey=22477] [http://www.gpnotebook.co.uk/simplepage.cfm?ID=1966407688&linkID=205&cook=yes]''<br />
<br />
*[[Polio]]<br />
*[[Multiple sclerosis]]<br />
<br />
===Scissor gait===<br />
Legs flexed slightly at the hips and knees, giving the appearance of crouching, with the knees and thighs hitting or crossing in a scissors-like movement. Often mixed with or accompanied by spastic gait, a stiff, foot-dragging walk caused by one-sided, long-term muscle contraction. Most common in patients with spastic cerebral palsy, usually [[spastic diplegia|diplegic]] and [[spastic paraplegia|paraplegic]] varieties. The individual is forced to walk on [[tiptoe]] unless the [[Tibialis anterior muscle|dorsiflexor]] muscles are released by an orthaepedic surgical procedure. Muscle contractures of the [[adductor]]s result in thighs and knees rubbing together and crossing in a manner analogous to scissors.<br />
<br />
These features are typical, and usually result in some form and to some degree regardless of the mildness or severity of the spastic CP condition.<br />
<br />
*rigidity and excessive adduction of the leg in swing<br />
*plantar flexion of the ankle<br />
*flexion at the knee<br />
*adduction and internal rotation at the hip<br />
*contractures of all spastic muscles<br />
*complicated assisting movements of the upper limbs when walking [http://www.nlm.nih.gov/medlineplus/ency/article/003199.htm].[http://www.gpnotebook.co.uk/simplepage.cfm?ID=-120586227&linkID=208&cook=yes]<br />
<br />
====See Also====<br />
<br />
*[[Spastic diplegia]]<br />
*[[Pernicious anemia]]<br />
*[[Spastic paraplegia]]<br />
<br />
===[[Sensory ataxia]] gait/Stomping gait===<br />
''Uncoordinated walking [http://medical.webends.com/kw/Gait%20Ataxia] [http://physicaltherapy.about.com/od/abbreviationsandterms/g/Gait.htm] [http://www.gpnotebook.co.uk/simplepage.cfm?ID=-1737818075&linkID=207&cook=yes] [http://www.diseasesdatabase.com/ddb29285.htm]'' <br />
<br />
*[[Friedreich's ataxia]]<br />
*[[Pernicious anemia]]<br /><br />
*Tabes Dorsalis (Syphilis)<br />
<br />
===Spastic gait===<br />
''Asymmetric foot dragging. [http://www.nlm.nih.gov/medlineplus/ency/article/003199.htm] [http://physicaltherapy.about.com/od/abbreviationsandterms/g/Gait.htm]''<br />
<br />
*[[Brain tumor]]<br />
*[[Sturge-Weber syndrome]]<br />
*[[Cerebral palsy]]<br />
<br />
===[[Trendelenburg gait]]===<br />
<br />
*weakness of the [[abductor]] muscles of the lower limb, principally [[gluteus medius]]<br />
<br />
===Waddling/Myopathic gait===<br />
''Walking like a duck. [http://www.nlm.nih.gov/medlineplus/ency/article/003199.htm] [http://www.gpnotebook.co.uk/simplepage.cfm?ID=147849232&linkID=209&cook=yes] ''<br />
<br />
*[[Pregnancy]]<br />
<br />
===Magnetic gait===<br />
Feet seem attached to floor as if by a magnet. In magnetic gait, each step is initiated in a "wresting" motion carrying feet upward and forward. Magnetic gait can be visualized in terms of a powerful magnet being forcefully pulled from a steel plate.<br />
<br />
*[[Normal pressure hydrocephalus]] (NPH)<br />
<br />
==References==<br />
{{reflist|2}}<br />
<br />
==See also==<br />
<br />
*[[Ataxia]]<br />
*[[Limp]]<br />
*[[Foot drop]]<br />
*[[Gait Abnormality Rating Scale]]<br />
<br />
==External links==<br />
<br />
*[http://www.childrenshospital.org/az/Site932/printerfriendlypageS932P0.html Children's Hospital Boston]<br />
*[http://www.univie.ac.at/cga/faq/classification.html Classification]<br />
*[http://www.univie.ac.at/cga/archives/25-7-96/ Case Study]<br />
*[http://medstat.med.utah.edu/neurologicexam/html/gait_abnormal.html Utah]<br />
*{{GPNotebook|1376124935}}<br />
{{Symptoms and signs}}<br />
{{jb1}}<br />
{{WikiDoc Help Menu}}<br />
{{WikiDoc Sources}}<br />
<br />
[[Category:Disease]]<br />
[[Category:Neurology]]<br />
[[Category:Primary care]]</div>
Usmanaliakbar
https://www.wikidoc.org/index.php?title=Gait_abnormality&diff=1695871
Gait abnormality
2021-04-01T01:57:18Z
<p>Usmanaliakbar: </p>
<hr />
<div>__NOTOC__ <br />
{| class="infobox" style="float:right;"<br />
|-<br />
| [[File:Siren.gif|30px|link= Gait Abnormality resident survival guide]]|| <br> || <br><br />
| [[Gait Abnormality survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']]<br />
|}'''For patient information, click [[Gait Abnormality(patient information)|here]]'''<br />
{{SI}} <br />
{{CMG}} {{AE}} {{Usman Ali Akbar}}<br />
<br />
{{SK}} Gait disturbance<br />
<br />
==Overview==<br />
<br />
== Complete Differential Diagnosis ==<br />
* [[Appendicitis]]<br />
* Cerebellar lesions <br />
* [[Cerebral Palsy]]<br />
* [[Cerebrovascular disease]]<br />
* [[Chondrodystrophia]]<br />
* [[Chondromalacia Patellae]]<br />
* Damage of the [[symphysis]]<br />
* [[Degenerative joint disease]]<br />
* [[Discitis]]<br />
* [[Drugs]]<br />
**[[Artemether and lumefantrin]]<br />
**[[Interferon gamma]]<br />
**[[Perampanel]]<br />
* [[Dystonia]]<br />
* [[Encephalitis]]<br />
* Foreign body in shoe<br />
* [[Fredreich's Ataxia]]<br />
* [[Hemophilia]]<br />
* [[Hernia]]s<br />
* [[Hydrocephalus]]<br />
* Leg length discrepancy<br />
* [[Legg-Calve-Perthes Disease]]<br />
* Local [[neoplasm]]<br />
* [[Meningitis]]<br />
* [[Metastases]]<br />
* [[Multiple Sclerosis]]<br />
* [[Neuromuscular]] disorders<br />
* [[Osgood-Schlatter Disease]]<br />
* [[Osteomalacia]]<br />
* [[Osteochondritis Dissecans]]<br />
* [[Osteomyelitis]]<br />
* [[Parkinson's Disease|Parkinsonism]]<br />
* [[Periostitis]]<br />
* [[Poliomyelitis]]<br />
* [[Polyneuropathy]]<br />
* Poorly fitting shoes<br />
* [[Rickets]]<br />
* Sensory [[ataxia]]<br />
* [[Septic Arthritis]]<br />
* [[Sickle cell Disease]]<br />
* [[Somatization Syndrome]]<br />
* Splinter in foot<br />
* [[Tabes Dorsalis]]<br />
* [[Testicular torsion]]<br />
* [[Trauma]]<br />
* Viral [[arthritis]] <ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref> <ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X</ref><br />
<br />
Persons suffering from [[peripheral neuropathy]] experience [[numbness]] and [[tingling]] in their hands and feet. This can cause difficulty in walking, climbing stairs and maintaining [[balance]]. Gait abnormality that results from [[chemotherapy]] is generally temporary in nature, though recovery times of six months to a year are common.<br />
<br />
==Specific abnormalities and examples of causes==<br />
===Antalgic gait===<br />
''User favors certain motions to avoid acute pain. [http://www.gpnotebook.co.uk/simplepage.cfm?ID=671481857]''<br />
* [[Physical trauma|Trauma]]<br />
* [[Osteoarthritis]]<br />
* [[Pelvic girdle pain]]<br />
<br />
===Drunken gait/Cerebellar ataxia===<br />
''Reeling in a style like that of an intoxicated person. [http://www.gpnotebook.co.uk/simplepage.cfm?ID=-972685307&linkID=203&cook=yes]''<br />
* [[Ataxia]]<br />
* [[Cerebellar lesion]]s<br />
* [[Cerebellar degeneration]]<br />
* [[Intoxication]]s<br />
<br />
===Festinating gait/Parkinsonian gait===<br />
''Patient moves with short, jerky steps. Term derives from Latin "festino", or "to hurry". [http://www.medfriendly.com/festinatinggait.html] [http://physicaltherapy.about.com/od/abbreviationsandterms/g/Gait.htm] [http://www.gpnotebook.co.uk/simplepage.cfm?ID=610992140&linkID=206&cook=yes]''<br />
* [[Parkinson's disease]]<br />
<br />
===Pigeon gait===<br />
''Torsional abnormalities. [http://www.gpnotebook.co.uk/simplepage.cfm?ID=1590689848]''<br />
* [[Hip dysplasia]]<br />
<br />
===Propulsive gait===<br />
''Stiff, with head and neck bent. [http://www.nlm.nih.gov/medlineplus/ency/article/003199.htm] ''<br />
* [[Carbon monoxide poisoning]]<br />
* [[Parkinson's disease]]<br />
<br />
===Steppage gait/High stepping gait===<br />
''Toes point down. [http://www.nlm.nih.gov/medlineplus/ency/article/003199.htm] [http://www.medterms.com/script/main/art.asp?articlekey=22477] [http://www.gpnotebook.co.uk/simplepage.cfm?ID=1966407688&linkID=205&cook=yes]''<br />
* [[Polio]]<br />
* [[Multiple sclerosis]]<br />
<br />
===Scissor gait===<br />
Legs flexed slightly at the hips and knees, giving the appearance of crouching, with the knees and thighs hitting or crossing in a scissors-like movement. Often mixed with or accompanied by spastic gait, a stiff, foot-dragging walk caused by one-sided, long-term muscle contraction. Most common in patients with spastic cerebral palsy, usually [[spastic diplegia|diplegic]] and [[spastic paraplegia|paraplegic]] varieties. The individual is forced to walk on [[tiptoe]] unless the [[Tibialis anterior muscle|dorsiflexor]] muscles are released by an orthaepedic surgical procedure. Muscle contractures of the [[adductor]]s result in thighs and knees rubbing together and crossing in a manner analogous to scissors.<br />
<br />
These features are typical, and usually result in some form and to some degree regardless of the mildness or severity of the spastic CP condition.<br />
<br />
* rigidity and excessive adduction of the leg in swing<br />
* plantar flexion of the ankle<br />
* flexion at the knee<br />
* adduction and internal rotation at the hip<br />
* contractures of all spastic muscles<br />
* complicated assisting movements of the upper limbs when walking [http://www.nlm.nih.gov/medlineplus/ency/article/003199.htm].[http://www.gpnotebook.co.uk/simplepage.cfm?ID=-120586227&linkID=208&cook=yes] <br />
<br />
====See Also====<br />
* [[Spastic diplegia]]<br />
* [[Pernicious anemia]]<br />
* [[Spastic paraplegia]]<br />
<br />
===[[Sensory ataxia]] gait/Stomping gait===<br />
''Uncoordinated walking [http://medical.webends.com/kw/Gait%20Ataxia] [http://physicaltherapy.about.com/od/abbreviationsandterms/g/Gait.htm] [http://www.gpnotebook.co.uk/simplepage.cfm?ID=-1737818075&linkID=207&cook=yes] [http://www.diseasesdatabase.com/ddb29285.htm]'' <br />
* [[Friedreich's ataxia]]<br />
* [[Pernicious anemia]]<br /><br />
* Tabes Dorsalis (Syphilis)<br />
<br />
===Spastic gait===<br />
''Asymmetric foot dragging. [http://www.nlm.nih.gov/medlineplus/ency/article/003199.htm] [http://physicaltherapy.about.com/od/abbreviationsandterms/g/Gait.htm]''<br />
* [[Brain tumor]]<br />
* [[Sturge-Weber syndrome]]<br />
* [[Cerebral palsy]]<br />
<br />
===[[Trendelenburg gait]]===<br />
* weakness of the [[abductor]] muscles of the lower limb, principally [[gluteus medius]]<br />
<br />
===Waddling/Myopathic gait===<br />
''Walking like a duck. [http://www.nlm.nih.gov/medlineplus/ency/article/003199.htm] [http://www.gpnotebook.co.uk/simplepage.cfm?ID=147849232&linkID=209&cook=yes] ''<br />
* [[Pregnancy]]<br />
<br />
===Magnetic gait===<br />
Feet seem attached to floor as if by a magnet. In magnetic gait, each step is initiated in a "wresting" motion carrying feet upward and forward. Magnetic gait can be visualized in terms of a powerful magnet being forcefully pulled from a steel plate.<br />
* [[Normal pressure hydrocephalus]] (NPH)<br />
<br />
==References==<br />
{{reflist|2}}<br />
<br />
==See also==<br />
* [[Ataxia]]<br />
* [[Limp]]<br />
* [[Foot drop]]<br />
* [[Gait Abnormality Rating Scale]]<br />
<br />
==External links==<br />
* [http://www.childrenshospital.org/az/Site932/printerfriendlypageS932P0.html Children's Hospital Boston]<br />
* [http://www.univie.ac.at/cga/faq/classification.html Classification]<br />
* [http://www.univie.ac.at/cga/archives/25-7-96/ Case Study]<br />
* [http://medstat.med.utah.edu/neurologicexam/html/gait_abnormal.html Utah]<br />
* {{GPNotebook|1376124935}}<br />
{{Symptoms and signs}}<br />
{{jb1}}<br />
{{WikiDoc Help Menu}}<br />
{{WikiDoc Sources}}<br />
<br />
[[Category:Disease]]<br />
[[Category:Neurology]]<br />
[[Category:Primary care]]</div>
Usmanaliakbar
https://www.wikidoc.org/index.php?title=Bloating_resident_survival_guide&diff=1690548
Bloating resident survival guide
2021-02-18T15:41:58Z
<p>Usmanaliakbar: Synonyms&Keywords</p>
<hr />
<div>__NOTOC__<br />
<br />
{{CMG}} {{AE}} {{Usman Ali Akbar}}<br />
<br />
{{SK}}Approach to abdominal bloating, Approach to abdominal belching, Approach to flatulence, Use of FODMAPs.<br />
<br />
{| class="infobox" style="margin: 0 0 0 0; border: 0; float: right; width: 100px; background: #A8A8A8; position: fixed; top: 250px; right: 21px; border-radius: 0 0 10px 10px;" cellpadding="0" cellspacing="0" ;<br />
|-<br />
! style="padding: 0 5px; font-size: 85%; background: #A8A8A8" align="center" |{{fontcolor|#2B3B44|Bloating resident survival guide Microchapters}}<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Overview|Overview]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Causes|Causes]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#FIRE: Focused Initial Rapid Evaluation|FIRE]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Complete Diagnostic Approach|Diagnosis]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Treatment|Treatment]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Do's|Do's]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Don'ts|Don'ts]]<br />
|}<br />
<br />
==Overview==<br />
[[Bloating]] is one of the most common gastrointestinal complaints that is attributed by the patient as the subjective sensation of incorrectly perceived excess [[gas]]. There are multiple non-functional etiologies of abdominal bloating and distention. Primary functional abdominal distention (FABD) should be diagnosed as a single entity and it doesn't overlap with other functional gastrointestinal disorders. Rome IV diagnostic criteria mention the co-existence of mild abdominal pain and/or minor bowel movements. FABD can be treated with [[antispasmodic]] along with [[peppermint oil]] in [[randomized controlled trials]]. A stepwise approach is usually needed that counter the dietary interventions, [[microbiome]] modulation, and medical therapy in the management of FABD.<br />
<br />
==Causes==<br />
The causes of abdominal bloating are numerous and are managed according to the etiology.<ref name="Lacy Gabbard Crowell 2011 pp. 729–39">{{cite journal | last=Lacy | first=BE | last2=Gabbard | first2=SL | last3=Crowell | first3=MD | title=Pathophysiology, evaluation, and treatment of bloating: hope, hype, or hot air? | journal=Gastroenterology & hepatology | volume=7 | issue=11 | year=2011 | issn=1554-7914 | pmid=22298969 | pmc=3264926 | pages=729–39}}</ref><ref name="Malagelada Accarino Azpiroz 2017 pp. 1221–1231">{{cite journal | last=Malagelada | first=Juan R | last2=Accarino | first2=Anna | last3=Azpiroz | first3=Fernando | title=Bloating and Abdominal Distension: Old Misconceptions and Current Knowledge | journal=The American journal of gastroenterology | publisher=Ovid Technologies (Wolters Kluwer Health) | volume=112 | issue=8 | year=2017 | issn=0002-9270 | pmid=28508867 | doi=10.1038/ajg.2017.129 | pages=1221–1231}}</ref><br />
<br />
*<br />
<br />
{| class="wikitable"<br />
|+<br />
Causes of Abdominal Bloating<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Intestinal Disorders<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Motility Disorders<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Malabsorption disorders<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Infectious causes<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Dietary causes<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Misc.<br />
|-<br />
|[[Adhesions]]<br />
[[Malignancy]]<br />
|[[Diabetes]]<br />
<br />
[[Scleroderma]]<br />
<br />
Pseudo-obstruction<br />
<br />
Medications<br />
|[[Lactose intolerance]]<br />
[[Fructose intolerance]]<br />
<br />
[[Celiac disease]]<br />
<br />
[[Pancreatic insufficiency]]<br />
|[[Small intestinal bacterial overgrowth]]<br />
[[Giardiasis]]<br />
|Gas-producing foods<br />
FODMAPs<br />
|[[Irritable bowel syndrome]] <br /><br />
|}<br />
<br />
*<br />
<br />
==Complete Diagnostic Approach==<br />
Shown below is an algorithm summarizing the diagnosis of abdominal bloating according to American College of Gastroenterology guidelines.<ref name="Foley Burgell Barrett Gibson 2014 pp. 561–571">{{cite journal | last=Foley | first=A | last2=Burgell | first2=R | last3=Barrett | first3=JS | last4=Gibson | first4=PR | title=Management Strategies for Abdominal Bloating and Distension | journal=Gastroenterology & Hepatology | volume=10 | issue=9 | year=2014 | pmid=27551250 | pmc=4991532 | pages=561–571}}</ref><ref name="Lacy Cangemi Vazquez-Roque 2021 pp. 219–231.e1">{{cite journal | last=Lacy | first=Brian E. | last2=Cangemi | first2=David | last3=Vazquez-Roque | first3=Maria | title=Management of Chronic Abdominal Distension and Bloating | journal=Clinical Gastroenterology and Hepatology | publisher=Elsevier BV | volume=19 | issue=2 | year=2021 | issn=1542-3565 | doi=10.1016/j.cgh.2020.03.056 | pages=219–231.e1}}</ref><br />
{{familytree/start |summary=PE diagnosis Algorithm.}}<br />
{{familytree | | | | A01 | | | A01= Patient with abdominal bloating and Distention }}<br />
{{familytree | | | | |!| | | | }}<br />
{{familytree | | | | B01 | | | B01= Look for the <br><br />
* Alarm signs<br />
*Overlapping functional gastrointestinal disorders<br />
*[[Bacterial overgrowth]] (Small intestine bacterial overgrowth)<br />
* Dietary intolerances<br />
*[[Celiac Disease]]<br />
* Weight gain <br />
*[[Constipation]] <br />
*[[Hydrogen breath test]] <br />
*Any pyschological comorbidities}}<br />
{{familytree | | |,|-|^|-|.| | }}<br />
{{familytree | | C01 | | C02 | C01= Yes | C02=No}}<br />
{{familytree | | |!| | | |!| | }}<br />
{{familytree | | C01 | | C02 | C01=<br />
* Reassurance the patient, recommend [[diaphragmatic breathing]]<br />
*Diet intervention: Low FODMAP (fermentable oligo-, di-, mono-saccharides and polyols) diet <br />
*Iniate sympotmatic treatment such as [[peppermint oil]] or [[Simethicone]] | C02= Treat Accordingly}}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= *Trial of [[Rifaximin]]/[[Probiotics]] }}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= No Response }}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= [[Antidepressants]]<br />
*[[Psychological therapy]]<br />
*Hypnotherapy, [[Cognitive behavioral therapy]] (CBT)}}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= No Response }}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= <br />
*Referral to specialized Neurogastroenterology center <br />
*Referral for the CT/MRI [[Electromyography]]<br />
*Referral for the abdominal biofeedback therapy)}}<br />
{{familytree/end}}<br />
<br />
==Treatment==<br />
Shown below is an algorithm summarizing the treatment of abdominal bloating according the the American College of Gastroenterology guidelines.<ref name="Schmulson Chang pp. 1071–1086">{{cite journal | last=Schmulson | first=M. | last2=Chang | first2=L. | title=Review article: the treatment of functional abdominal bloating and distension | journal=Alimentary Pharmacology & Therapeutics | publisher=Wiley | volume=33 | issue=10 | date=2011-03-29 | issn=0269-2813 | doi=10.1111/j.1365-2036.2011.04637.x | pages=1071–1086}}</ref><br />
{{familytree/start |summary=PE diagnosis Algorithm.}}<br />
{{familytree | | | | | | | | A01 |A01= Treatment of bloating is based on etiology of bloating.}} <br />
{{familytree | | | | | | | | |!| | | | | |}}<br />
{{familytree | | | | | | | |C01| | | | | |C01= Dietary changes are suggested for bloating <br />
*Diet<br />
*[[Exercise]] and [[posture]]<br />
*Over-the-counter medications<br />
*[[Probiotics]]<br />
*[[Antibiotics]]<br />
*Smooth muscle [[antispasmodics]]<br />
*Osmotic laxatives<br />
*Prokinetic agents<br />
*Chloride channel activators<br />
*[[Tricyclic antidepressants]]<br />
<br />
Are any warning signs present?<br />
*anemia,GI bleeding, weight loss>10% of the body weight, and family history of GI malignancy. }}<br />
{{familytree | | | | | | | | |!| | | | | | }}<br />
{{Family tree | | | | | |,|-|-|^|-|-|.| | }}<br />
{{Family tree | | | | | C01 | | | | C02 |C01= Yes| C02= No}}<br />
{{familytree | | | | | |!| | | | | |!| | | | }}<br />
{{familytree | | | | | |F01| | | |F02| | |F01= Treat accordingly<br><br />
*Labs<br />
*[[Endoscopy]]<br />
*Imaging|F02=Functional?}}<br />
{{familytree | | | | | | | | | | | | |!| | | }}<br />
{{familytree | | | | | | | | | | | | |!| | | | | | | }}<br />
{{familytree | | | |,|-|-|-|v|-|-|-|-|+|-|.| | }}<br />
{{familytree | | | |!| | | |!| | | | |!| |!| | }}<br />
{{familytree | | | D01 | | D02 | | D03 | | D04 | |D01=[[Constipation]]|D02=Functional dyspepsia|D03=Non-constipation IBS|D04=Bloating alone}}<br />
{{familytree | | | |`|-|-|-|^|-|-|+|-|-|-|-|-|'|}}<br />
{{familytree | | | | | | | | | | |!| | | | | | | | | }}<br />
{{familytree | | | | | | | | | | A02 | | | | | |A02= Lifestyle and nonspecific dietary advice.<br><br />
*Education about low FODMAP diet <br><ref name="Altobelli Del Negro Angeletti Latella p=940">{{cite journal | last=Altobelli | first=Emma | last2=Del Negro | first2=Valerio | last3=Angeletti | first3=Paolo | last4=Latella | first4=Giovanni | title=Low-FODMAP Diet Improves Irritable Bowel Syndrome Symptoms: A Meta-Analysis | journal=Nutrients | publisher=MDPI AG | volume=9 | issue=9 | date=2017-08-26 | issn=2072-6643 | doi=10.3390/nu9090940 | page=940}}</ref><br />
* Treat constipation aggressively and minimize bowel distention<br><br />
*Consider the use of [[Rifaximin]]<br />
*Consider probiotics, Psychological therapy, [[CBT]], and/or [[antidepressants]]<br><br />
*Consider Biodfeedback neuromodulation }}<br />
{{familytree/end}}<br />
<br />
==Do's==<br />
<br />
*Use of [[probiotics]] can help reduce [[bloating]].<br />
*Antidepressants can help to reduce the symptoms of [[IBS]] but the data is unclear over the reduction of bloating.<ref name="Seo Kim Oh pp. 433–453">{{cite journal | last=Seo | first=A Young | last2=Kim | first2=Nayoung | last3=Oh | first3=Dong Hyun | title=Abdominal Bloating: Pathophysiology and Treatment | journal=Journal of Neurogastroenterology and Motility | publisher=The Korean Society of Neurogastroenterology and Motility | volume=19 | issue=4 | date=2013-10-31 | issn=2093-0879 | doi=10.5056/jnm.2013.19.4.433 | pages=433–453}}</ref><br />
*[[Hypnotherapy]] has been reported to be useful in reducing symptoms of bloating.<br />
*Bowel training and [[diaphragmatic breathing]] have been useful in the management of [[bloating]] however the data is unclear.<br />
<br />
==Don'ts==<br />
<br />
*Artificial sweeteners containing [[sorbitol]], [[mannitol]], [[xylitol]] should be avoided.<ref name="Kamphuis Guiard Leveque Olier 2020 pp. 652–663.e6">{{cite journal | last=Kamphuis | first=Jasper B.J. | last2=Guiard | first2=Bruno | last3=Leveque | first3=Mathilde | last4=Olier | first4=Maiwenn | last5=Jouanin | first5=Isabelle | last6=Yvon | first6=Sophie | last7=Tondereau | first7=Valerie | last8=Rivière | first8=Pauline | last9=Guéraud | first9=Françoise | last10=Chevolleau | first10=Sylvie | last11=Noguer-Meireles | first11=Maria-Helena | last12=Martin | first12=Jean- François | last13=Debrauwer | first13=Laurent | last14=Eutamène | first14=Helene | last15=Theodorou | first15=Vassilia | title=Lactose and Fructo-oligosaccharides Increase Visceral Sensitivity in Mice via Glycation Processes, Increasing Mast Cell Density in Colonic Mucosa | journal=Gastroenterology | publisher=Elsevier BV | volume=158 | issue=3 | year=2020 | issn=0016-5085 | doi=10.1053/j.gastro.2019.10.037 | pages=652–663.e6}}</ref><br />
*Medications ([[anticholinergics]], [[opiates]], [[calcium channel blockers]], antidepressants) should also be avoided as they have an effect on [[bloating]].<ref name="Mari Abu Backer Mahamid Amara pp. 1075–1084">{{cite journal | last=Mari | first=Amir | last2=Abu Backer | first2=Fadi | last3=Mahamid | first3=Mahmud | last4=Amara | first4=Hana | last5=Carter | first5=Dan | last6=Boltin | first6=Doron | last7=Dickman | first7=Ram | title=Bloating and Abdominal Distension: Clinical Approach and Management | journal=Advances in Therapy | publisher=Springer Science and Business Media LLC | volume=36 | issue=5 | date=2019-03-16 | issn=0741-238X | doi=10.1007/s12325-019-00924-7 | pages=1075–1084}}</ref><br />
*20% of [[carbohydrates]] in baked beans and 7–10% in [[wheat]], oats, potatoes, and corn, and 1% in white rice are not absorbed well in the [[intestine]] and they can predispose to [[bloating]].<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
[[Category:Projects]]<br />
[[Category:Resident survival guide]]<br />
[[Category:Gastroenterology]]</div>
Usmanaliakbar
https://www.wikidoc.org/index.php?title=Bloating_resident_survival_guide&diff=1690547
Bloating resident survival guide
2021-02-18T15:35:53Z
<p>Usmanaliakbar: /* Complete Diagnostic Approach */</p>
<hr />
<div>__NOTOC__<br />
<br />
{{CMG}} {{AE}} {{Usman Ali Akbar}}<br />
<br />
{{SK}}<br />
<br />
{| class="infobox" style="margin: 0 0 0 0; border: 0; float: right; width: 100px; background: #A8A8A8; position: fixed; top: 250px; right: 21px; border-radius: 0 0 10px 10px;" cellpadding="0" cellspacing="0" ;<br />
|-<br />
! style="padding: 0 5px; font-size: 85%; background: #A8A8A8" align="center" |{{fontcolor|#2B3B44|Bloating resident survival guide Microchapters}}<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Overview|Overview]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Causes|Causes]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#FIRE: Focused Initial Rapid Evaluation|FIRE]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Complete Diagnostic Approach|Diagnosis]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Treatment|Treatment]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Do's|Do's]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Don'ts|Don'ts]]<br />
|}<br />
<br />
==Overview==<br />
[[Bloating]] is one of the most common gastrointestinal complaints that is attributed by the patient as the subjective sensation of incorrectly perceived excess [[gas]]. There are multiple non-functional etiologies of abdominal bloating and distention. Primary functional abdominal distention (FABD) should be diagnosed as a single entity and it doesn't overlap with other functional gastrointestinal disorders. Rome IV diagnostic criteria mention the co-existence of mild abdominal pain and/or minor bowel movements. FABD can be treated with [[antispasmodic]] along with [[peppermint oil]] in [[randomized controlled trials]]. A stepwise approach is usually needed that counter the dietary interventions, [[microbiome]] modulation, and medical therapy in the management of FABD.<br />
<br />
==Causes==<br />
The causes of abdominal bloating are numerous and are managed according to the etiology.<ref name="Lacy Gabbard Crowell 2011 pp. 729–39">{{cite journal | last=Lacy | first=BE | last2=Gabbard | first2=SL | last3=Crowell | first3=MD | title=Pathophysiology, evaluation, and treatment of bloating: hope, hype, or hot air? | journal=Gastroenterology & hepatology | volume=7 | issue=11 | year=2011 | issn=1554-7914 | pmid=22298969 | pmc=3264926 | pages=729–39}}</ref><ref name="Malagelada Accarino Azpiroz 2017 pp. 1221–1231">{{cite journal | last=Malagelada | first=Juan R | last2=Accarino | first2=Anna | last3=Azpiroz | first3=Fernando | title=Bloating and Abdominal Distension: Old Misconceptions and Current Knowledge | journal=The American journal of gastroenterology | publisher=Ovid Technologies (Wolters Kluwer Health) | volume=112 | issue=8 | year=2017 | issn=0002-9270 | pmid=28508867 | doi=10.1038/ajg.2017.129 | pages=1221–1231}}</ref><br />
<br />
*<br />
<br />
{| class="wikitable"<br />
|+<br />
Causes of Abdominal Bloating<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Intestinal Disorders<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Motility Disorders<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Malabsorption disorders<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Infectious causes<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Dietary causes<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Misc.<br />
|-<br />
|[[Adhesions]]<br />
[[Malignancy]]<br />
|[[Diabetes]]<br />
<br />
[[Scleroderma]]<br />
<br />
Pseudo-obstruction<br />
<br />
Medications<br />
|[[Lactose intolerance]]<br />
[[Fructose intolerance]]<br />
<br />
[[Celiac disease]]<br />
<br />
[[Pancreatic insufficiency]]<br />
|[[Small intestinal bacterial overgrowth]]<br />
[[Giardiasis]]<br />
|Gas-producing foods<br />
FODMAPs<br />
|[[Irritable bowel syndrome]] <br /><br />
|}<br />
<br />
*<br />
<br />
==Complete Diagnostic Approach==<br />
Shown below is an algorithm summarizing the diagnosis of abdominal bloating according to American College of Gastroenterology guidelines.<ref name="Foley Burgell Barrett Gibson 2014 pp. 561–571">{{cite journal | last=Foley | first=A | last2=Burgell | first2=R | last3=Barrett | first3=JS | last4=Gibson | first4=PR | title=Management Strategies for Abdominal Bloating and Distension | journal=Gastroenterology & Hepatology | volume=10 | issue=9 | year=2014 | pmid=27551250 | pmc=4991532 | pages=561–571}}</ref><ref name="Lacy Cangemi Vazquez-Roque 2021 pp. 219–231.e1">{{cite journal | last=Lacy | first=Brian E. | last2=Cangemi | first2=David | last3=Vazquez-Roque | first3=Maria | title=Management of Chronic Abdominal Distension and Bloating | journal=Clinical Gastroenterology and Hepatology | publisher=Elsevier BV | volume=19 | issue=2 | year=2021 | issn=1542-3565 | doi=10.1016/j.cgh.2020.03.056 | pages=219–231.e1}}</ref><br />
{{familytree/start |summary=PE diagnosis Algorithm.}}<br />
{{familytree | | | | A01 | | | A01= Patient with abdominal bloating and Distention }}<br />
{{familytree | | | | |!| | | | }}<br />
{{familytree | | | | B01 | | | B01= Look for the <br><br />
* Alarm signs<br />
*Overlapping functional gastrointestinal disorders<br />
*[[Bacterial overgrowth]] (Small intestine bacterial overgrowth)<br />
* Dietary intolerances<br />
*[[Celiac Disease]]<br />
* Weight gain <br />
*[[Constipation]] <br />
*[[Hydrogen breath test]] <br />
*Any pyschological comorbidities}}<br />
{{familytree | | |,|-|^|-|.| | }}<br />
{{familytree | | C01 | | C02 | C01= Yes | C02=No}}<br />
{{familytree | | |!| | | |!| | }}<br />
{{familytree | | C01 | | C02 | C01=<br />
* Reassurance the patient, recommend [[diaphragmatic breathing]]<br />
*Diet intervention: Low FODMAP (fermentable oligo-, di-, mono-saccharides and polyols) diet <br />
*Iniate sympotmatic treatment such as [[peppermint oil]] or [[Simethicone]] | C02= Treat Accordingly}}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= *Trial of [[Rifaximin]]/[[Probiotics]] }}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= No Response }}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= [[Antidepressants]]<br />
*[[Psychological therapy]]<br />
*Hypnotherapy, [[Cognitive behavioral therapy]] (CBT)}}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= No Response }}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= <br />
*Referral to specialized Neurogastroenterology center <br />
*Referral for the CT/MRI [[Electromyography]]<br />
*Referral for the abdominal biofeedback therapy)}}<br />
{{familytree/end}}<br />
<br />
==Treatment==<br />
Shown below is an algorithm summarizing the treatment of abdominal bloating according the the American College of Gastroenterology guidelines.<ref name="Schmulson Chang pp. 1071–1086">{{cite journal | last=Schmulson | first=M. | last2=Chang | first2=L. | title=Review article: the treatment of functional abdominal bloating and distension | journal=Alimentary Pharmacology & Therapeutics | publisher=Wiley | volume=33 | issue=10 | date=2011-03-29 | issn=0269-2813 | doi=10.1111/j.1365-2036.2011.04637.x | pages=1071–1086}}</ref><br />
{{familytree/start |summary=PE diagnosis Algorithm.}}<br />
{{familytree | | | | | | | | A01 |A01= Treatment of bloating is based on etiology of bloating.}} <br />
{{familytree | | | | | | | | |!| | | | | |}}<br />
{{familytree | | | | | | | |C01| | | | | |C01= Dietary changes are suggested for bloating <br />
*Diet<br />
*[[Exercise]] and [[posture]]<br />
*Over-the-counter medications<br />
*[[Probiotics]]<br />
*[[Antibiotics]]<br />
*Smooth muscle [[antispasmodics]]<br />
*Osmotic laxatives<br />
*Prokinetic agents<br />
*Chloride channel activators<br />
*[[Tricyclic antidepressants]]<br />
<br />
Are any warning signs present?<br />
*anemia,GI bleeding, weight loss>10% of the body weight, and family history of GI malignancy. }}<br />
{{familytree | | | | | | | | |!| | | | | | }}<br />
{{Family tree | | | | | |,|-|-|^|-|-|.| | }}<br />
{{Family tree | | | | | C01 | | | | C02 |C01= Yes| C02= No}}<br />
{{familytree | | | | | |!| | | | | |!| | | | }}<br />
{{familytree | | | | | |F01| | | |F02| | |F01= Treat accordingly<br><br />
*Labs<br />
*[[Endoscopy]]<br />
*Imaging|F02=Functional?}}<br />
{{familytree | | | | | | | | | | | | |!| | | }}<br />
{{familytree | | | | | | | | | | | | |!| | | | | | | }}<br />
{{familytree | | | |,|-|-|-|v|-|-|-|-|+|-|.| | }}<br />
{{familytree | | | |!| | | |!| | | | |!| |!| | }}<br />
{{familytree | | | D01 | | D02 | | D03 | | D04 | |D01=[[Constipation]]|D02=Functional dyspepsia|D03=Non-constipation IBS|D04=Bloating alone}}<br />
{{familytree | | | |`|-|-|-|^|-|-|+|-|-|-|-|-|'|}}<br />
{{familytree | | | | | | | | | | |!| | | | | | | | | }}<br />
{{familytree | | | | | | | | | | A02 | | | | | |A02= Lifestyle and nonspecific dietary advice.<br><br />
*Education about low FODMAP diet <br><ref name="Altobelli Del Negro Angeletti Latella p=940">{{cite journal | last=Altobelli | first=Emma | last2=Del Negro | first2=Valerio | last3=Angeletti | first3=Paolo | last4=Latella | first4=Giovanni | title=Low-FODMAP Diet Improves Irritable Bowel Syndrome Symptoms: A Meta-Analysis | journal=Nutrients | publisher=MDPI AG | volume=9 | issue=9 | date=2017-08-26 | issn=2072-6643 | doi=10.3390/nu9090940 | page=940}}</ref><br />
* Treat constipation aggressively and minimize bowel distention<br><br />
*Consider the use of [[Rifaximin]]<br />
*Consider probiotics, Psychological therapy, [[CBT]], and/or [[antidepressants]]<br><br />
*Consider Biodfeedback neuromodulation }}<br />
{{familytree/end}}<br />
<br />
==Do's==<br />
<br />
*Use of [[probiotics]] can help reduce [[bloating]].<br />
*Antidepressants can help to reduce the symptoms of [[IBS]] but the data is unclear over the reduction of bloating.<ref name="Seo Kim Oh pp. 433–453">{{cite journal | last=Seo | first=A Young | last2=Kim | first2=Nayoung | last3=Oh | first3=Dong Hyun | title=Abdominal Bloating: Pathophysiology and Treatment | journal=Journal of Neurogastroenterology and Motility | publisher=The Korean Society of Neurogastroenterology and Motility | volume=19 | issue=4 | date=2013-10-31 | issn=2093-0879 | doi=10.5056/jnm.2013.19.4.433 | pages=433–453}}</ref><br />
*[[Hypnotherapy]] has been reported to be useful in reducing symptoms of bloating.<br />
*Bowel training and [[diaphragmatic breathing]] have been useful in the management of [[bloating]] however the data is unclear.<br />
<br />
==Don'ts==<br />
<br />
*Artificial sweeteners containing [[sorbitol]], [[mannitol]], [[xylitol]] should be avoided.<ref name="Kamphuis Guiard Leveque Olier 2020 pp. 652–663.e6">{{cite journal | last=Kamphuis | first=Jasper B.J. | last2=Guiard | first2=Bruno | last3=Leveque | first3=Mathilde | last4=Olier | first4=Maiwenn | last5=Jouanin | first5=Isabelle | last6=Yvon | first6=Sophie | last7=Tondereau | first7=Valerie | last8=Rivière | first8=Pauline | last9=Guéraud | first9=Françoise | last10=Chevolleau | first10=Sylvie | last11=Noguer-Meireles | first11=Maria-Helena | last12=Martin | first12=Jean- François | last13=Debrauwer | first13=Laurent | last14=Eutamène | first14=Helene | last15=Theodorou | first15=Vassilia | title=Lactose and Fructo-oligosaccharides Increase Visceral Sensitivity in Mice via Glycation Processes, Increasing Mast Cell Density in Colonic Mucosa | journal=Gastroenterology | publisher=Elsevier BV | volume=158 | issue=3 | year=2020 | issn=0016-5085 | doi=10.1053/j.gastro.2019.10.037 | pages=652–663.e6}}</ref><br />
*Medications ([[anticholinergics]], [[opiates]], [[calcium channel blockers]], antidepressants) should also be avoided as they have an effect on [[bloating]].<ref name="Mari Abu Backer Mahamid Amara pp. 1075–1084">{{cite journal | last=Mari | first=Amir | last2=Abu Backer | first2=Fadi | last3=Mahamid | first3=Mahmud | last4=Amara | first4=Hana | last5=Carter | first5=Dan | last6=Boltin | first6=Doron | last7=Dickman | first7=Ram | title=Bloating and Abdominal Distension: Clinical Approach and Management | journal=Advances in Therapy | publisher=Springer Science and Business Media LLC | volume=36 | issue=5 | date=2019-03-16 | issn=0741-238X | doi=10.1007/s12325-019-00924-7 | pages=1075–1084}}</ref><br />
*20% of [[carbohydrates]] in baked beans and 7–10% in [[wheat]], oats, potatoes, and corn, and 1% in white rice are not absorbed well in the [[intestine]] and they can predispose to [[bloating]].<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
[[Category:Projects]]<br />
[[Category:Resident survival guide]]<br />
[[Category:Gastroenterology]]</div>
Usmanaliakbar
https://www.wikidoc.org/index.php?title=Bloating_resident_survival_guide&diff=1690546
Bloating resident survival guide
2021-02-18T15:34:31Z
<p>Usmanaliakbar: /* Don'ts */</p>
<hr />
<div>__NOTOC__<br />
<br />
{{CMG}} {{AE}} {{Usman Ali Akbar}}<br />
<br />
{{SK}}<br />
<br />
{| class="infobox" style="margin: 0 0 0 0; border: 0; float: right; width: 100px; background: #A8A8A8; position: fixed; top: 250px; right: 21px; border-radius: 0 0 10px 10px;" cellpadding="0" cellspacing="0" ;<br />
|-<br />
! style="padding: 0 5px; font-size: 85%; background: #A8A8A8" align="center" |{{fontcolor|#2B3B44|Bloating resident survival guide Microchapters}}<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Overview|Overview]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Causes|Causes]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#FIRE: Focused Initial Rapid Evaluation|FIRE]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Complete Diagnostic Approach|Diagnosis]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Treatment|Treatment]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Do's|Do's]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Don'ts|Don'ts]]<br />
|}<br />
<br />
==Overview==<br />
[[Bloating]] is one of the most common gastrointestinal complaints that is attributed by the patient as the subjective sensation of incorrectly perceived excess [[gas]]. There are multiple non-functional etiologies of abdominal bloating and distention. Primary functional abdominal distention (FABD) should be diagnosed as a single entity and it doesn't overlap with other functional gastrointestinal disorders. Rome IV diagnostic criteria mention the co-existence of mild abdominal pain and/or minor bowel movements. FABD can be treated with [[antispasmodic]] along with [[peppermint oil]] in [[randomized controlled trials]]. A stepwise approach is usually needed that counter the dietary interventions, [[microbiome]] modulation, and medical therapy in the management of FABD.<br />
<br />
==Causes==<br />
The causes of abdominal bloating are numerous and are managed according to the etiology.<ref name="Lacy Gabbard Crowell 2011 pp. 729–39">{{cite journal | last=Lacy | first=BE | last2=Gabbard | first2=SL | last3=Crowell | first3=MD | title=Pathophysiology, evaluation, and treatment of bloating: hope, hype, or hot air? | journal=Gastroenterology & hepatology | volume=7 | issue=11 | year=2011 | issn=1554-7914 | pmid=22298969 | pmc=3264926 | pages=729–39}}</ref><ref name="Malagelada Accarino Azpiroz 2017 pp. 1221–1231">{{cite journal | last=Malagelada | first=Juan R | last2=Accarino | first2=Anna | last3=Azpiroz | first3=Fernando | title=Bloating and Abdominal Distension: Old Misconceptions and Current Knowledge | journal=The American journal of gastroenterology | publisher=Ovid Technologies (Wolters Kluwer Health) | volume=112 | issue=8 | year=2017 | issn=0002-9270 | pmid=28508867 | doi=10.1038/ajg.2017.129 | pages=1221–1231}}</ref><br />
<br />
*<br />
<br />
{| class="wikitable"<br />
|+<br />
Causes of Abdominal Bloating<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Intestinal Disorders<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Motility Disorders<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Malabsorption disorders<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Infectious causes<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Dietary causes<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Misc.<br />
|-<br />
|[[Adhesions]]<br />
[[Malignancy]]<br />
|[[Diabetes]]<br />
<br />
[[Scleroderma]]<br />
<br />
Pseudo-obstruction<br />
<br />
Medications<br />
|[[Lactose intolerance]]<br />
[[Fructose intolerance]]<br />
<br />
[[Celiac disease]]<br />
<br />
[[Pancreatic insufficiency]]<br />
|[[Small intestinal bacterial overgrowth]]<br />
[[Giardiasis]]<br />
|Gas-producing foods<br />
FODMAPs<br />
|[[Irritable bowel syndrome]] <br /><br />
|}<br />
<br />
*<br />
<br />
==Complete Diagnostic Approach==<br />
Shown below is an algorithm summarizing the diagnosis of abdominal bloating according to American College of Gastroenterology guidelines.<ref name="Foley Burgell Barrett Gibson 2014 pp. 561–571">{{cite journal | last=Foley | first=A | last2=Burgell | first2=R | last3=Barrett | first3=JS | last4=Gibson | first4=PR | title=Management Strategies for Abdominal Bloating and Distension | journal=Gastroenterology & Hepatology | volume=10 | issue=9 | year=2014 | pmid=27551250 | pmc=4991532 | pages=561–571}}</ref><ref name="Lacy Cangemi Vazquez-Roque 2021 pp. 219–231.e1">{{cite journal | last=Lacy | first=Brian E. | last2=Cangemi | first2=David | last3=Vazquez-Roque | first3=Maria | title=Management of Chronic Abdominal Distension and Bloating | journal=Clinical Gastroenterology and Hepatology | publisher=Elsevier BV | volume=19 | issue=2 | year=2021 | issn=1542-3565 | doi=10.1016/j.cgh.2020.03.056 | pages=219–231.e1}}</ref><br />
{{familytree/start |summary=PE diagnosis Algorithm.}}<br />
{{familytree | | | | A01 | | | A01= Patient with abdominal bloating and Distention }}<br />
{{familytree | | | | |!| | | | }}<br />
{{familytree | | | | B01 | | | B01= Look for the <br><br />
* Alarm signs<br />
*Overlapping functional gastrointestinal disorders<br />
*[[Bacterial overgrowth]] (Small intestine bacterial overgrowth)<br />
* Dietary intolerances<br />
*[[Celiac Disease]]<br />
* Weight gain <br />
*[[Constipation]] <br />
*[[Hydrogen breath test]] <br />
*Any pyschological comorbidities}}<br />
{{familytree | | |,|-|^|-|.| | }}<br />
{{familytree | | C01 | | C02 | C01= Yes | C02=No}}<br />
{{familytree | | |!| | | |!| | }}<br />
{{familytree | | C01 | | C02 | C01=<br />
* Reassurance the patient, recommend [[diaphragmatic breathing]]<br />
*Diet intervention: Low FODMAP diet <br />
*Iniate sympotmatic treatment such as [[peppermint oil]] or [[Simethicone]] | C02= Treat Accordingly}}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= *Trial of [[Rifaximin]]/[[Probiotics]] }}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= No Response }}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= [[Antidepressants]]<br />
*[[Psychological therapy]]<br />
*Hypnotherapy, [[Cognitive behavioral therapy]] (CBT)}}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= No Response }}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= <br />
*Referral to specialized Neurogastroenterology center <br />
*Referral for the CT/MRI [[Electromyography]]<br />
*Referral for the abdominal biofeedback therapy)}}<br />
{{familytree/end}}<br />
<br />
==Treatment==<br />
Shown below is an algorithm summarizing the treatment of abdominal bloating according the the American College of Gastroenterology guidelines.<ref name="Schmulson Chang pp. 1071–1086">{{cite journal | last=Schmulson | first=M. | last2=Chang | first2=L. | title=Review article: the treatment of functional abdominal bloating and distension | journal=Alimentary Pharmacology & Therapeutics | publisher=Wiley | volume=33 | issue=10 | date=2011-03-29 | issn=0269-2813 | doi=10.1111/j.1365-2036.2011.04637.x | pages=1071–1086}}</ref><br />
{{familytree/start |summary=PE diagnosis Algorithm.}}<br />
{{familytree | | | | | | | | A01 |A01= Treatment of bloating is based on etiology of bloating.}} <br />
{{familytree | | | | | | | | |!| | | | | |}}<br />
{{familytree | | | | | | | |C01| | | | | |C01= Dietary changes are suggested for bloating <br />
*Diet<br />
*[[Exercise]] and [[posture]]<br />
*Over-the-counter medications<br />
*[[Probiotics]]<br />
*[[Antibiotics]]<br />
*Smooth muscle [[antispasmodics]]<br />
*Osmotic laxatives<br />
*Prokinetic agents<br />
*Chloride channel activators<br />
*[[Tricyclic antidepressants]]<br />
<br />
Are any warning signs present?<br />
*anemia,GI bleeding, weight loss>10% of the body weight, and family history of GI malignancy. }}<br />
{{familytree | | | | | | | | |!| | | | | | }}<br />
{{Family tree | | | | | |,|-|-|^|-|-|.| | }}<br />
{{Family tree | | | | | C01 | | | | C02 |C01= Yes| C02= No}}<br />
{{familytree | | | | | |!| | | | | |!| | | | }}<br />
{{familytree | | | | | |F01| | | |F02| | |F01= Treat accordingly<br><br />
*Labs<br />
*[[Endoscopy]]<br />
*Imaging|F02=Functional?}}<br />
{{familytree | | | | | | | | | | | | |!| | | }}<br />
{{familytree | | | | | | | | | | | | |!| | | | | | | }}<br />
{{familytree | | | |,|-|-|-|v|-|-|-|-|+|-|.| | }}<br />
{{familytree | | | |!| | | |!| | | | |!| |!| | }}<br />
{{familytree | | | D01 | | D02 | | D03 | | D04 | |D01=[[Constipation]]|D02=Functional dyspepsia|D03=Non-constipation IBS|D04=Bloating alone}}<br />
{{familytree | | | |`|-|-|-|^|-|-|+|-|-|-|-|-|'|}}<br />
{{familytree | | | | | | | | | | |!| | | | | | | | | }}<br />
{{familytree | | | | | | | | | | A02 | | | | | |A02= Lifestyle and nonspecific dietary advice.<br><br />
*Education about low FODMAP diet <br><ref name="Altobelli Del Negro Angeletti Latella p=940">{{cite journal | last=Altobelli | first=Emma | last2=Del Negro | first2=Valerio | last3=Angeletti | first3=Paolo | last4=Latella | first4=Giovanni | title=Low-FODMAP Diet Improves Irritable Bowel Syndrome Symptoms: A Meta-Analysis | journal=Nutrients | publisher=MDPI AG | volume=9 | issue=9 | date=2017-08-26 | issn=2072-6643 | doi=10.3390/nu9090940 | page=940}}</ref><br />
* Treat constipation aggressively and minimize bowel distention<br><br />
*Consider the use of [[Rifaximin]]<br />
*Consider probiotics, Psychological therapy, [[CBT]], and/or [[antidepressants]]<br><br />
*Consider Biodfeedback neuromodulation }}<br />
{{familytree/end}}<br />
<br />
==Do's==<br />
<br />
*Use of [[probiotics]] can help reduce [[bloating]].<br />
*Antidepressants can help to reduce the symptoms of [[IBS]] but the data is unclear over the reduction of bloating.<ref name="Seo Kim Oh pp. 433–453">{{cite journal | last=Seo | first=A Young | last2=Kim | first2=Nayoung | last3=Oh | first3=Dong Hyun | title=Abdominal Bloating: Pathophysiology and Treatment | journal=Journal of Neurogastroenterology and Motility | publisher=The Korean Society of Neurogastroenterology and Motility | volume=19 | issue=4 | date=2013-10-31 | issn=2093-0879 | doi=10.5056/jnm.2013.19.4.433 | pages=433–453}}</ref><br />
*[[Hypnotherapy]] has been reported to be useful in reducing symptoms of bloating.<br />
*Bowel training and [[diaphragmatic breathing]] have been useful in the management of [[bloating]] however the data is unclear.<br />
<br />
==Don'ts==<br />
<br />
*Artificial sweeteners containing [[sorbitol]], [[mannitol]], [[xylitol]] should be avoided.<ref name="Kamphuis Guiard Leveque Olier 2020 pp. 652–663.e6">{{cite journal | last=Kamphuis | first=Jasper B.J. | last2=Guiard | first2=Bruno | last3=Leveque | first3=Mathilde | last4=Olier | first4=Maiwenn | last5=Jouanin | first5=Isabelle | last6=Yvon | first6=Sophie | last7=Tondereau | first7=Valerie | last8=Rivière | first8=Pauline | last9=Guéraud | first9=Françoise | last10=Chevolleau | first10=Sylvie | last11=Noguer-Meireles | first11=Maria-Helena | last12=Martin | first12=Jean- François | last13=Debrauwer | first13=Laurent | last14=Eutamène | first14=Helene | last15=Theodorou | first15=Vassilia | title=Lactose and Fructo-oligosaccharides Increase Visceral Sensitivity in Mice via Glycation Processes, Increasing Mast Cell Density in Colonic Mucosa | journal=Gastroenterology | publisher=Elsevier BV | volume=158 | issue=3 | year=2020 | issn=0016-5085 | doi=10.1053/j.gastro.2019.10.037 | pages=652–663.e6}}</ref><br />
*Medications ([[anticholinergics]], [[opiates]], [[calcium channel blockers]], antidepressants) should also be avoided as they have an effect on [[bloating]].<ref name="Mari Abu Backer Mahamid Amara pp. 1075–1084">{{cite journal | last=Mari | first=Amir | last2=Abu Backer | first2=Fadi | last3=Mahamid | first3=Mahmud | last4=Amara | first4=Hana | last5=Carter | first5=Dan | last6=Boltin | first6=Doron | last7=Dickman | first7=Ram | title=Bloating and Abdominal Distension: Clinical Approach and Management | journal=Advances in Therapy | publisher=Springer Science and Business Media LLC | volume=36 | issue=5 | date=2019-03-16 | issn=0741-238X | doi=10.1007/s12325-019-00924-7 | pages=1075–1084}}</ref><br />
*20% of [[carbohydrates]] in baked beans and 7–10% in [[wheat]], oats, potatoes, and corn, and 1% in white rice are not absorbed well in the [[intestine]] and they can predispose to [[bloating]].<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
[[Category:Projects]]<br />
[[Category:Resident survival guide]]<br />
[[Category:Gastroenterology]]</div>
Usmanaliakbar
https://www.wikidoc.org/index.php?title=Bloating_resident_survival_guide&diff=1690545
Bloating resident survival guide
2021-02-18T15:33:47Z
<p>Usmanaliakbar: /* Causes */</p>
<hr />
<div>__NOTOC__<br />
<br />
{{CMG}} {{AE}} {{Usman Ali Akbar}}<br />
<br />
{{SK}}<br />
<br />
{| class="infobox" style="margin: 0 0 0 0; border: 0; float: right; width: 100px; background: #A8A8A8; position: fixed; top: 250px; right: 21px; border-radius: 0 0 10px 10px;" cellpadding="0" cellspacing="0" ;<br />
|-<br />
! style="padding: 0 5px; font-size: 85%; background: #A8A8A8" align="center" |{{fontcolor|#2B3B44|Bloating resident survival guide Microchapters}}<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Overview|Overview]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Causes|Causes]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#FIRE: Focused Initial Rapid Evaluation|FIRE]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Complete Diagnostic Approach|Diagnosis]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Treatment|Treatment]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Do's|Do's]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Don'ts|Don'ts]]<br />
|}<br />
<br />
==Overview==<br />
[[Bloating]] is one of the most common gastrointestinal complaints that is attributed by the patient as the subjective sensation of incorrectly perceived excess [[gas]]. There are multiple non-functional etiologies of abdominal bloating and distention. Primary functional abdominal distention (FABD) should be diagnosed as a single entity and it doesn't overlap with other functional gastrointestinal disorders. Rome IV diagnostic criteria mention the co-existence of mild abdominal pain and/or minor bowel movements. FABD can be treated with [[antispasmodic]] along with [[peppermint oil]] in [[randomized controlled trials]]. A stepwise approach is usually needed that counter the dietary interventions, [[microbiome]] modulation, and medical therapy in the management of FABD.<br />
<br />
==Causes==<br />
The causes of abdominal bloating are numerous and are managed according to the etiology.<ref name="Lacy Gabbard Crowell 2011 pp. 729–39">{{cite journal | last=Lacy | first=BE | last2=Gabbard | first2=SL | last3=Crowell | first3=MD | title=Pathophysiology, evaluation, and treatment of bloating: hope, hype, or hot air? | journal=Gastroenterology & hepatology | volume=7 | issue=11 | year=2011 | issn=1554-7914 | pmid=22298969 | pmc=3264926 | pages=729–39}}</ref><ref name="Malagelada Accarino Azpiroz 2017 pp. 1221–1231">{{cite journal | last=Malagelada | first=Juan R | last2=Accarino | first2=Anna | last3=Azpiroz | first3=Fernando | title=Bloating and Abdominal Distension: Old Misconceptions and Current Knowledge | journal=The American journal of gastroenterology | publisher=Ovid Technologies (Wolters Kluwer Health) | volume=112 | issue=8 | year=2017 | issn=0002-9270 | pmid=28508867 | doi=10.1038/ajg.2017.129 | pages=1221–1231}}</ref><br />
<br />
*<br />
<br />
{| class="wikitable"<br />
|+<br />
Causes of Abdominal Bloating<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Intestinal Disorders<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Motility Disorders<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Malabsorption disorders<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Infectious causes<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Dietary causes<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Misc.<br />
|-<br />
|[[Adhesions]]<br />
[[Malignancy]]<br />
|[[Diabetes]]<br />
<br />
[[Scleroderma]]<br />
<br />
Pseudo-obstruction<br />
<br />
Medications<br />
|[[Lactose intolerance]]<br />
[[Fructose intolerance]]<br />
<br />
[[Celiac disease]]<br />
<br />
[[Pancreatic insufficiency]]<br />
|[[Small intestinal bacterial overgrowth]]<br />
[[Giardiasis]]<br />
|Gas-producing foods<br />
FODMAPs<br />
|[[Irritable bowel syndrome]] <br /><br />
|}<br />
<br />
*<br />
<br />
==Complete Diagnostic Approach==<br />
Shown below is an algorithm summarizing the diagnosis of abdominal bloating according to American College of Gastroenterology guidelines.<ref name="Foley Burgell Barrett Gibson 2014 pp. 561–571">{{cite journal | last=Foley | first=A | last2=Burgell | first2=R | last3=Barrett | first3=JS | last4=Gibson | first4=PR | title=Management Strategies for Abdominal Bloating and Distension | journal=Gastroenterology & Hepatology | volume=10 | issue=9 | year=2014 | pmid=27551250 | pmc=4991532 | pages=561–571}}</ref><ref name="Lacy Cangemi Vazquez-Roque 2021 pp. 219–231.e1">{{cite journal | last=Lacy | first=Brian E. | last2=Cangemi | first2=David | last3=Vazquez-Roque | first3=Maria | title=Management of Chronic Abdominal Distension and Bloating | journal=Clinical Gastroenterology and Hepatology | publisher=Elsevier BV | volume=19 | issue=2 | year=2021 | issn=1542-3565 | doi=10.1016/j.cgh.2020.03.056 | pages=219–231.e1}}</ref><br />
{{familytree/start |summary=PE diagnosis Algorithm.}}<br />
{{familytree | | | | A01 | | | A01= Patient with abdominal bloating and Distention }}<br />
{{familytree | | | | |!| | | | }}<br />
{{familytree | | | | B01 | | | B01= Look for the <br><br />
* Alarm signs<br />
*Overlapping functional gastrointestinal disorders<br />
*[[Bacterial overgrowth]] (Small intestine bacterial overgrowth)<br />
* Dietary intolerances<br />
*[[Celiac Disease]]<br />
* Weight gain <br />
*[[Constipation]] <br />
*[[Hydrogen breath test]] <br />
*Any pyschological comorbidities}}<br />
{{familytree | | |,|-|^|-|.| | }}<br />
{{familytree | | C01 | | C02 | C01= Yes | C02=No}}<br />
{{familytree | | |!| | | |!| | }}<br />
{{familytree | | C01 | | C02 | C01=<br />
* Reassurance the patient, recommend [[diaphragmatic breathing]]<br />
*Diet intervention: Low FODMAP diet <br />
*Iniate sympotmatic treatment such as [[peppermint oil]] or [[Simethicone]] | C02= Treat Accordingly}}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= *Trial of [[Rifaximin]]/[[Probiotics]] }}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= No Response }}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= [[Antidepressants]]<br />
*[[Psychological therapy]]<br />
*Hypnotherapy, [[Cognitive behavioral therapy]] (CBT)}}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= No Response }}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= <br />
*Referral to specialized Neurogastroenterology center <br />
*Referral for the CT/MRI [[Electromyography]]<br />
*Referral for the abdominal biofeedback therapy)}}<br />
{{familytree/end}}<br />
<br />
==Treatment==<br />
Shown below is an algorithm summarizing the treatment of abdominal bloating according the the American College of Gastroenterology guidelines.<ref name="Schmulson Chang pp. 1071–1086">{{cite journal | last=Schmulson | first=M. | last2=Chang | first2=L. | title=Review article: the treatment of functional abdominal bloating and distension | journal=Alimentary Pharmacology & Therapeutics | publisher=Wiley | volume=33 | issue=10 | date=2011-03-29 | issn=0269-2813 | doi=10.1111/j.1365-2036.2011.04637.x | pages=1071–1086}}</ref><br />
{{familytree/start |summary=PE diagnosis Algorithm.}}<br />
{{familytree | | | | | | | | A01 |A01= Treatment of bloating is based on etiology of bloating.}} <br />
{{familytree | | | | | | | | |!| | | | | |}}<br />
{{familytree | | | | | | | |C01| | | | | |C01= Dietary changes are suggested for bloating <br />
*Diet<br />
*[[Exercise]] and [[posture]]<br />
*Over-the-counter medications<br />
*[[Probiotics]]<br />
*[[Antibiotics]]<br />
*Smooth muscle [[antispasmodics]]<br />
*Osmotic laxatives<br />
*Prokinetic agents<br />
*Chloride channel activators<br />
*[[Tricyclic antidepressants]]<br />
<br />
Are any warning signs present?<br />
*anemia,GI bleeding, weight loss>10% of the body weight, and family history of GI malignancy. }}<br />
{{familytree | | | | | | | | |!| | | | | | }}<br />
{{Family tree | | | | | |,|-|-|^|-|-|.| | }}<br />
{{Family tree | | | | | C01 | | | | C02 |C01= Yes| C02= No}}<br />
{{familytree | | | | | |!| | | | | |!| | | | }}<br />
{{familytree | | | | | |F01| | | |F02| | |F01= Treat accordingly<br><br />
*Labs<br />
*[[Endoscopy]]<br />
*Imaging|F02=Functional?}}<br />
{{familytree | | | | | | | | | | | | |!| | | }}<br />
{{familytree | | | | | | | | | | | | |!| | | | | | | }}<br />
{{familytree | | | |,|-|-|-|v|-|-|-|-|+|-|.| | }}<br />
{{familytree | | | |!| | | |!| | | | |!| |!| | }}<br />
{{familytree | | | D01 | | D02 | | D03 | | D04 | |D01=[[Constipation]]|D02=Functional dyspepsia|D03=Non-constipation IBS|D04=Bloating alone}}<br />
{{familytree | | | |`|-|-|-|^|-|-|+|-|-|-|-|-|'|}}<br />
{{familytree | | | | | | | | | | |!| | | | | | | | | }}<br />
{{familytree | | | | | | | | | | A02 | | | | | |A02= Lifestyle and nonspecific dietary advice.<br><br />
*Education about low FODMAP diet <br><ref name="Altobelli Del Negro Angeletti Latella p=940">{{cite journal | last=Altobelli | first=Emma | last2=Del Negro | first2=Valerio | last3=Angeletti | first3=Paolo | last4=Latella | first4=Giovanni | title=Low-FODMAP Diet Improves Irritable Bowel Syndrome Symptoms: A Meta-Analysis | journal=Nutrients | publisher=MDPI AG | volume=9 | issue=9 | date=2017-08-26 | issn=2072-6643 | doi=10.3390/nu9090940 | page=940}}</ref><br />
* Treat constipation aggressively and minimize bowel distention<br><br />
*Consider the use of [[Rifaximin]]<br />
*Consider probiotics, Psychological therapy, [[CBT]], and/or [[antidepressants]]<br><br />
*Consider Biodfeedback neuromodulation }}<br />
{{familytree/end}}<br />
<br />
==Do's==<br />
<br />
*Use of [[probiotics]] can help reduce [[bloating]].<br />
*Antidepressants can help to reduce the symptoms of [[IBS]] but the data is unclear over the reduction of bloating.<ref name="Seo Kim Oh pp. 433–453">{{cite journal | last=Seo | first=A Young | last2=Kim | first2=Nayoung | last3=Oh | first3=Dong Hyun | title=Abdominal Bloating: Pathophysiology and Treatment | journal=Journal of Neurogastroenterology and Motility | publisher=The Korean Society of Neurogastroenterology and Motility | volume=19 | issue=4 | date=2013-10-31 | issn=2093-0879 | doi=10.5056/jnm.2013.19.4.433 | pages=433–453}}</ref><br />
*[[Hypnotherapy]] has been reported to be useful in reducing symptoms of bloating.<br />
*Bowel training and [[diaphragmatic breathing]] have been useful in the management of [[bloating]] however the data is unclear.<br />
<br />
==Don'ts==<br />
<br />
*Artificial sweeteners containing [[sorbitol]], [[mannitol]], [[xylitol]] should be avoided.<ref name="Kamphuis Guiard Leveque Olier 2020 pp. 652–663.e6">{{cite journal | last=Kamphuis | first=Jasper B.J. | last2=Guiard | first2=Bruno | last3=Leveque | first3=Mathilde | last4=Olier | first4=Maiwenn | last5=Jouanin | first5=Isabelle | last6=Yvon | first6=Sophie | last7=Tondereau | first7=Valerie | last8=Rivière | first8=Pauline | last9=Guéraud | first9=Françoise | last10=Chevolleau | first10=Sylvie | last11=Noguer-Meireles | first11=Maria-Helena | last12=Martin | first12=Jean- François | last13=Debrauwer | first13=Laurent | last14=Eutamène | first14=Helene | last15=Theodorou | first15=Vassilia | title=Lactose and Fructo-oligosaccharides Increase Visceral Sensitivity in Mice via Glycation Processes, Increasing Mast Cell Density in Colonic Mucosa | journal=Gastroenterology | publisher=Elsevier BV | volume=158 | issue=3 | year=2020 | issn=0016-5085 | doi=10.1053/j.gastro.2019.10.037 | pages=652–663.e6}}</ref><br />
*Medications ([[anticholinergics]], [[opiates]], [[calcium channel blockers]], antidepressants) should also be avoided as they have an effect on [[bloating]].<ref name="Mari Abu Backer Mahamid Amara pp. 1075–1084">{{cite journal | last=Mari | first=Amir | last2=Abu Backer | first2=Fadi | last3=Mahamid | first3=Mahmud | last4=Amara | first4=Hana | last5=Carter | first5=Dan | last6=Boltin | first6=Doron | last7=Dickman | first7=Ram | title=Bloating and Abdominal Distension: Clinical Approach and Management | journal=Advances in Therapy | publisher=Springer Science and Business Media LLC | volume=36 | issue=5 | date=2019-03-16 | issn=0741-238X | doi=10.1007/s12325-019-00924-7 | pages=1075–1084}}</ref><br />
*Twenty percent of [[carbohydrates]] in baked beans and 7–10% in [[wheat]], oats, potatoes, and corn, and 1% in white rice are not absorbed well in the [[intestine]] and they can produce [[bloating]].<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
[[Category:Projects]]<br />
[[Category:Resident survival guide]]<br />
[[Category:Gastroenterology]]</div>
Usmanaliakbar
https://www.wikidoc.org/index.php?title=Bloating_resident_survival_guide&diff=1690544
Bloating resident survival guide
2021-02-18T15:32:50Z
<p>Usmanaliakbar: /* Don'ts */</p>
<hr />
<div>__NOTOC__<br />
<br />
{{CMG}} {{AE}} {{Usman Ali Akbar}}<br />
<br />
{{SK}}<br />
<br />
{| class="infobox" style="margin: 0 0 0 0; border: 0; float: right; width: 100px; background: #A8A8A8; position: fixed; top: 250px; right: 21px; border-radius: 0 0 10px 10px;" cellpadding="0" cellspacing="0" ;<br />
|-<br />
! style="padding: 0 5px; font-size: 85%; background: #A8A8A8" align="center" |{{fontcolor|#2B3B44|Bloating resident survival guide Microchapters}}<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Overview|Overview]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Causes|Causes]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#FIRE: Focused Initial Rapid Evaluation|FIRE]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Complete Diagnostic Approach|Diagnosis]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Treatment|Treatment]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Do's|Do's]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Don'ts|Don'ts]]<br />
|}<br />
<br />
==Overview==<br />
[[Bloating]] is one of the most common gastrointestinal complaints that is attributed by the patient as the subjective sensation of incorrectly perceived excess [[gas]]. There are multiple non-functional etiologies of abdominal bloating and distention. Primary functional abdominal distention (FABD) should be diagnosed as a single entity and it doesn't overlap with other functional gastrointestinal disorders. Rome IV diagnostic criteria mention the co-existence of mild abdominal pain and/or minor bowel movements. FABD can be treated with [[antispasmodic]] along with [[peppermint oil]] in [[randomized controlled trials]]. A stepwise approach is usually needed that counter the dietary interventions, [[microbiome]] modulation, and medical therapy in the management of FABD.<br />
<br />
==Causes==<br />
The causes of abdominal bloating are numerous and are managed according to the etiology.<ref name="Lacy Gabbard Crowell 2011 pp. 729–39">{{cite journal | last=Lacy | first=BE | last2=Gabbard | first2=SL | last3=Crowell | first3=MD | title=Pathophysiology, evaluation, and treatment of bloating: hope, hype, or hot air? | journal=Gastroenterology & hepatology | volume=7 | issue=11 | year=2011 | issn=1554-7914 | pmid=22298969 | pmc=3264926 | pages=729–39}}</ref><br />
<br />
*<br />
<br />
{| class="wikitable"<br />
|+<br />
Causes of Abdominal Bloating<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Intestinal Disorders<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Motility Disorders<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Malabsorption disorders<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Infectious causes<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Dietary causes<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Misc.<br />
|-<br />
|[[Adhesions]]<br />
[[Malignancy]]<br />
|[[Diabetes]]<br />
<br />
[[Scleroderma]]<br />
<br />
Pseudo-obstruction<br />
<br />
Medications<br />
|[[Lactose intolerance]]<br />
[[Fructose intolerance]]<br />
<br />
[[Celiac disease]]<br />
<br />
[[Pancreatic insufficiency]]<br />
|[[Small intestinal bacterial overgrowth]]<br />
[[Giardiasis]]<br />
|Gas-producing foods<br />
FODMAPs<br />
|[[Irritable bowel syndrome]] <br /><br />
|}<br />
<br />
*<br />
<br />
==Complete Diagnostic Approach==<br />
Shown below is an algorithm summarizing the diagnosis of abdominal bloating according to American College of Gastroenterology guidelines.<ref name="Foley Burgell Barrett Gibson 2014 pp. 561–571">{{cite journal | last=Foley | first=A | last2=Burgell | first2=R | last3=Barrett | first3=JS | last4=Gibson | first4=PR | title=Management Strategies for Abdominal Bloating and Distension | journal=Gastroenterology & Hepatology | volume=10 | issue=9 | year=2014 | pmid=27551250 | pmc=4991532 | pages=561–571}}</ref><ref name="Lacy Cangemi Vazquez-Roque 2021 pp. 219–231.e1">{{cite journal | last=Lacy | first=Brian E. | last2=Cangemi | first2=David | last3=Vazquez-Roque | first3=Maria | title=Management of Chronic Abdominal Distension and Bloating | journal=Clinical Gastroenterology and Hepatology | publisher=Elsevier BV | volume=19 | issue=2 | year=2021 | issn=1542-3565 | doi=10.1016/j.cgh.2020.03.056 | pages=219–231.e1}}</ref><br />
{{familytree/start |summary=PE diagnosis Algorithm.}}<br />
{{familytree | | | | A01 | | | A01= Patient with abdominal bloating and Distention }}<br />
{{familytree | | | | |!| | | | }}<br />
{{familytree | | | | B01 | | | B01= Look for the <br><br />
* Alarm signs<br />
*Overlapping functional gastrointestinal disorders<br />
*[[Bacterial overgrowth]] (Small intestine bacterial overgrowth)<br />
* Dietary intolerances<br />
*[[Celiac Disease]]<br />
* Weight gain <br />
*[[Constipation]] <br />
*[[Hydrogen breath test]] <br />
*Any pyschological comorbidities}}<br />
{{familytree | | |,|-|^|-|.| | }}<br />
{{familytree | | C01 | | C02 | C01= Yes | C02=No}}<br />
{{familytree | | |!| | | |!| | }}<br />
{{familytree | | C01 | | C02 | C01=<br />
* Reassurance the patient, recommend [[diaphragmatic breathing]]<br />
*Diet intervention: Low FODMAP diet <br />
*Iniate sympotmatic treatment such as [[peppermint oil]] or [[Simethicone]] | C02= Treat Accordingly}}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= *Trial of [[Rifaximin]]/[[Probiotics]] }}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= No Response }}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= [[Antidepressants]]<br />
*[[Psychological therapy]]<br />
*Hypnotherapy, [[Cognitive behavioral therapy]] (CBT)}}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= No Response }}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= <br />
*Referral to specialized Neurogastroenterology center <br />
*Referral for the CT/MRI [[Electromyography]]<br />
*Referral for the abdominal biofeedback therapy)}}<br />
{{familytree/end}}<br />
<br />
==Treatment==<br />
Shown below is an algorithm summarizing the treatment of abdominal bloating according the the American College of Gastroenterology guidelines.<ref name="Schmulson Chang pp. 1071–1086">{{cite journal | last=Schmulson | first=M. | last2=Chang | first2=L. | title=Review article: the treatment of functional abdominal bloating and distension | journal=Alimentary Pharmacology & Therapeutics | publisher=Wiley | volume=33 | issue=10 | date=2011-03-29 | issn=0269-2813 | doi=10.1111/j.1365-2036.2011.04637.x | pages=1071–1086}}</ref><br />
{{familytree/start |summary=PE diagnosis Algorithm.}}<br />
{{familytree | | | | | | | | A01 |A01= Treatment of bloating is based on etiology of bloating.}} <br />
{{familytree | | | | | | | | |!| | | | | |}}<br />
{{familytree | | | | | | | |C01| | | | | |C01= Dietary changes are suggested for bloating <br />
*Diet<br />
*[[Exercise]] and [[posture]]<br />
*Over-the-counter medications<br />
*[[Probiotics]]<br />
*[[Antibiotics]]<br />
*Smooth muscle [[antispasmodics]]<br />
*Osmotic laxatives<br />
*Prokinetic agents<br />
*Chloride channel activators<br />
*[[Tricyclic antidepressants]]<br />
<br />
Are any warning signs present?<br />
*anemia,GI bleeding, weight loss>10% of the body weight, and family history of GI malignancy. }}<br />
{{familytree | | | | | | | | |!| | | | | | }}<br />
{{Family tree | | | | | |,|-|-|^|-|-|.| | }}<br />
{{Family tree | | | | | C01 | | | | C02 |C01= Yes| C02= No}}<br />
{{familytree | | | | | |!| | | | | |!| | | | }}<br />
{{familytree | | | | | |F01| | | |F02| | |F01= Treat accordingly<br><br />
*Labs<br />
*[[Endoscopy]]<br />
*Imaging|F02=Functional?}}<br />
{{familytree | | | | | | | | | | | | |!| | | }}<br />
{{familytree | | | | | | | | | | | | |!| | | | | | | }}<br />
{{familytree | | | |,|-|-|-|v|-|-|-|-|+|-|.| | }}<br />
{{familytree | | | |!| | | |!| | | | |!| |!| | }}<br />
{{familytree | | | D01 | | D02 | | D03 | | D04 | |D01=[[Constipation]]|D02=Functional dyspepsia|D03=Non-constipation IBS|D04=Bloating alone}}<br />
{{familytree | | | |`|-|-|-|^|-|-|+|-|-|-|-|-|'|}}<br />
{{familytree | | | | | | | | | | |!| | | | | | | | | }}<br />
{{familytree | | | | | | | | | | A02 | | | | | |A02= Lifestyle and nonspecific dietary advice.<br><br />
*Education about low FODMAP diet <br><ref name="Altobelli Del Negro Angeletti Latella p=940">{{cite journal | last=Altobelli | first=Emma | last2=Del Negro | first2=Valerio | last3=Angeletti | first3=Paolo | last4=Latella | first4=Giovanni | title=Low-FODMAP Diet Improves Irritable Bowel Syndrome Symptoms: A Meta-Analysis | journal=Nutrients | publisher=MDPI AG | volume=9 | issue=9 | date=2017-08-26 | issn=2072-6643 | doi=10.3390/nu9090940 | page=940}}</ref><br />
* Treat constipation aggressively and minimize bowel distention<br><br />
*Consider the use of [[Rifaximin]]<br />
*Consider probiotics, Psychological therapy, [[CBT]], and/or [[antidepressants]]<br><br />
*Consider Biodfeedback neuromodulation }}<br />
{{familytree/end}}<br />
<br />
==Do's==<br />
<br />
*Use of [[probiotics]] can help reduce [[bloating]].<br />
*Antidepressants can help to reduce the symptoms of [[IBS]] but the data is unclear over the reduction of bloating.<ref name="Seo Kim Oh pp. 433–453">{{cite journal | last=Seo | first=A Young | last2=Kim | first2=Nayoung | last3=Oh | first3=Dong Hyun | title=Abdominal Bloating: Pathophysiology and Treatment | journal=Journal of Neurogastroenterology and Motility | publisher=The Korean Society of Neurogastroenterology and Motility | volume=19 | issue=4 | date=2013-10-31 | issn=2093-0879 | doi=10.5056/jnm.2013.19.4.433 | pages=433–453}}</ref><br />
*[[Hypnotherapy]] has been reported to be useful in reducing symptoms of bloating.<br />
*Bowel training and [[diaphragmatic breathing]] have been useful in the management of [[bloating]] however the data is unclear.<br />
<br />
==Don'ts==<br />
<br />
*Artificial sweeteners containing [[sorbitol]], [[mannitol]], [[xylitol]] should be avoided.<ref name="Kamphuis Guiard Leveque Olier 2020 pp. 652–663.e6">{{cite journal | last=Kamphuis | first=Jasper B.J. | last2=Guiard | first2=Bruno | last3=Leveque | first3=Mathilde | last4=Olier | first4=Maiwenn | last5=Jouanin | first5=Isabelle | last6=Yvon | first6=Sophie | last7=Tondereau | first7=Valerie | last8=Rivière | first8=Pauline | last9=Guéraud | first9=Françoise | last10=Chevolleau | first10=Sylvie | last11=Noguer-Meireles | first11=Maria-Helena | last12=Martin | first12=Jean- François | last13=Debrauwer | first13=Laurent | last14=Eutamène | first14=Helene | last15=Theodorou | first15=Vassilia | title=Lactose and Fructo-oligosaccharides Increase Visceral Sensitivity in Mice via Glycation Processes, Increasing Mast Cell Density in Colonic Mucosa | journal=Gastroenterology | publisher=Elsevier BV | volume=158 | issue=3 | year=2020 | issn=0016-5085 | doi=10.1053/j.gastro.2019.10.037 | pages=652–663.e6}}</ref><br />
*Medications ([[anticholinergics]], [[opiates]], [[calcium channel blockers]], antidepressants) should also be avoided as they have an effect on [[bloating]].<ref name="Mari Abu Backer Mahamid Amara pp. 1075–1084">{{cite journal | last=Mari | first=Amir | last2=Abu Backer | first2=Fadi | last3=Mahamid | first3=Mahmud | last4=Amara | first4=Hana | last5=Carter | first5=Dan | last6=Boltin | first6=Doron | last7=Dickman | first7=Ram | title=Bloating and Abdominal Distension: Clinical Approach and Management | journal=Advances in Therapy | publisher=Springer Science and Business Media LLC | volume=36 | issue=5 | date=2019-03-16 | issn=0741-238X | doi=10.1007/s12325-019-00924-7 | pages=1075–1084}}</ref><br />
*Twenty percent of [[carbohydrates]] in baked beans and 7–10% in [[wheat]], oats, potatoes, and corn, and 1% in white rice are not absorbed well in the [[intestine]] and they can produce [[bloating]].<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
[[Category:Projects]]<br />
[[Category:Resident survival guide]]<br />
[[Category:Gastroenterology]]</div>
Usmanaliakbar
https://www.wikidoc.org/index.php?title=Bloating_resident_survival_guide&diff=1690542
Bloating resident survival guide
2021-02-18T15:31:45Z
<p>Usmanaliakbar: /* Don'ts */</p>
<hr />
<div>__NOTOC__<br />
<br />
{{CMG}} {{AE}} {{Usman Ali Akbar}}<br />
<br />
{{SK}}<br />
<br />
{| class="infobox" style="margin: 0 0 0 0; border: 0; float: right; width: 100px; background: #A8A8A8; position: fixed; top: 250px; right: 21px; border-radius: 0 0 10px 10px;" cellpadding="0" cellspacing="0" ;<br />
|-<br />
! style="padding: 0 5px; font-size: 85%; background: #A8A8A8" align="center" |{{fontcolor|#2B3B44|Bloating resident survival guide Microchapters}}<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Overview|Overview]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Causes|Causes]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#FIRE: Focused Initial Rapid Evaluation|FIRE]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Complete Diagnostic Approach|Diagnosis]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Treatment|Treatment]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Do's|Do's]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Don'ts|Don'ts]]<br />
|}<br />
<br />
==Overview==<br />
[[Bloating]] is one of the most common gastrointestinal complaints that is attributed by the patient as the subjective sensation of incorrectly perceived excess [[gas]]. There are multiple non-functional etiologies of abdominal bloating and distention. Primary functional abdominal distention (FABD) should be diagnosed as a single entity and it doesn't overlap with other functional gastrointestinal disorders. Rome IV diagnostic criteria mention the co-existence of mild abdominal pain and/or minor bowel movements. FABD can be treated with [[antispasmodic]] along with [[peppermint oil]] in [[randomized controlled trials]]. A stepwise approach is usually needed that counter the dietary interventions, [[microbiome]] modulation, and medical therapy in the management of FABD.<br />
<br />
==Causes==<br />
The causes of abdominal bloating are numerous and are managed according to the etiology.<ref name="Lacy Gabbard Crowell 2011 pp. 729–39">{{cite journal | last=Lacy | first=BE | last2=Gabbard | first2=SL | last3=Crowell | first3=MD | title=Pathophysiology, evaluation, and treatment of bloating: hope, hype, or hot air? | journal=Gastroenterology & hepatology | volume=7 | issue=11 | year=2011 | issn=1554-7914 | pmid=22298969 | pmc=3264926 | pages=729–39}}</ref><br />
<br />
*<br />
<br />
{| class="wikitable"<br />
|+<br />
Causes of Abdominal Bloating<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Intestinal Disorders<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Motility Disorders<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Malabsorption disorders<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Infectious causes<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Dietary causes<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Misc.<br />
|-<br />
|[[Adhesions]]<br />
[[Malignancy]]<br />
|[[Diabetes]]<br />
<br />
[[Scleroderma]]<br />
<br />
Pseudo-obstruction<br />
<br />
Medications<br />
|[[Lactose intolerance]]<br />
[[Fructose intolerance]]<br />
<br />
[[Celiac disease]]<br />
<br />
[[Pancreatic insufficiency]]<br />
|[[Small intestinal bacterial overgrowth]]<br />
[[Giardiasis]]<br />
|Gas-producing foods<br />
FODMAPs<br />
|[[Irritable bowel syndrome]] <br /><br />
|}<br />
<br />
*<br />
<br />
==Complete Diagnostic Approach==<br />
Shown below is an algorithm summarizing the diagnosis of abdominal bloating according to American College of Gastroenterology guidelines.<ref name="Foley Burgell Barrett Gibson 2014 pp. 561–571">{{cite journal | last=Foley | first=A | last2=Burgell | first2=R | last3=Barrett | first3=JS | last4=Gibson | first4=PR | title=Management Strategies for Abdominal Bloating and Distension | journal=Gastroenterology & Hepatology | volume=10 | issue=9 | year=2014 | pmid=27551250 | pmc=4991532 | pages=561–571}}</ref><ref name="Lacy Cangemi Vazquez-Roque 2021 pp. 219–231.e1">{{cite journal | last=Lacy | first=Brian E. | last2=Cangemi | first2=David | last3=Vazquez-Roque | first3=Maria | title=Management of Chronic Abdominal Distension and Bloating | journal=Clinical Gastroenterology and Hepatology | publisher=Elsevier BV | volume=19 | issue=2 | year=2021 | issn=1542-3565 | doi=10.1016/j.cgh.2020.03.056 | pages=219–231.e1}}</ref><br />
{{familytree/start |summary=PE diagnosis Algorithm.}}<br />
{{familytree | | | | A01 | | | A01= Patient with abdominal bloating and Distention }}<br />
{{familytree | | | | |!| | | | }}<br />
{{familytree | | | | B01 | | | B01= Look for the <br><br />
* Alarm signs<br />
*Overlapping functional gastrointestinal disorders<br />
*[[Bacterial overgrowth]] (Small intestine bacterial overgrowth)<br />
* Dietary intolerances<br />
*[[Celiac Disease]]<br />
* Weight gain <br />
*[[Constipation]] <br />
*[[Hydrogen breath test]] <br />
*Any pyschological comorbidities}}<br />
{{familytree | | |,|-|^|-|.| | }}<br />
{{familytree | | C01 | | C02 | C01= Yes | C02=No}}<br />
{{familytree | | |!| | | |!| | }}<br />
{{familytree | | C01 | | C02 | C01=<br />
* Reassurance the patient, recommend [[diaphragmatic breathing]]<br />
*Diet intervention: Low FODMAP diet <br />
*Iniate sympotmatic treatment such as [[peppermint oil]] or [[Simethicone]] | C02= Treat Accordingly}}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= *Trial of [[Rifaximin]]/[[Probiotics]] }}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= No Response }}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= [[Antidepressants]]<br />
*[[Psychological therapy]]<br />
*Hypnotherapy, [[Cognitive behavioral therapy]] (CBT)}}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= No Response }}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= <br />
*Referral to specialized Neurogastroenterology center <br />
*Referral for the CT/MRI [[Electromyography]]<br />
*Referral for the abdominal biofeedback therapy)}}<br />
{{familytree/end}}<br />
<br />
==Treatment==<br />
Shown below is an algorithm summarizing the treatment of abdominal bloating according the the American College of Gastroenterology guidelines.<ref name="Schmulson Chang pp. 1071–1086">{{cite journal | last=Schmulson | first=M. | last2=Chang | first2=L. | title=Review article: the treatment of functional abdominal bloating and distension | journal=Alimentary Pharmacology & Therapeutics | publisher=Wiley | volume=33 | issue=10 | date=2011-03-29 | issn=0269-2813 | doi=10.1111/j.1365-2036.2011.04637.x | pages=1071–1086}}</ref><br />
{{familytree/start |summary=PE diagnosis Algorithm.}}<br />
{{familytree | | | | | | | | A01 |A01= Treatment of bloating is based on etiology of bloating.}} <br />
{{familytree | | | | | | | | |!| | | | | |}}<br />
{{familytree | | | | | | | |C01| | | | | |C01= Dietary changes are suggested for bloating <br />
*Diet<br />
*[[Exercise]] and [[posture]]<br />
*Over-the-counter medications<br />
*[[Probiotics]]<br />
*[[Antibiotics]]<br />
*Smooth muscle [[antispasmodics]]<br />
*Osmotic laxatives<br />
*Prokinetic agents<br />
*Chloride channel activators<br />
*[[Tricyclic antidepressants]]<br />
<br />
Are any warning signs present?<br />
*anemia,GI bleeding, weight loss>10% of the body weight, and family history of GI malignancy. }}<br />
{{familytree | | | | | | | | |!| | | | | | }}<br />
{{Family tree | | | | | |,|-|-|^|-|-|.| | }}<br />
{{Family tree | | | | | C01 | | | | C02 |C01= Yes| C02= No}}<br />
{{familytree | | | | | |!| | | | | |!| | | | }}<br />
{{familytree | | | | | |F01| | | |F02| | |F01= Treat accordingly<br><br />
*Labs<br />
*[[Endoscopy]]<br />
*Imaging|F02=Functional?}}<br />
{{familytree | | | | | | | | | | | | |!| | | }}<br />
{{familytree | | | | | | | | | | | | |!| | | | | | | }}<br />
{{familytree | | | |,|-|-|-|v|-|-|-|-|+|-|.| | }}<br />
{{familytree | | | |!| | | |!| | | | |!| |!| | }}<br />
{{familytree | | | D01 | | D02 | | D03 | | D04 | |D01=[[Constipation]]|D02=Functional dyspepsia|D03=Non-constipation IBS|D04=Bloating alone}}<br />
{{familytree | | | |`|-|-|-|^|-|-|+|-|-|-|-|-|'|}}<br />
{{familytree | | | | | | | | | | |!| | | | | | | | | }}<br />
{{familytree | | | | | | | | | | A02 | | | | | |A02= Lifestyle and nonspecific dietary advice.<br><br />
*Education about low FODMAP diet <br><ref name="Altobelli Del Negro Angeletti Latella p=940">{{cite journal | last=Altobelli | first=Emma | last2=Del Negro | first2=Valerio | last3=Angeletti | first3=Paolo | last4=Latella | first4=Giovanni | title=Low-FODMAP Diet Improves Irritable Bowel Syndrome Symptoms: A Meta-Analysis | journal=Nutrients | publisher=MDPI AG | volume=9 | issue=9 | date=2017-08-26 | issn=2072-6643 | doi=10.3390/nu9090940 | page=940}}</ref><br />
* Treat constipation aggressively and minimize bowel distention<br><br />
*Consider the use of [[Rifaximin]]<br />
*Consider probiotics, Psychological therapy, [[CBT]], and/or [[antidepressants]]<br><br />
*Consider Biodfeedback neuromodulation }}<br />
{{familytree/end}}<br />
<br />
==Do's==<br />
<br />
*Use of [[probiotics]] can help reduce [[bloating]].<br />
*Antidepressants can help to reduce the symptoms of [[IBS]] but the data is unclear over the reduction of bloating.<ref name="Seo Kim Oh pp. 433–453">{{cite journal | last=Seo | first=A Young | last2=Kim | first2=Nayoung | last3=Oh | first3=Dong Hyun | title=Abdominal Bloating: Pathophysiology and Treatment | journal=Journal of Neurogastroenterology and Motility | publisher=The Korean Society of Neurogastroenterology and Motility | volume=19 | issue=4 | date=2013-10-31 | issn=2093-0879 | doi=10.5056/jnm.2013.19.4.433 | pages=433–453}}</ref><br />
*[[Hypnotherapy]] has been reported to be useful in reducing symptoms of bloating.<br />
*Bowel training and [[diaphragmatic breathing]] have been useful in the management of [[bloating]] however the data is unclear.<br />
<br />
==Don'ts==<br />
<br />
*Artificial sweeteners containing [[sorbitol]], [[mannitol]], [[xylitol]] should be avoided.<br />
*Medications ([[anticholinergics]], [[opiates]], [[calcium channel blockers]], antidepressants) should also be avoided as they have an effect on [[bloating]].<ref name="Mari Abu Backer Mahamid Amara pp. 1075–1084">{{cite journal | last=Mari | first=Amir | last2=Abu Backer | first2=Fadi | last3=Mahamid | first3=Mahmud | last4=Amara | first4=Hana | last5=Carter | first5=Dan | last6=Boltin | first6=Doron | last7=Dickman | first7=Ram | title=Bloating and Abdominal Distension: Clinical Approach and Management | journal=Advances in Therapy | publisher=Springer Science and Business Media LLC | volume=36 | issue=5 | date=2019-03-16 | issn=0741-238X | doi=10.1007/s12325-019-00924-7 | pages=1075–1084}}</ref><br />
*Twenty percent of [[carbohydrates]] in baked beans and 7–10% in [[wheat]], oats, potatoes, and corn, and 1% in white rice are not absorbed well in the [[intestine]] and they can produce [[bloating]].<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
[[Category:Projects]]<br />
[[Category:Resident survival guide]]<br />
[[Category:Gastroenterology]]</div>
Usmanaliakbar
https://www.wikidoc.org/index.php?title=Bloating_resident_survival_guide&diff=1690541
Bloating resident survival guide
2021-02-18T15:31:00Z
<p>Usmanaliakbar: /* Do's */</p>
<hr />
<div>__NOTOC__<br />
<br />
{{CMG}} {{AE}} {{Usman Ali Akbar}}<br />
<br />
{{SK}}<br />
<br />
{| class="infobox" style="margin: 0 0 0 0; border: 0; float: right; width: 100px; background: #A8A8A8; position: fixed; top: 250px; right: 21px; border-radius: 0 0 10px 10px;" cellpadding="0" cellspacing="0" ;<br />
|-<br />
! style="padding: 0 5px; font-size: 85%; background: #A8A8A8" align="center" |{{fontcolor|#2B3B44|Bloating resident survival guide Microchapters}}<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Overview|Overview]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Causes|Causes]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#FIRE: Focused Initial Rapid Evaluation|FIRE]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Complete Diagnostic Approach|Diagnosis]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Treatment|Treatment]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Do's|Do's]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Don'ts|Don'ts]]<br />
|}<br />
<br />
==Overview==<br />
[[Bloating]] is one of the most common gastrointestinal complaints that is attributed by the patient as the subjective sensation of incorrectly perceived excess [[gas]]. There are multiple non-functional etiologies of abdominal bloating and distention. Primary functional abdominal distention (FABD) should be diagnosed as a single entity and it doesn't overlap with other functional gastrointestinal disorders. Rome IV diagnostic criteria mention the co-existence of mild abdominal pain and/or minor bowel movements. FABD can be treated with [[antispasmodic]] along with [[peppermint oil]] in [[randomized controlled trials]]. A stepwise approach is usually needed that counter the dietary interventions, [[microbiome]] modulation, and medical therapy in the management of FABD.<br />
<br />
==Causes==<br />
The causes of abdominal bloating are numerous and are managed according to the etiology.<ref name="Lacy Gabbard Crowell 2011 pp. 729–39">{{cite journal | last=Lacy | first=BE | last2=Gabbard | first2=SL | last3=Crowell | first3=MD | title=Pathophysiology, evaluation, and treatment of bloating: hope, hype, or hot air? | journal=Gastroenterology & hepatology | volume=7 | issue=11 | year=2011 | issn=1554-7914 | pmid=22298969 | pmc=3264926 | pages=729–39}}</ref><br />
<br />
*<br />
<br />
{| class="wikitable"<br />
|+<br />
Causes of Abdominal Bloating<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Intestinal Disorders<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Motility Disorders<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Malabsorption disorders<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Infectious causes<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Dietary causes<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Misc.<br />
|-<br />
|[[Adhesions]]<br />
[[Malignancy]]<br />
|[[Diabetes]]<br />
<br />
[[Scleroderma]]<br />
<br />
Pseudo-obstruction<br />
<br />
Medications<br />
|[[Lactose intolerance]]<br />
[[Fructose intolerance]]<br />
<br />
[[Celiac disease]]<br />
<br />
[[Pancreatic insufficiency]]<br />
|[[Small intestinal bacterial overgrowth]]<br />
[[Giardiasis]]<br />
|Gas-producing foods<br />
FODMAPs<br />
|[[Irritable bowel syndrome]] <br /><br />
|}<br />
<br />
*<br />
<br />
==Complete Diagnostic Approach==<br />
Shown below is an algorithm summarizing the diagnosis of abdominal bloating according to American College of Gastroenterology guidelines.<ref name="Foley Burgell Barrett Gibson 2014 pp. 561–571">{{cite journal | last=Foley | first=A | last2=Burgell | first2=R | last3=Barrett | first3=JS | last4=Gibson | first4=PR | title=Management Strategies for Abdominal Bloating and Distension | journal=Gastroenterology & Hepatology | volume=10 | issue=9 | year=2014 | pmid=27551250 | pmc=4991532 | pages=561–571}}</ref><ref name="Lacy Cangemi Vazquez-Roque 2021 pp. 219–231.e1">{{cite journal | last=Lacy | first=Brian E. | last2=Cangemi | first2=David | last3=Vazquez-Roque | first3=Maria | title=Management of Chronic Abdominal Distension and Bloating | journal=Clinical Gastroenterology and Hepatology | publisher=Elsevier BV | volume=19 | issue=2 | year=2021 | issn=1542-3565 | doi=10.1016/j.cgh.2020.03.056 | pages=219–231.e1}}</ref><br />
{{familytree/start |summary=PE diagnosis Algorithm.}}<br />
{{familytree | | | | A01 | | | A01= Patient with abdominal bloating and Distention }}<br />
{{familytree | | | | |!| | | | }}<br />
{{familytree | | | | B01 | | | B01= Look for the <br><br />
* Alarm signs<br />
*Overlapping functional gastrointestinal disorders<br />
*[[Bacterial overgrowth]] (Small intestine bacterial overgrowth)<br />
* Dietary intolerances<br />
*[[Celiac Disease]]<br />
* Weight gain <br />
*[[Constipation]] <br />
*[[Hydrogen breath test]] <br />
*Any pyschological comorbidities}}<br />
{{familytree | | |,|-|^|-|.| | }}<br />
{{familytree | | C01 | | C02 | C01= Yes | C02=No}}<br />
{{familytree | | |!| | | |!| | }}<br />
{{familytree | | C01 | | C02 | C01=<br />
* Reassurance the patient, recommend [[diaphragmatic breathing]]<br />
*Diet intervention: Low FODMAP diet <br />
*Iniate sympotmatic treatment such as [[peppermint oil]] or [[Simethicone]] | C02= Treat Accordingly}}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= *Trial of [[Rifaximin]]/[[Probiotics]] }}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= No Response }}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= [[Antidepressants]]<br />
*[[Psychological therapy]]<br />
*Hypnotherapy, [[Cognitive behavioral therapy]] (CBT)}}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= No Response }}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= <br />
*Referral to specialized Neurogastroenterology center <br />
*Referral for the CT/MRI [[Electromyography]]<br />
*Referral for the abdominal biofeedback therapy)}}<br />
{{familytree/end}}<br />
<br />
==Treatment==<br />
Shown below is an algorithm summarizing the treatment of abdominal bloating according the the American College of Gastroenterology guidelines.<ref name="Schmulson Chang pp. 1071–1086">{{cite journal | last=Schmulson | first=M. | last2=Chang | first2=L. | title=Review article: the treatment of functional abdominal bloating and distension | journal=Alimentary Pharmacology & Therapeutics | publisher=Wiley | volume=33 | issue=10 | date=2011-03-29 | issn=0269-2813 | doi=10.1111/j.1365-2036.2011.04637.x | pages=1071–1086}}</ref><br />
{{familytree/start |summary=PE diagnosis Algorithm.}}<br />
{{familytree | | | | | | | | A01 |A01= Treatment of bloating is based on etiology of bloating.}} <br />
{{familytree | | | | | | | | |!| | | | | |}}<br />
{{familytree | | | | | | | |C01| | | | | |C01= Dietary changes are suggested for bloating <br />
*Diet<br />
*[[Exercise]] and [[posture]]<br />
*Over-the-counter medications<br />
*[[Probiotics]]<br />
*[[Antibiotics]]<br />
*Smooth muscle [[antispasmodics]]<br />
*Osmotic laxatives<br />
*Prokinetic agents<br />
*Chloride channel activators<br />
*[[Tricyclic antidepressants]]<br />
<br />
Are any warning signs present?<br />
*anemia,GI bleeding, weight loss>10% of the body weight, and family history of GI malignancy. }}<br />
{{familytree | | | | | | | | |!| | | | | | }}<br />
{{Family tree | | | | | |,|-|-|^|-|-|.| | }}<br />
{{Family tree | | | | | C01 | | | | C02 |C01= Yes| C02= No}}<br />
{{familytree | | | | | |!| | | | | |!| | | | }}<br />
{{familytree | | | | | |F01| | | |F02| | |F01= Treat accordingly<br><br />
*Labs<br />
*[[Endoscopy]]<br />
*Imaging|F02=Functional?}}<br />
{{familytree | | | | | | | | | | | | |!| | | }}<br />
{{familytree | | | | | | | | | | | | |!| | | | | | | }}<br />
{{familytree | | | |,|-|-|-|v|-|-|-|-|+|-|.| | }}<br />
{{familytree | | | |!| | | |!| | | | |!| |!| | }}<br />
{{familytree | | | D01 | | D02 | | D03 | | D04 | |D01=[[Constipation]]|D02=Functional dyspepsia|D03=Non-constipation IBS|D04=Bloating alone}}<br />
{{familytree | | | |`|-|-|-|^|-|-|+|-|-|-|-|-|'|}}<br />
{{familytree | | | | | | | | | | |!| | | | | | | | | }}<br />
{{familytree | | | | | | | | | | A02 | | | | | |A02= Lifestyle and nonspecific dietary advice.<br><br />
*Education about low FODMAP diet <br><ref name="Altobelli Del Negro Angeletti Latella p=940">{{cite journal | last=Altobelli | first=Emma | last2=Del Negro | first2=Valerio | last3=Angeletti | first3=Paolo | last4=Latella | first4=Giovanni | title=Low-FODMAP Diet Improves Irritable Bowel Syndrome Symptoms: A Meta-Analysis | journal=Nutrients | publisher=MDPI AG | volume=9 | issue=9 | date=2017-08-26 | issn=2072-6643 | doi=10.3390/nu9090940 | page=940}}</ref><br />
* Treat constipation aggressively and minimize bowel distention<br><br />
*Consider the use of [[Rifaximin]]<br />
*Consider probiotics, Psychological therapy, [[CBT]], and/or [[antidepressants]]<br><br />
*Consider Biodfeedback neuromodulation }}<br />
{{familytree/end}}<br />
<br />
==Do's==<br />
<br />
*Use of [[probiotics]] can help reduce [[bloating]].<br />
*Antidepressants can help to reduce the symptoms of [[IBS]] but the data is unclear over the reduction of bloating.<ref name="Seo Kim Oh pp. 433–453">{{cite journal | last=Seo | first=A Young | last2=Kim | first2=Nayoung | last3=Oh | first3=Dong Hyun | title=Abdominal Bloating: Pathophysiology and Treatment | journal=Journal of Neurogastroenterology and Motility | publisher=The Korean Society of Neurogastroenterology and Motility | volume=19 | issue=4 | date=2013-10-31 | issn=2093-0879 | doi=10.5056/jnm.2013.19.4.433 | pages=433–453}}</ref><br />
*[[Hypnotherapy]] has been reported to be useful in reducing symptoms of bloating.<br />
*Bowel training and [[diaphragmatic breathing]] have been useful in the management of [[bloating]] however the data is unclear.<br />
<br />
==Don'ts==<br />
<br />
*Artificial sweeteners containing [[sorbitol]], [[mannitol]], [[xylitol]] should be avoided.<br />
*Medications ([[anticholinergics]], [[opiates]], [[calcium channel blockers]], antidepressants) should also be avoided as they have an effect on [[bloating]].<br />
*Twenty percent of [[carbohydrates]] in baked beans and 7–10% in [[wheat]], oats, potatoes, and corn, and 1% in white rice are not absorbed well in the [[intestine]] and they can produce [[bloating]].<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
[[Category:Projects]]<br />
[[Category:Resident survival guide]]<br />
[[Category:Gastroenterology]]</div>
Usmanaliakbar
https://www.wikidoc.org/index.php?title=Bloating_resident_survival_guide&diff=1690540
Bloating resident survival guide
2021-02-18T15:30:16Z
<p>Usmanaliakbar: /* Treatment */</p>
<hr />
<div>__NOTOC__<br />
<br />
{{CMG}} {{AE}} {{Usman Ali Akbar}}<br />
<br />
{{SK}}<br />
<br />
{| class="infobox" style="margin: 0 0 0 0; border: 0; float: right; width: 100px; background: #A8A8A8; position: fixed; top: 250px; right: 21px; border-radius: 0 0 10px 10px;" cellpadding="0" cellspacing="0" ;<br />
|-<br />
! style="padding: 0 5px; font-size: 85%; background: #A8A8A8" align="center" |{{fontcolor|#2B3B44|Bloating resident survival guide Microchapters}}<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Overview|Overview]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Causes|Causes]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#FIRE: Focused Initial Rapid Evaluation|FIRE]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Complete Diagnostic Approach|Diagnosis]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Treatment|Treatment]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Do's|Do's]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Don'ts|Don'ts]]<br />
|}<br />
<br />
==Overview==<br />
[[Bloating]] is one of the most common gastrointestinal complaints that is attributed by the patient as the subjective sensation of incorrectly perceived excess [[gas]]. There are multiple non-functional etiologies of abdominal bloating and distention. Primary functional abdominal distention (FABD) should be diagnosed as a single entity and it doesn't overlap with other functional gastrointestinal disorders. Rome IV diagnostic criteria mention the co-existence of mild abdominal pain and/or minor bowel movements. FABD can be treated with [[antispasmodic]] along with [[peppermint oil]] in [[randomized controlled trials]]. A stepwise approach is usually needed that counter the dietary interventions, [[microbiome]] modulation, and medical therapy in the management of FABD.<br />
<br />
==Causes==<br />
The causes of abdominal bloating are numerous and are managed according to the etiology.<ref name="Lacy Gabbard Crowell 2011 pp. 729–39">{{cite journal | last=Lacy | first=BE | last2=Gabbard | first2=SL | last3=Crowell | first3=MD | title=Pathophysiology, evaluation, and treatment of bloating: hope, hype, or hot air? | journal=Gastroenterology & hepatology | volume=7 | issue=11 | year=2011 | issn=1554-7914 | pmid=22298969 | pmc=3264926 | pages=729–39}}</ref><br />
<br />
*<br />
<br />
{| class="wikitable"<br />
|+<br />
Causes of Abdominal Bloating<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Intestinal Disorders<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Motility Disorders<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Malabsorption disorders<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Infectious causes<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Dietary causes<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Misc.<br />
|-<br />
|[[Adhesions]]<br />
[[Malignancy]]<br />
|[[Diabetes]]<br />
<br />
[[Scleroderma]]<br />
<br />
Pseudo-obstruction<br />
<br />
Medications<br />
|[[Lactose intolerance]]<br />
[[Fructose intolerance]]<br />
<br />
[[Celiac disease]]<br />
<br />
[[Pancreatic insufficiency]]<br />
|[[Small intestinal bacterial overgrowth]]<br />
[[Giardiasis]]<br />
|Gas-producing foods<br />
FODMAPs<br />
|[[Irritable bowel syndrome]] <br /><br />
|}<br />
<br />
*<br />
<br />
==Complete Diagnostic Approach==<br />
Shown below is an algorithm summarizing the diagnosis of abdominal bloating according to American College of Gastroenterology guidelines.<ref name="Foley Burgell Barrett Gibson 2014 pp. 561–571">{{cite journal | last=Foley | first=A | last2=Burgell | first2=R | last3=Barrett | first3=JS | last4=Gibson | first4=PR | title=Management Strategies for Abdominal Bloating and Distension | journal=Gastroenterology & Hepatology | volume=10 | issue=9 | year=2014 | pmid=27551250 | pmc=4991532 | pages=561–571}}</ref><ref name="Lacy Cangemi Vazquez-Roque 2021 pp. 219–231.e1">{{cite journal | last=Lacy | first=Brian E. | last2=Cangemi | first2=David | last3=Vazquez-Roque | first3=Maria | title=Management of Chronic Abdominal Distension and Bloating | journal=Clinical Gastroenterology and Hepatology | publisher=Elsevier BV | volume=19 | issue=2 | year=2021 | issn=1542-3565 | doi=10.1016/j.cgh.2020.03.056 | pages=219–231.e1}}</ref><br />
{{familytree/start |summary=PE diagnosis Algorithm.}}<br />
{{familytree | | | | A01 | | | A01= Patient with abdominal bloating and Distention }}<br />
{{familytree | | | | |!| | | | }}<br />
{{familytree | | | | B01 | | | B01= Look for the <br><br />
* Alarm signs<br />
*Overlapping functional gastrointestinal disorders<br />
*[[Bacterial overgrowth]] (Small intestine bacterial overgrowth)<br />
* Dietary intolerances<br />
*[[Celiac Disease]]<br />
* Weight gain <br />
*[[Constipation]] <br />
*[[Hydrogen breath test]] <br />
*Any pyschological comorbidities}}<br />
{{familytree | | |,|-|^|-|.| | }}<br />
{{familytree | | C01 | | C02 | C01= Yes | C02=No}}<br />
{{familytree | | |!| | | |!| | }}<br />
{{familytree | | C01 | | C02 | C01=<br />
* Reassurance the patient, recommend [[diaphragmatic breathing]]<br />
*Diet intervention: Low FODMAP diet <br />
*Iniate sympotmatic treatment such as [[peppermint oil]] or [[Simethicone]] | C02= Treat Accordingly}}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= *Trial of [[Rifaximin]]/[[Probiotics]] }}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= No Response }}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= [[Antidepressants]]<br />
*[[Psychological therapy]]<br />
*Hypnotherapy, [[Cognitive behavioral therapy]] (CBT)}}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= No Response }}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= <br />
*Referral to specialized Neurogastroenterology center <br />
*Referral for the CT/MRI [[Electromyography]]<br />
*Referral for the abdominal biofeedback therapy)}}<br />
{{familytree/end}}<br />
<br />
==Treatment==<br />
Shown below is an algorithm summarizing the treatment of abdominal bloating according the the American College of Gastroenterology guidelines.<ref name="Schmulson Chang pp. 1071–1086">{{cite journal | last=Schmulson | first=M. | last2=Chang | first2=L. | title=Review article: the treatment of functional abdominal bloating and distension | journal=Alimentary Pharmacology & Therapeutics | publisher=Wiley | volume=33 | issue=10 | date=2011-03-29 | issn=0269-2813 | doi=10.1111/j.1365-2036.2011.04637.x | pages=1071–1086}}</ref><br />
{{familytree/start |summary=PE diagnosis Algorithm.}}<br />
{{familytree | | | | | | | | A01 |A01= Treatment of bloating is based on etiology of bloating.}} <br />
{{familytree | | | | | | | | |!| | | | | |}}<br />
{{familytree | | | | | | | |C01| | | | | |C01= Dietary changes are suggested for bloating <br />
*Diet<br />
*[[Exercise]] and [[posture]]<br />
*Over-the-counter medications<br />
*[[Probiotics]]<br />
*[[Antibiotics]]<br />
*Smooth muscle [[antispasmodics]]<br />
*Osmotic laxatives<br />
*Prokinetic agents<br />
*Chloride channel activators<br />
*[[Tricyclic antidepressants]]<br />
<br />
Are any warning signs present?<br />
*anemia,GI bleeding, weight loss>10% of the body weight, and family history of GI malignancy. }}<br />
{{familytree | | | | | | | | |!| | | | | | }}<br />
{{Family tree | | | | | |,|-|-|^|-|-|.| | }}<br />
{{Family tree | | | | | C01 | | | | C02 |C01= Yes| C02= No}}<br />
{{familytree | | | | | |!| | | | | |!| | | | }}<br />
{{familytree | | | | | |F01| | | |F02| | |F01= Treat accordingly<br><br />
*Labs<br />
*[[Endoscopy]]<br />
*Imaging|F02=Functional?}}<br />
{{familytree | | | | | | | | | | | | |!| | | }}<br />
{{familytree | | | | | | | | | | | | |!| | | | | | | }}<br />
{{familytree | | | |,|-|-|-|v|-|-|-|-|+|-|.| | }}<br />
{{familytree | | | |!| | | |!| | | | |!| |!| | }}<br />
{{familytree | | | D01 | | D02 | | D03 | | D04 | |D01=[[Constipation]]|D02=Functional dyspepsia|D03=Non-constipation IBS|D04=Bloating alone}}<br />
{{familytree | | | |`|-|-|-|^|-|-|+|-|-|-|-|-|'|}}<br />
{{familytree | | | | | | | | | | |!| | | | | | | | | }}<br />
{{familytree | | | | | | | | | | A02 | | | | | |A02= Lifestyle and nonspecific dietary advice.<br><br />
*Education about low FODMAP diet <br><ref name="Altobelli Del Negro Angeletti Latella p=940">{{cite journal | last=Altobelli | first=Emma | last2=Del Negro | first2=Valerio | last3=Angeletti | first3=Paolo | last4=Latella | first4=Giovanni | title=Low-FODMAP Diet Improves Irritable Bowel Syndrome Symptoms: A Meta-Analysis | journal=Nutrients | publisher=MDPI AG | volume=9 | issue=9 | date=2017-08-26 | issn=2072-6643 | doi=10.3390/nu9090940 | page=940}}</ref><br />
* Treat constipation aggressively and minimize bowel distention<br><br />
*Consider the use of [[Rifaximin]]<br />
*Consider probiotics, Psychological therapy, [[CBT]], and/or [[antidepressants]]<br><br />
*Consider Biodfeedback neuromodulation }}<br />
{{familytree/end}}<br />
<br />
==Do's==<br />
<br />
*Use of [[probiotics]] can help reduce [[bloating]].<br />
*Antidepressants can help to reduce the symptoms of [[IBS]] but the data is unclear over the reduction of bloating.<br />
*[[Hypnotherapy]] has been reported to be useful in reducing symptoms of bloating.<br />
*Bowel training and [[diaphragmatic breathing]] have been useful in the management of [[bloating]] however the data is unclear.<br />
<br />
==Don'ts==<br />
<br />
*Artificial sweeteners containing [[sorbitol]], [[mannitol]], [[xylitol]] should be avoided.<br />
*Medications ([[anticholinergics]], [[opiates]], [[calcium channel blockers]], antidepressants) should also be avoided as they have an effect on [[bloating]].<br />
*Twenty percent of [[carbohydrates]] in baked beans and 7–10% in [[wheat]], oats, potatoes, and corn, and 1% in white rice are not absorbed well in the [[intestine]] and they can produce [[bloating]].<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
[[Category:Projects]]<br />
[[Category:Resident survival guide]]<br />
[[Category:Gastroenterology]]</div>
Usmanaliakbar
https://www.wikidoc.org/index.php?title=Bloating_resident_survival_guide&diff=1690539
Bloating resident survival guide
2021-02-18T15:29:27Z
<p>Usmanaliakbar: /* Treatment */</p>
<hr />
<div>__NOTOC__<br />
<br />
{{CMG}} {{AE}} {{Usman Ali Akbar}}<br />
<br />
{{SK}}<br />
<br />
{| class="infobox" style="margin: 0 0 0 0; border: 0; float: right; width: 100px; background: #A8A8A8; position: fixed; top: 250px; right: 21px; border-radius: 0 0 10px 10px;" cellpadding="0" cellspacing="0" ;<br />
|-<br />
! style="padding: 0 5px; font-size: 85%; background: #A8A8A8" align="center" |{{fontcolor|#2B3B44|Bloating resident survival guide Microchapters}}<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Overview|Overview]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Causes|Causes]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#FIRE: Focused Initial Rapid Evaluation|FIRE]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Complete Diagnostic Approach|Diagnosis]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Treatment|Treatment]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Do's|Do's]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Don'ts|Don'ts]]<br />
|}<br />
<br />
==Overview==<br />
[[Bloating]] is one of the most common gastrointestinal complaints that is attributed by the patient as the subjective sensation of incorrectly perceived excess [[gas]]. There are multiple non-functional etiologies of abdominal bloating and distention. Primary functional abdominal distention (FABD) should be diagnosed as a single entity and it doesn't overlap with other functional gastrointestinal disorders. Rome IV diagnostic criteria mention the co-existence of mild abdominal pain and/or minor bowel movements. FABD can be treated with [[antispasmodic]] along with [[peppermint oil]] in [[randomized controlled trials]]. A stepwise approach is usually needed that counter the dietary interventions, [[microbiome]] modulation, and medical therapy in the management of FABD.<br />
<br />
==Causes==<br />
The causes of abdominal bloating are numerous and are managed according to the etiology.<ref name="Lacy Gabbard Crowell 2011 pp. 729–39">{{cite journal | last=Lacy | first=BE | last2=Gabbard | first2=SL | last3=Crowell | first3=MD | title=Pathophysiology, evaluation, and treatment of bloating: hope, hype, or hot air? | journal=Gastroenterology & hepatology | volume=7 | issue=11 | year=2011 | issn=1554-7914 | pmid=22298969 | pmc=3264926 | pages=729–39}}</ref><br />
<br />
*<br />
<br />
{| class="wikitable"<br />
|+<br />
Causes of Abdominal Bloating<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Intestinal Disorders<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Motility Disorders<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Malabsorption disorders<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Infectious causes<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Dietary causes<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Misc.<br />
|-<br />
|[[Adhesions]]<br />
[[Malignancy]]<br />
|[[Diabetes]]<br />
<br />
[[Scleroderma]]<br />
<br />
Pseudo-obstruction<br />
<br />
Medications<br />
|[[Lactose intolerance]]<br />
[[Fructose intolerance]]<br />
<br />
[[Celiac disease]]<br />
<br />
[[Pancreatic insufficiency]]<br />
|[[Small intestinal bacterial overgrowth]]<br />
[[Giardiasis]]<br />
|Gas-producing foods<br />
FODMAPs<br />
|[[Irritable bowel syndrome]] <br /><br />
|}<br />
<br />
*<br />
<br />
==Complete Diagnostic Approach==<br />
Shown below is an algorithm summarizing the diagnosis of abdominal bloating according to American College of Gastroenterology guidelines.<ref name="Foley Burgell Barrett Gibson 2014 pp. 561–571">{{cite journal | last=Foley | first=A | last2=Burgell | first2=R | last3=Barrett | first3=JS | last4=Gibson | first4=PR | title=Management Strategies for Abdominal Bloating and Distension | journal=Gastroenterology & Hepatology | volume=10 | issue=9 | year=2014 | pmid=27551250 | pmc=4991532 | pages=561–571}}</ref><ref name="Lacy Cangemi Vazquez-Roque 2021 pp. 219–231.e1">{{cite journal | last=Lacy | first=Brian E. | last2=Cangemi | first2=David | last3=Vazquez-Roque | first3=Maria | title=Management of Chronic Abdominal Distension and Bloating | journal=Clinical Gastroenterology and Hepatology | publisher=Elsevier BV | volume=19 | issue=2 | year=2021 | issn=1542-3565 | doi=10.1016/j.cgh.2020.03.056 | pages=219–231.e1}}</ref><br />
{{familytree/start |summary=PE diagnosis Algorithm.}}<br />
{{familytree | | | | A01 | | | A01= Patient with abdominal bloating and Distention }}<br />
{{familytree | | | | |!| | | | }}<br />
{{familytree | | | | B01 | | | B01= Look for the <br><br />
* Alarm signs<br />
*Overlapping functional gastrointestinal disorders<br />
*[[Bacterial overgrowth]] (Small intestine bacterial overgrowth)<br />
* Dietary intolerances<br />
*[[Celiac Disease]]<br />
* Weight gain <br />
*[[Constipation]] <br />
*[[Hydrogen breath test]] <br />
*Any pyschological comorbidities}}<br />
{{familytree | | |,|-|^|-|.| | }}<br />
{{familytree | | C01 | | C02 | C01= Yes | C02=No}}<br />
{{familytree | | |!| | | |!| | }}<br />
{{familytree | | C01 | | C02 | C01=<br />
* Reassurance the patient, recommend [[diaphragmatic breathing]]<br />
*Diet intervention: Low FODMAP diet <br />
*Iniate sympotmatic treatment such as [[peppermint oil]] or [[Simethicone]] | C02= Treat Accordingly}}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= *Trial of [[Rifaximin]]/[[Probiotics]] }}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= No Response }}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= [[Antidepressants]]<br />
*[[Psychological therapy]]<br />
*Hypnotherapy, [[Cognitive behavioral therapy]] (CBT)}}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= No Response }}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= <br />
*Referral to specialized Neurogastroenterology center <br />
*Referral for the CT/MRI [[Electromyography]]<br />
*Referral for the abdominal biofeedback therapy)}}<br />
{{familytree/end}}<br />
<br />
==Treatment==<br />
Shown below is an algorithm summarizing the treatment of abdominal bloating according the the American College of Gastroenterology guidelines.<ref name="Schmulson Chang pp. 1071–1086">{{cite journal | last=Schmulson | first=M. | last2=Chang | first2=L. | title=Review article: the treatment of functional abdominal bloating and distension | journal=Alimentary Pharmacology & Therapeutics | publisher=Wiley | volume=33 | issue=10 | date=2011-03-29 | issn=0269-2813 | doi=10.1111/j.1365-2036.2011.04637.x | pages=1071–1086}}</ref><br />
{{familytree/start |summary=PE diagnosis Algorithm.}}<br />
{{familytree | | | | | | | | A01 |A01= Treatment of bloating is based on etiology of bloating.}} <br />
{{familytree | | | | | | | | |!| | | | | |}}<br />
{{familytree | | | | | | | |C01| | | | | |C01= Dietary changes are suggested for bloating <br />
*Diet<br />
*[[Exercise]] and [[posture]]<br />
*Over-the-counter medications<br />
*[[Probiotics]]<br />
*[[Antibiotics]]<br />
*Smooth muscle [[antispasmodics]]<br />
*Osmotic laxatives<br />
*Prokinetic agents<br />
*Chloride channel activators<br />
*[[Tricyclic antidepressants]]<br />
<br />
Are any warning signs present?<br />
*anemia,GI bleeding, weight loss>10% of the body weight, and family history of GI malignancy. }}<br />
{{familytree | | | | | | | | |!| | | | | | }}<br />
{{Family tree | | | | | |,|-|-|^|-|-|.| | }}<br />
{{Family tree | | | | | C01 | | | | C02 |C01= Yes| C02= No}}<br />
{{familytree | | | | | |!| | | | | |!| | | | }}<br />
{{familytree | | | | | |F01| | | |F02| | |F01= Treat accordingly<br><br />
*Labs<br />
*[[Endoscopy]]<br />
*Imaging|F02=Functional?}}<br />
{{familytree | | | | | | | | | | | | |!| | | }}<br />
{{familytree | | | | | | | | | | | | |!| | | | | | | }}<br />
{{familytree | | | |,|-|-|-|v|-|-|-|-|+|-|.| | }}<br />
{{familytree | | | |!| | | |!| | | | |!| |!| | }}<br />
{{familytree | | | D01 | | D02 | | D03 | | D04 | |D01=[[Constipation]]|D02=Functional dyspepsia|D03=Non-constipation IBS|D04=Bloating alone}}<br />
{{familytree | | | |`|-|-|-|^|-|-|+|-|-|-|-|-|'|}}<br />
{{familytree | | | | | | | | | | |!| | | | | | | | | }}<br />
{{familytree | | | | | | | | | | A02 | | | | | |A02= Lifestyle and nonspecific dietary advice.<br><br />
*Education about low FODMAP diet <br><br />
* Treat constipation aggressively and minimize bowel distention<br><br />
*Consider the use of [[Rifaximin]]<br />
*Consider probiotics, Psychological therapy, [[CBT]], and/or [[antidepressants]]<br><br />
*Consider Biodfeedback neuromodulation }}<br />
{{familytree/end}}<br />
<br />
==Do's==<br />
<br />
*Use of [[probiotics]] can help reduce [[bloating]].<br />
*Antidepressants can help to reduce the symptoms of [[IBS]] but the data is unclear over the reduction of bloating.<br />
*[[Hypnotherapy]] has been reported to be useful in reducing symptoms of bloating.<br />
*Bowel training and [[diaphragmatic breathing]] have been useful in the management of [[bloating]] however the data is unclear.<br />
<br />
==Don'ts==<br />
<br />
*Artificial sweeteners containing [[sorbitol]], [[mannitol]], [[xylitol]] should be avoided.<br />
*Medications ([[anticholinergics]], [[opiates]], [[calcium channel blockers]], antidepressants) should also be avoided as they have an effect on [[bloating]].<br />
*Twenty percent of [[carbohydrates]] in baked beans and 7–10% in [[wheat]], oats, potatoes, and corn, and 1% in white rice are not absorbed well in the [[intestine]] and they can produce [[bloating]].<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
[[Category:Projects]]<br />
[[Category:Resident survival guide]]<br />
[[Category:Gastroenterology]]</div>
Usmanaliakbar
https://www.wikidoc.org/index.php?title=Bloating_resident_survival_guide&diff=1690538
Bloating resident survival guide
2021-02-18T15:28:41Z
<p>Usmanaliakbar: /* Complete Diagnostic Approach */</p>
<hr />
<div>__NOTOC__<br />
<br />
{{CMG}} {{AE}} {{Usman Ali Akbar}}<br />
<br />
{{SK}}<br />
<br />
{| class="infobox" style="margin: 0 0 0 0; border: 0; float: right; width: 100px; background: #A8A8A8; position: fixed; top: 250px; right: 21px; border-radius: 0 0 10px 10px;" cellpadding="0" cellspacing="0" ;<br />
|-<br />
! style="padding: 0 5px; font-size: 85%; background: #A8A8A8" align="center" |{{fontcolor|#2B3B44|Bloating resident survival guide Microchapters}}<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Overview|Overview]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Causes|Causes]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#FIRE: Focused Initial Rapid Evaluation|FIRE]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Complete Diagnostic Approach|Diagnosis]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Treatment|Treatment]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Do's|Do's]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Don'ts|Don'ts]]<br />
|}<br />
<br />
==Overview==<br />
[[Bloating]] is one of the most common gastrointestinal complaints that is attributed by the patient as the subjective sensation of incorrectly perceived excess [[gas]]. There are multiple non-functional etiologies of abdominal bloating and distention. Primary functional abdominal distention (FABD) should be diagnosed as a single entity and it doesn't overlap with other functional gastrointestinal disorders. Rome IV diagnostic criteria mention the co-existence of mild abdominal pain and/or minor bowel movements. FABD can be treated with [[antispasmodic]] along with [[peppermint oil]] in [[randomized controlled trials]]. A stepwise approach is usually needed that counter the dietary interventions, [[microbiome]] modulation, and medical therapy in the management of FABD.<br />
<br />
==Causes==<br />
The causes of abdominal bloating are numerous and are managed according to the etiology.<ref name="Lacy Gabbard Crowell 2011 pp. 729–39">{{cite journal | last=Lacy | first=BE | last2=Gabbard | first2=SL | last3=Crowell | first3=MD | title=Pathophysiology, evaluation, and treatment of bloating: hope, hype, or hot air? | journal=Gastroenterology & hepatology | volume=7 | issue=11 | year=2011 | issn=1554-7914 | pmid=22298969 | pmc=3264926 | pages=729–39}}</ref><br />
<br />
*<br />
<br />
{| class="wikitable"<br />
|+<br />
Causes of Abdominal Bloating<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Intestinal Disorders<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Motility Disorders<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Malabsorption disorders<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Infectious causes<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Dietary causes<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Misc.<br />
|-<br />
|[[Adhesions]]<br />
[[Malignancy]]<br />
|[[Diabetes]]<br />
<br />
[[Scleroderma]]<br />
<br />
Pseudo-obstruction<br />
<br />
Medications<br />
|[[Lactose intolerance]]<br />
[[Fructose intolerance]]<br />
<br />
[[Celiac disease]]<br />
<br />
[[Pancreatic insufficiency]]<br />
|[[Small intestinal bacterial overgrowth]]<br />
[[Giardiasis]]<br />
|Gas-producing foods<br />
FODMAPs<br />
|[[Irritable bowel syndrome]] <br /><br />
|}<br />
<br />
*<br />
<br />
==Complete Diagnostic Approach==<br />
Shown below is an algorithm summarizing the diagnosis of abdominal bloating according to American College of Gastroenterology guidelines.<ref name="Foley Burgell Barrett Gibson 2014 pp. 561–571">{{cite journal | last=Foley | first=A | last2=Burgell | first2=R | last3=Barrett | first3=JS | last4=Gibson | first4=PR | title=Management Strategies for Abdominal Bloating and Distension | journal=Gastroenterology & Hepatology | volume=10 | issue=9 | year=2014 | pmid=27551250 | pmc=4991532 | pages=561–571}}</ref><ref name="Lacy Cangemi Vazquez-Roque 2021 pp. 219–231.e1">{{cite journal | last=Lacy | first=Brian E. | last2=Cangemi | first2=David | last3=Vazquez-Roque | first3=Maria | title=Management of Chronic Abdominal Distension and Bloating | journal=Clinical Gastroenterology and Hepatology | publisher=Elsevier BV | volume=19 | issue=2 | year=2021 | issn=1542-3565 | doi=10.1016/j.cgh.2020.03.056 | pages=219–231.e1}}</ref><br />
{{familytree/start |summary=PE diagnosis Algorithm.}}<br />
{{familytree | | | | A01 | | | A01= Patient with abdominal bloating and Distention }}<br />
{{familytree | | | | |!| | | | }}<br />
{{familytree | | | | B01 | | | B01= Look for the <br><br />
* Alarm signs<br />
*Overlapping functional gastrointestinal disorders<br />
*[[Bacterial overgrowth]] (Small intestine bacterial overgrowth)<br />
* Dietary intolerances<br />
*[[Celiac Disease]]<br />
* Weight gain <br />
*[[Constipation]] <br />
*[[Hydrogen breath test]] <br />
*Any pyschological comorbidities}}<br />
{{familytree | | |,|-|^|-|.| | }}<br />
{{familytree | | C01 | | C02 | C01= Yes | C02=No}}<br />
{{familytree | | |!| | | |!| | }}<br />
{{familytree | | C01 | | C02 | C01=<br />
* Reassurance the patient, recommend [[diaphragmatic breathing]]<br />
*Diet intervention: Low FODMAP diet <br />
*Iniate sympotmatic treatment such as [[peppermint oil]] or [[Simethicone]] | C02= Treat Accordingly}}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= *Trial of [[Rifaximin]]/[[Probiotics]] }}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= No Response }}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= [[Antidepressants]]<br />
*[[Psychological therapy]]<br />
*Hypnotherapy, [[Cognitive behavioral therapy]] (CBT)}}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= No Response }}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= <br />
*Referral to specialized Neurogastroenterology center <br />
*Referral for the CT/MRI [[Electromyography]]<br />
*Referral for the abdominal biofeedback therapy)}}<br />
{{familytree/end}}<br />
<br />
==Treatment==<br />
Shown below is an algorithm summarizing the treatment of abdominal bloating according the the American College of Gastroenterology guidelines.<br />
{{familytree/start |summary=PE diagnosis Algorithm.}}<br />
{{familytree | | | | | | | | A01 |A01= Treatment of bloating is based on etiology of bloating.}} <br />
{{familytree | | | | | | | | |!| | | | | |}}<br />
{{familytree | | | | | | | |C01| | | | | |C01= Dietary changes are suggested for bloating <br />
*Diet<br />
*[[Exercise]] and [[posture]]<br />
*Over-the-counter medications<br />
*[[Probiotics]]<br />
*[[Antibiotics]]<br />
*Smooth muscle [[antispasmodics]]<br />
*Osmotic laxatives<br />
*Prokinetic agents<br />
*Chloride channel activators<br />
*[[Tricyclic antidepressants]]<br />
<br />
Are any warning signs present?<br />
*anemia,GI bleeding, weight loss>10% of the body weight, and family history of GI malignancy. }}<br />
{{familytree | | | | | | | | |!| | | | | | }}<br />
{{Family tree | | | | | |,|-|-|^|-|-|.| | }}<br />
{{Family tree | | | | | C01 | | | | C02 |C01= Yes| C02= No}}<br />
{{familytree | | | | | |!| | | | | |!| | | | }}<br />
{{familytree | | | | | |F01| | | |F02| | |F01= Treat accordingly<br><br />
*Labs<br />
*[[Endoscopy]]<br />
*Imaging|F02=Functional?}}<br />
{{familytree | | | | | | | | | | | | |!| | | }}<br />
{{familytree | | | | | | | | | | | | |!| | | | | | | }}<br />
{{familytree | | | |,|-|-|-|v|-|-|-|-|+|-|.| | }}<br />
{{familytree | | | |!| | | |!| | | | |!| |!| | }}<br />
{{familytree | | | D01 | | D02 | | D03 | | D04 | |D01=[[Constipation]]|D02=Functional dyspepsia|D03=Non-constipation IBS|D04=Bloating alone}}<br />
{{familytree | | | |`|-|-|-|^|-|-|+|-|-|-|-|-|'|}}<br />
{{familytree | | | | | | | | | | |!| | | | | | | | | }}<br />
{{familytree | | | | | | | | | | A02 | | | | | |A02= Lifestyle and nonspecific dietary advice.<br><br />
*Education about low FODMAP diet <br><br />
* Treat constipation aggressively and minimize bowel distention<br><br />
*Consider the use of [[Rifaximin]]<br />
*Consider probiotics, Psychological therapy, [[CBT]], and/or [[antidepressants]]<br><br />
*Consider Biodfeedback neuromodulation }}<br />
{{familytree/end}}<br />
<br />
==Do's==<br />
<br />
*Use of [[probiotics]] can help reduce [[bloating]].<br />
*Antidepressants can help to reduce the symptoms of [[IBS]] but the data is unclear over the reduction of bloating.<br />
*[[Hypnotherapy]] has been reported to be useful in reducing symptoms of bloating.<br />
*Bowel training and [[diaphragmatic breathing]] have been useful in the management of [[bloating]] however the data is unclear.<br />
<br />
==Don'ts==<br />
<br />
*Artificial sweeteners containing [[sorbitol]], [[mannitol]], [[xylitol]] should be avoided.<br />
*Medications ([[anticholinergics]], [[opiates]], [[calcium channel blockers]], antidepressants) should also be avoided as they have an effect on [[bloating]].<br />
*Twenty percent of [[carbohydrates]] in baked beans and 7–10% in [[wheat]], oats, potatoes, and corn, and 1% in white rice are not absorbed well in the [[intestine]] and they can produce [[bloating]].<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
[[Category:Projects]]<br />
[[Category:Resident survival guide]]<br />
[[Category:Gastroenterology]]</div>
Usmanaliakbar
https://www.wikidoc.org/index.php?title=Bloating_resident_survival_guide&diff=1690537
Bloating resident survival guide
2021-02-18T15:28:02Z
<p>Usmanaliakbar: /* Complete Diagnostic Approach */</p>
<hr />
<div>__NOTOC__<br />
<br />
{{CMG}} {{AE}} {{Usman Ali Akbar}}<br />
<br />
{{SK}}<br />
<br />
{| class="infobox" style="margin: 0 0 0 0; border: 0; float: right; width: 100px; background: #A8A8A8; position: fixed; top: 250px; right: 21px; border-radius: 0 0 10px 10px;" cellpadding="0" cellspacing="0" ;<br />
|-<br />
! style="padding: 0 5px; font-size: 85%; background: #A8A8A8" align="center" |{{fontcolor|#2B3B44|Bloating resident survival guide Microchapters}}<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Overview|Overview]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Causes|Causes]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#FIRE: Focused Initial Rapid Evaluation|FIRE]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Complete Diagnostic Approach|Diagnosis]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Treatment|Treatment]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Do's|Do's]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Don'ts|Don'ts]]<br />
|}<br />
<br />
==Overview==<br />
[[Bloating]] is one of the most common gastrointestinal complaints that is attributed by the patient as the subjective sensation of incorrectly perceived excess [[gas]]. There are multiple non-functional etiologies of abdominal bloating and distention. Primary functional abdominal distention (FABD) should be diagnosed as a single entity and it doesn't overlap with other functional gastrointestinal disorders. Rome IV diagnostic criteria mention the co-existence of mild abdominal pain and/or minor bowel movements. FABD can be treated with [[antispasmodic]] along with [[peppermint oil]] in [[randomized controlled trials]]. A stepwise approach is usually needed that counter the dietary interventions, [[microbiome]] modulation, and medical therapy in the management of FABD.<br />
<br />
==Causes==<br />
The causes of abdominal bloating are numerous and are managed according to the etiology.<ref name="Lacy Gabbard Crowell 2011 pp. 729–39">{{cite journal | last=Lacy | first=BE | last2=Gabbard | first2=SL | last3=Crowell | first3=MD | title=Pathophysiology, evaluation, and treatment of bloating: hope, hype, or hot air? | journal=Gastroenterology & hepatology | volume=7 | issue=11 | year=2011 | issn=1554-7914 | pmid=22298969 | pmc=3264926 | pages=729–39}}</ref><br />
<br />
*<br />
<br />
{| class="wikitable"<br />
|+<br />
Causes of Abdominal Bloating<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Intestinal Disorders<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Motility Disorders<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Malabsorption disorders<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Infectious causes<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Dietary causes<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Misc.<br />
|-<br />
|[[Adhesions]]<br />
[[Malignancy]]<br />
|[[Diabetes]]<br />
<br />
[[Scleroderma]]<br />
<br />
Pseudo-obstruction<br />
<br />
Medications<br />
|[[Lactose intolerance]]<br />
[[Fructose intolerance]]<br />
<br />
[[Celiac disease]]<br />
<br />
[[Pancreatic insufficiency]]<br />
|[[Small intestinal bacterial overgrowth]]<br />
[[Giardiasis]]<br />
|Gas-producing foods<br />
FODMAPs<br />
|[[Irritable bowel syndrome]] <br /><br />
|}<br />
<br />
*<br />
<br />
==Complete Diagnostic Approach==<br />
Shown below is an algorithm summarizing the diagnosis of abdominal bloating according to American College of Gastroenterology guidelines.<ref name="Foley Burgell Barrett Gibson 2014 pp. 561–571">{{cite journal | last=Foley | first=A | last2=Burgell | first2=R | last3=Barrett | first3=JS | last4=Gibson | first4=PR | title=Management Strategies for Abdominal Bloating and Distension | journal=Gastroenterology & Hepatology | volume=10 | issue=9 | year=2014 | pmid=27551250 | pmc=4991532 | pages=561–571}}</ref><br />
{{familytree/start |summary=PE diagnosis Algorithm.}}<br />
{{familytree | | | | A01 | | | A01= Patient with abdominal bloating and Distention }}<br />
{{familytree | | | | |!| | | | }}<br />
{{familytree | | | | B01 | | | B01= Look for the <br><br />
* Alarm signs<br />
*Overlapping functional gastrointestinal disorders<br />
*[[Bacterial overgrowth]] (Small intestine bacterial overgrowth)<br />
* Dietary intolerances<br />
*[[Celiac Disease]]<br />
* Weight gain <br />
*[[Constipation]] <br />
*[[Hydrogen breath test]] <br />
*Any pyschological comorbidities}}<br />
{{familytree | | |,|-|^|-|.| | }}<br />
{{familytree | | C01 | | C02 | C01= Yes | C02=No}}<br />
{{familytree | | |!| | | |!| | }}<br />
{{familytree | | C01 | | C02 | C01=<br />
* Reassurance the patient, recommend [[diaphragmatic breathing]]<br />
*Diet intervention: Low FODMAP diet <br />
*Iniate sympotmatic treatment such as [[peppermint oil]] or [[Simethicone]] | C02= Treat Accordingly}}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= *Trial of [[Rifaximin]]/[[Probiotics]] }}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= No Response }}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= [[Antidepressants]]<br />
*[[Psychological therapy]]<br />
*Hypnotherapy, [[Cognitive behavioral therapy]] (CBT)}}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= No Response }}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= <br />
*Referral to specialized Neurogastroenterology center <br />
*Referral for the CT/MRI [[Electromyography]]<br />
*Referral for the abdominal biofeedback therapy)}}<br />
{{familytree/end}}<br />
<br />
==Treatment==<br />
Shown below is an algorithm summarizing the treatment of abdominal bloating according the the American College of Gastroenterology guidelines.<br />
{{familytree/start |summary=PE diagnosis Algorithm.}}<br />
{{familytree | | | | | | | | A01 |A01= Treatment of bloating is based on etiology of bloating.}} <br />
{{familytree | | | | | | | | |!| | | | | |}}<br />
{{familytree | | | | | | | |C01| | | | | |C01= Dietary changes are suggested for bloating <br />
*Diet<br />
*[[Exercise]] and [[posture]]<br />
*Over-the-counter medications<br />
*[[Probiotics]]<br />
*[[Antibiotics]]<br />
*Smooth muscle [[antispasmodics]]<br />
*Osmotic laxatives<br />
*Prokinetic agents<br />
*Chloride channel activators<br />
*[[Tricyclic antidepressants]]<br />
<br />
Are any warning signs present?<br />
*anemia,GI bleeding, weight loss>10% of the body weight, and family history of GI malignancy. }}<br />
{{familytree | | | | | | | | |!| | | | | | }}<br />
{{Family tree | | | | | |,|-|-|^|-|-|.| | }}<br />
{{Family tree | | | | | C01 | | | | C02 |C01= Yes| C02= No}}<br />
{{familytree | | | | | |!| | | | | |!| | | | }}<br />
{{familytree | | | | | |F01| | | |F02| | |F01= Treat accordingly<br><br />
*Labs<br />
*[[Endoscopy]]<br />
*Imaging|F02=Functional?}}<br />
{{familytree | | | | | | | | | | | | |!| | | }}<br />
{{familytree | | | | | | | | | | | | |!| | | | | | | }}<br />
{{familytree | | | |,|-|-|-|v|-|-|-|-|+|-|.| | }}<br />
{{familytree | | | |!| | | |!| | | | |!| |!| | }}<br />
{{familytree | | | D01 | | D02 | | D03 | | D04 | |D01=[[Constipation]]|D02=Functional dyspepsia|D03=Non-constipation IBS|D04=Bloating alone}}<br />
{{familytree | | | |`|-|-|-|^|-|-|+|-|-|-|-|-|'|}}<br />
{{familytree | | | | | | | | | | |!| | | | | | | | | }}<br />
{{familytree | | | | | | | | | | A02 | | | | | |A02= Lifestyle and nonspecific dietary advice.<br><br />
*Education about low FODMAP diet <br><br />
* Treat constipation aggressively and minimize bowel distention<br><br />
*Consider the use of [[Rifaximin]]<br />
*Consider probiotics, Psychological therapy, [[CBT]], and/or [[antidepressants]]<br><br />
*Consider Biodfeedback neuromodulation }}<br />
{{familytree/end}}<br />
<br />
==Do's==<br />
<br />
*Use of [[probiotics]] can help reduce [[bloating]].<br />
*Antidepressants can help to reduce the symptoms of [[IBS]] but the data is unclear over the reduction of bloating.<br />
*[[Hypnotherapy]] has been reported to be useful in reducing symptoms of bloating.<br />
*Bowel training and [[diaphragmatic breathing]] have been useful in the management of [[bloating]] however the data is unclear.<br />
<br />
==Don'ts==<br />
<br />
*Artificial sweeteners containing [[sorbitol]], [[mannitol]], [[xylitol]] should be avoided.<br />
*Medications ([[anticholinergics]], [[opiates]], [[calcium channel blockers]], antidepressants) should also be avoided as they have an effect on [[bloating]].<br />
*Twenty percent of [[carbohydrates]] in baked beans and 7–10% in [[wheat]], oats, potatoes, and corn, and 1% in white rice are not absorbed well in the [[intestine]] and they can produce [[bloating]].<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
[[Category:Projects]]<br />
[[Category:Resident survival guide]]<br />
[[Category:Gastroenterology]]</div>
Usmanaliakbar
https://www.wikidoc.org/index.php?title=Bloating_resident_survival_guide&diff=1690536
Bloating resident survival guide
2021-02-18T15:27:21Z
<p>Usmanaliakbar: /* Complete Diagnostic Approach */</p>
<hr />
<div>__NOTOC__<br />
<br />
{{CMG}} {{AE}} {{Usman Ali Akbar}}<br />
<br />
{{SK}}<br />
<br />
{| class="infobox" style="margin: 0 0 0 0; border: 0; float: right; width: 100px; background: #A8A8A8; position: fixed; top: 250px; right: 21px; border-radius: 0 0 10px 10px;" cellpadding="0" cellspacing="0" ;<br />
|-<br />
! style="padding: 0 5px; font-size: 85%; background: #A8A8A8" align="center" |{{fontcolor|#2B3B44|Bloating resident survival guide Microchapters}}<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Overview|Overview]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Causes|Causes]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#FIRE: Focused Initial Rapid Evaluation|FIRE]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Complete Diagnostic Approach|Diagnosis]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Treatment|Treatment]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Do's|Do's]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Don'ts|Don'ts]]<br />
|}<br />
<br />
==Overview==<br />
[[Bloating]] is one of the most common gastrointestinal complaints that is attributed by the patient as the subjective sensation of incorrectly perceived excess [[gas]]. There are multiple non-functional etiologies of abdominal bloating and distention. Primary functional abdominal distention (FABD) should be diagnosed as a single entity and it doesn't overlap with other functional gastrointestinal disorders. Rome IV diagnostic criteria mention the co-existence of mild abdominal pain and/or minor bowel movements. FABD can be treated with [[antispasmodic]] along with [[peppermint oil]] in [[randomized controlled trials]]. A stepwise approach is usually needed that counter the dietary interventions, [[microbiome]] modulation, and medical therapy in the management of FABD.<br />
<br />
==Causes==<br />
The causes of abdominal bloating are numerous and are managed according to the etiology.<ref name="Lacy Gabbard Crowell 2011 pp. 729–39">{{cite journal | last=Lacy | first=BE | last2=Gabbard | first2=SL | last3=Crowell | first3=MD | title=Pathophysiology, evaluation, and treatment of bloating: hope, hype, or hot air? | journal=Gastroenterology & hepatology | volume=7 | issue=11 | year=2011 | issn=1554-7914 | pmid=22298969 | pmc=3264926 | pages=729–39}}</ref><br />
<br />
*<br />
<br />
{| class="wikitable"<br />
|+<br />
Causes of Abdominal Bloating<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Intestinal Disorders<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Motility Disorders<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Malabsorption disorders<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Infectious causes<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Dietary causes<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Misc.<br />
|-<br />
|[[Adhesions]]<br />
[[Malignancy]]<br />
|[[Diabetes]]<br />
<br />
[[Scleroderma]]<br />
<br />
Pseudo-obstruction<br />
<br />
Medications<br />
|[[Lactose intolerance]]<br />
[[Fructose intolerance]]<br />
<br />
[[Celiac disease]]<br />
<br />
[[Pancreatic insufficiency]]<br />
|[[Small intestinal bacterial overgrowth]]<br />
[[Giardiasis]]<br />
|Gas-producing foods<br />
FODMAPs<br />
|[[Irritable bowel syndrome]] <br /><br />
|}<br />
<br />
*<br />
<br />
==Complete Diagnostic Approach==<br />
Shown below is an algorithm summarizing the diagnosis of abdominal bloating according to American College of Gastroenterology guidelines.<br />
{{familytree/start |summary=PE diagnosis Algorithm.}}<br />
{{familytree | | | | A01 | | | A01= Patient with abdominal bloating and Distention }}<br />
{{familytree | | | | |!| | | | }}<br />
{{familytree | | | | B01 | | | B01= Look for the <br><br />
* Alarm signs<br />
*Overlapping functional gastrointestinal disorders<br />
*[[Bacterial overgrowth]] (Small intestine bacterial overgrowth)<br />
* Dietary intolerances<br />
*[[Celiac Disease]]<br />
* Weight gain <br />
*[[Constipation]] <br />
*[[Hydrogen breath test]] <br />
*Any pyschological comorbidities}}<br />
{{familytree | | |,|-|^|-|.| | }}<br />
{{familytree | | C01 | | C02 | C01= Yes | C02=No}}<br />
{{familytree | | |!| | | |!| | }}<br />
{{familytree | | C01 | | C02 | C01=<br />
* Reassurance the patient, recommend [[diaphragmatic breathing]]<br />
*Diet intervention: Low FODMAP diet <br />
*Iniate sympotmatic treatment such as [[peppermint oil]] or [[Simethicone]] | C02= Treat Accordingly}}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= *Trial of [[Rifaximin]]/[[Probiotics]] }}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= No Response }}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= [[Antidepressants]]<br />
*[[Psychological therapy]]<br />
*Hypnotherapy, [[Cognitive behavioral therapy]] (CBT)}}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= No Response }}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= <br />
*Referral to specialized Neurogastroenterology center <br />
*Referral for the CT/MRI [[Electromyography]]<br />
*Referral for the abdominal biofeedback therapy)}}<br />
{{familytree/end}}<br />
<br />
==Treatment==<br />
Shown below is an algorithm summarizing the treatment of abdominal bloating according the the American College of Gastroenterology guidelines.<br />
{{familytree/start |summary=PE diagnosis Algorithm.}}<br />
{{familytree | | | | | | | | A01 |A01= Treatment of bloating is based on etiology of bloating.}} <br />
{{familytree | | | | | | | | |!| | | | | |}}<br />
{{familytree | | | | | | | |C01| | | | | |C01= Dietary changes are suggested for bloating <br />
*Diet<br />
*[[Exercise]] and [[posture]]<br />
*Over-the-counter medications<br />
*[[Probiotics]]<br />
*[[Antibiotics]]<br />
*Smooth muscle [[antispasmodics]]<br />
*Osmotic laxatives<br />
*Prokinetic agents<br />
*Chloride channel activators<br />
*[[Tricyclic antidepressants]]<br />
<br />
Are any warning signs present?<br />
*anemia,GI bleeding, weight loss>10% of the body weight, and family history of GI malignancy. }}<br />
{{familytree | | | | | | | | |!| | | | | | }}<br />
{{Family tree | | | | | |,|-|-|^|-|-|.| | }}<br />
{{Family tree | | | | | C01 | | | | C02 |C01= Yes| C02= No}}<br />
{{familytree | | | | | |!| | | | | |!| | | | }}<br />
{{familytree | | | | | |F01| | | |F02| | |F01= Treat accordingly<br><br />
*Labs<br />
*[[Endoscopy]]<br />
*Imaging|F02=Functional?}}<br />
{{familytree | | | | | | | | | | | | |!| | | }}<br />
{{familytree | | | | | | | | | | | | |!| | | | | | | }}<br />
{{familytree | | | |,|-|-|-|v|-|-|-|-|+|-|.| | }}<br />
{{familytree | | | |!| | | |!| | | | |!| |!| | }}<br />
{{familytree | | | D01 | | D02 | | D03 | | D04 | |D01=[[Constipation]]|D02=Functional dyspepsia|D03=Non-constipation IBS|D04=Bloating alone}}<br />
{{familytree | | | |`|-|-|-|^|-|-|+|-|-|-|-|-|'|}}<br />
{{familytree | | | | | | | | | | |!| | | | | | | | | }}<br />
{{familytree | | | | | | | | | | A02 | | | | | |A02= Lifestyle and nonspecific dietary advice.<br><br />
*Education about low FODMAP diet <br><br />
* Treat constipation aggressively and minimize bowel distention<br><br />
*Consider the use of [[Rifaximin]]<br />
*Consider probiotics, Psychological therapy, [[CBT]], and/or [[antidepressants]]<br><br />
*Consider Biodfeedback neuromodulation }}<br />
{{familytree/end}}<br />
<br />
==Do's==<br />
<br />
*Use of [[probiotics]] can help reduce [[bloating]].<br />
*Antidepressants can help to reduce the symptoms of [[IBS]] but the data is unclear over the reduction of bloating.<br />
*[[Hypnotherapy]] has been reported to be useful in reducing symptoms of bloating.<br />
*Bowel training and [[diaphragmatic breathing]] have been useful in the management of [[bloating]] however the data is unclear.<br />
<br />
==Don'ts==<br />
<br />
*Artificial sweeteners containing [[sorbitol]], [[mannitol]], [[xylitol]] should be avoided.<br />
*Medications ([[anticholinergics]], [[opiates]], [[calcium channel blockers]], antidepressants) should also be avoided as they have an effect on [[bloating]].<br />
*Twenty percent of [[carbohydrates]] in baked beans and 7–10% in [[wheat]], oats, potatoes, and corn, and 1% in white rice are not absorbed well in the [[intestine]] and they can produce [[bloating]].<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
[[Category:Projects]]<br />
[[Category:Resident survival guide]]<br />
[[Category:Gastroenterology]]</div>
Usmanaliakbar
https://www.wikidoc.org/index.php?title=Bloating_resident_survival_guide&diff=1690535
Bloating resident survival guide
2021-02-18T15:26:50Z
<p>Usmanaliakbar: /* Treatment */</p>
<hr />
<div>__NOTOC__<br />
<br />
{{CMG}} {{AE}} {{Usman Ali Akbar}}<br />
<br />
{{SK}}<br />
<br />
{| class="infobox" style="margin: 0 0 0 0; border: 0; float: right; width: 100px; background: #A8A8A8; position: fixed; top: 250px; right: 21px; border-radius: 0 0 10px 10px;" cellpadding="0" cellspacing="0" ;<br />
|-<br />
! style="padding: 0 5px; font-size: 85%; background: #A8A8A8" align="center" |{{fontcolor|#2B3B44|Bloating resident survival guide Microchapters}}<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Overview|Overview]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Causes|Causes]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#FIRE: Focused Initial Rapid Evaluation|FIRE]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Complete Diagnostic Approach|Diagnosis]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Treatment|Treatment]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Do's|Do's]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Don'ts|Don'ts]]<br />
|}<br />
<br />
==Overview==<br />
[[Bloating]] is one of the most common gastrointestinal complaints that is attributed by the patient as the subjective sensation of incorrectly perceived excess [[gas]]. There are multiple non-functional etiologies of abdominal bloating and distention. Primary functional abdominal distention (FABD) should be diagnosed as a single entity and it doesn't overlap with other functional gastrointestinal disorders. Rome IV diagnostic criteria mention the co-existence of mild abdominal pain and/or minor bowel movements. FABD can be treated with [[antispasmodic]] along with [[peppermint oil]] in [[randomized controlled trials]]. A stepwise approach is usually needed that counter the dietary interventions, [[microbiome]] modulation, and medical therapy in the management of FABD.<br />
<br />
==Causes==<br />
The causes of abdominal bloating are numerous and are managed according to the etiology.<ref name="Lacy Gabbard Crowell 2011 pp. 729–39">{{cite journal | last=Lacy | first=BE | last2=Gabbard | first2=SL | last3=Crowell | first3=MD | title=Pathophysiology, evaluation, and treatment of bloating: hope, hype, or hot air? | journal=Gastroenterology & hepatology | volume=7 | issue=11 | year=2011 | issn=1554-7914 | pmid=22298969 | pmc=3264926 | pages=729–39}}</ref><br />
<br />
*<br />
<br />
{| class="wikitable"<br />
|+<br />
Causes of Abdominal Bloating<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Intestinal Disorders<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Motility Disorders<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Malabsorption disorders<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Infectious causes<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Dietary causes<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Misc.<br />
|-<br />
|[[Adhesions]]<br />
[[Malignancy]]<br />
|[[Diabetes]]<br />
<br />
[[Scleroderma]]<br />
<br />
Pseudo-obstruction<br />
<br />
Medications<br />
|[[Lactose intolerance]]<br />
[[Fructose intolerance]]<br />
<br />
[[Celiac disease]]<br />
<br />
[[Pancreatic insufficiency]]<br />
|[[Small intestinal bacterial overgrowth]]<br />
[[Giardiasis]]<br />
|Gas-producing foods<br />
FODMAPs<br />
|[[Irritable bowel syndrome]] <br /><br />
|}<br />
<br />
*<br />
<br />
==Complete Diagnostic Approach==<br />
Shown below is an algorithm summarizing the diagnosis of <nowiki>[[disease name]]</nowiki> according to [...] guidelines.<br />
{{familytree/start |summary=PE diagnosis Algorithm.}}<br />
{{familytree | | | | A01 | | | A01= Patient with abdominal bloating and Distention }}<br />
{{familytree | | | | |!| | | | }}<br />
{{familytree | | | | B01 | | | B01= Look for the <br><br />
* Alarm signs<br />
*Overlapping functional gastrointestinal disorders<br />
*[[Bacterial overgrowth]] (Small intestine bacterial overgrowth)<br />
* Dietary intolerances<br />
*[[Celiac Disease]]<br />
* Weight gain <br />
*[[Constipation]] <br />
*[[Hydrogen breath test]] <br />
*Any pyschological comorbidities}}<br />
{{familytree | | |,|-|^|-|.| | }}<br />
{{familytree | | C01 | | C02 | C01= Yes | C02=No}}<br />
{{familytree | | |!| | | |!| | }}<br />
{{familytree | | C01 | | C02 | C01=<br />
* Reassurance the patient, recommend [[diaphragmatic breathing]]<br />
*Diet intervention: Low FODMAP diet <br />
*Iniate sympotmatic treatment such as [[peppermint oil]] or [[Simethicone]] | C02= Treat Accordingly}}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= *Trial of [[Rifaximin]]/[[Probiotics]] }}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= No Response }}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= [[Antidepressants]]<br />
*[[Psychological therapy]]<br />
*Hypnotherapy, [[Cognitive behavioral therapy]] (CBT)}}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= No Response }}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= <br />
*Referral to specialized Neurogastroenterology center <br />
*Referral for the CT/MRI [[Electromyography]]<br />
*Referral for the abdominal biofeedback therapy)}}<br />
{{familytree/end}}<br />
<br />
==Treatment==<br />
Shown below is an algorithm summarizing the treatment of abdominal bloating according the the American College of Gastroenterology guidelines.<br />
{{familytree/start |summary=PE diagnosis Algorithm.}}<br />
{{familytree | | | | | | | | A01 |A01= Treatment of bloating is based on etiology of bloating.}} <br />
{{familytree | | | | | | | | |!| | | | | |}}<br />
{{familytree | | | | | | | |C01| | | | | |C01= Dietary changes are suggested for bloating <br />
*Diet<br />
*[[Exercise]] and [[posture]]<br />
*Over-the-counter medications<br />
*[[Probiotics]]<br />
*[[Antibiotics]]<br />
*Smooth muscle [[antispasmodics]]<br />
*Osmotic laxatives<br />
*Prokinetic agents<br />
*Chloride channel activators<br />
*[[Tricyclic antidepressants]]<br />
<br />
Are any warning signs present?<br />
*anemia,GI bleeding, weight loss>10% of the body weight, and family history of GI malignancy. }}<br />
{{familytree | | | | | | | | |!| | | | | | }}<br />
{{Family tree | | | | | |,|-|-|^|-|-|.| | }}<br />
{{Family tree | | | | | C01 | | | | C02 |C01= Yes| C02= No}}<br />
{{familytree | | | | | |!| | | | | |!| | | | }}<br />
{{familytree | | | | | |F01| | | |F02| | |F01= Treat accordingly<br><br />
*Labs<br />
*[[Endoscopy]]<br />
*Imaging|F02=Functional?}}<br />
{{familytree | | | | | | | | | | | | |!| | | }}<br />
{{familytree | | | | | | | | | | | | |!| | | | | | | }}<br />
{{familytree | | | |,|-|-|-|v|-|-|-|-|+|-|.| | }}<br />
{{familytree | | | |!| | | |!| | | | |!| |!| | }}<br />
{{familytree | | | D01 | | D02 | | D03 | | D04 | |D01=[[Constipation]]|D02=Functional dyspepsia|D03=Non-constipation IBS|D04=Bloating alone}}<br />
{{familytree | | | |`|-|-|-|^|-|-|+|-|-|-|-|-|'|}}<br />
{{familytree | | | | | | | | | | |!| | | | | | | | | }}<br />
{{familytree | | | | | | | | | | A02 | | | | | |A02= Lifestyle and nonspecific dietary advice.<br><br />
*Education about low FODMAP diet <br><br />
* Treat constipation aggressively and minimize bowel distention<br><br />
*Consider the use of [[Rifaximin]]<br />
*Consider probiotics, Psychological therapy, [[CBT]], and/or [[antidepressants]]<br><br />
*Consider Biodfeedback neuromodulation }}<br />
{{familytree/end}}<br />
<br />
==Do's==<br />
<br />
*Use of [[probiotics]] can help reduce [[bloating]].<br />
*Antidepressants can help to reduce the symptoms of [[IBS]] but the data is unclear over the reduction of bloating.<br />
*[[Hypnotherapy]] has been reported to be useful in reducing symptoms of bloating.<br />
*Bowel training and [[diaphragmatic breathing]] have been useful in the management of [[bloating]] however the data is unclear.<br />
<br />
==Don'ts==<br />
<br />
*Artificial sweeteners containing [[sorbitol]], [[mannitol]], [[xylitol]] should be avoided.<br />
*Medications ([[anticholinergics]], [[opiates]], [[calcium channel blockers]], antidepressants) should also be avoided as they have an effect on [[bloating]].<br />
*Twenty percent of [[carbohydrates]] in baked beans and 7–10% in [[wheat]], oats, potatoes, and corn, and 1% in white rice are not absorbed well in the [[intestine]] and they can produce [[bloating]].<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
[[Category:Projects]]<br />
[[Category:Resident survival guide]]<br />
[[Category:Gastroenterology]]</div>
Usmanaliakbar
https://www.wikidoc.org/index.php?title=Bloating_resident_survival_guide&diff=1690534
Bloating resident survival guide
2021-02-18T15:23:54Z
<p>Usmanaliakbar: /* Causes */</p>
<hr />
<div>__NOTOC__<br />
<br />
{{CMG}} {{AE}} {{Usman Ali Akbar}}<br />
<br />
{{SK}}<br />
<br />
{| class="infobox" style="margin: 0 0 0 0; border: 0; float: right; width: 100px; background: #A8A8A8; position: fixed; top: 250px; right: 21px; border-radius: 0 0 10px 10px;" cellpadding="0" cellspacing="0" ;<br />
|-<br />
! style="padding: 0 5px; font-size: 85%; background: #A8A8A8" align="center" |{{fontcolor|#2B3B44|Bloating resident survival guide Microchapters}}<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Overview|Overview]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Causes|Causes]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#FIRE: Focused Initial Rapid Evaluation|FIRE]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Complete Diagnostic Approach|Diagnosis]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Treatment|Treatment]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Do's|Do's]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Don'ts|Don'ts]]<br />
|}<br />
<br />
==Overview==<br />
[[Bloating]] is one of the most common gastrointestinal complaints that is attributed by the patient as the subjective sensation of incorrectly perceived excess [[gas]]. There are multiple non-functional etiologies of abdominal bloating and distention. Primary functional abdominal distention (FABD) should be diagnosed as a single entity and it doesn't overlap with other functional gastrointestinal disorders. Rome IV diagnostic criteria mention the co-existence of mild abdominal pain and/or minor bowel movements. FABD can be treated with [[antispasmodic]] along with [[peppermint oil]] in [[randomized controlled trials]]. A stepwise approach is usually needed that counter the dietary interventions, [[microbiome]] modulation, and medical therapy in the management of FABD.<br />
<br />
==Causes==<br />
The causes of abdominal bloating are numerous and are managed according to the etiology.<ref name="Lacy Gabbard Crowell 2011 pp. 729–39">{{cite journal | last=Lacy | first=BE | last2=Gabbard | first2=SL | last3=Crowell | first3=MD | title=Pathophysiology, evaluation, and treatment of bloating: hope, hype, or hot air? | journal=Gastroenterology & hepatology | volume=7 | issue=11 | year=2011 | issn=1554-7914 | pmid=22298969 | pmc=3264926 | pages=729–39}}</ref><br />
<br />
*<br />
<br />
{| class="wikitable"<br />
|+<br />
Causes of Abdominal Bloating<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Intestinal Disorders<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Motility Disorders<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Malabsorption disorders<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Infectious causes<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Dietary causes<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Misc.<br />
|-<br />
|[[Adhesions]]<br />
[[Malignancy]]<br />
|[[Diabetes]]<br />
<br />
[[Scleroderma]]<br />
<br />
Pseudo-obstruction<br />
<br />
Medications<br />
|[[Lactose intolerance]]<br />
[[Fructose intolerance]]<br />
<br />
[[Celiac disease]]<br />
<br />
[[Pancreatic insufficiency]]<br />
|[[Small intestinal bacterial overgrowth]]<br />
[[Giardiasis]]<br />
|Gas-producing foods<br />
FODMAPs<br />
|[[Irritable bowel syndrome]] <br /><br />
|}<br />
<br />
*<br />
<br />
==Complete Diagnostic Approach==<br />
Shown below is an algorithm summarizing the diagnosis of <nowiki>[[disease name]]</nowiki> according to [...] guidelines.<br />
{{familytree/start |summary=PE diagnosis Algorithm.}}<br />
{{familytree | | | | A01 | | | A01= Patient with abdominal bloating and Distention }}<br />
{{familytree | | | | |!| | | | }}<br />
{{familytree | | | | B01 | | | B01= Look for the <br><br />
* Alarm signs<br />
*Overlapping functional gastrointestinal disorders<br />
*[[Bacterial overgrowth]] (Small intestine bacterial overgrowth)<br />
* Dietary intolerances<br />
*[[Celiac Disease]]<br />
* Weight gain <br />
*[[Constipation]] <br />
*[[Hydrogen breath test]] <br />
*Any pyschological comorbidities}}<br />
{{familytree | | |,|-|^|-|.| | }}<br />
{{familytree | | C01 | | C02 | C01= Yes | C02=No}}<br />
{{familytree | | |!| | | |!| | }}<br />
{{familytree | | C01 | | C02 | C01=<br />
* Reassurance the patient, recommend [[diaphragmatic breathing]]<br />
*Diet intervention: Low FODMAP diet <br />
*Iniate sympotmatic treatment such as [[peppermint oil]] or [[Simethicone]] | C02= Treat Accordingly}}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= *Trial of [[Rifaximin]]/[[Probiotics]] }}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= No Response }}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= [[Antidepressants]]<br />
*[[Psychological therapy]]<br />
*Hypnotherapy, [[Cognitive behavioral therapy]] (CBT)}}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= No Response }}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= <br />
*Referral to specialized Neurogastroenterology center <br />
*Referral for the CT/MRI [[Electromyography]]<br />
*Referral for the abdominal biofeedback therapy)}}<br />
{{familytree/end}}<br />
<br />
==Treatment==<br />
Shown below is an algorithm summarizing the treatment of <nowiki>[[disease name]]</nowiki> according the the [...] guidelines.<br />
{{familytree/start |summary=PE diagnosis Algorithm.}}<br />
{{familytree | | | | | | | | A01 |A01= Treatment of bloating is based on etiology of bloating.}} <br />
{{familytree | | | | | | | | |!| | | | | |}}<br />
{{familytree | | | | | | | |C01| | | | | |C01= Dietary changes are suggested for bloating <br />
*Diet<br />
*[[Exercise]] and [[posture]]<br />
*Over-the-counter medications<br />
*[[Probiotics]]<br />
*[[Antibiotics]]<br />
*Smooth muscle [[antispasmodics]]<br />
*Osmotic laxatives<br />
*Prokinetic agents<br />
*Chloride channel activators<br />
*[[Tricyclic antidepressants]]<br />
<br />
Are any warning signs present?<br />
*anemia,GI bleeding, weight loss>10% of the body weight, and family history of GI malignancy. }}<br />
{{familytree | | | | | | | | |!| | | | | | }}<br />
{{Family tree | | | | | |,|-|-|^|-|-|.| | }}<br />
{{Family tree | | | | | C01 | | | | C02 |C01= Yes| C02= No}}<br />
{{familytree | | | | | |!| | | | | |!| | | | }}<br />
{{familytree | | | | | |F01| | | |F02| | |F01= Treat accordingly<br><br />
*Labs<br />
*[[Endoscopy]]<br />
*Imaging|F02=Functional?}}<br />
{{familytree | | | | | | | | | | | | |!| | | }}<br />
{{familytree | | | | | | | | | | | | |!| | | | | | | }}<br />
{{familytree | | | |,|-|-|-|v|-|-|-|-|+|-|.| | }}<br />
{{familytree | | | |!| | | |!| | | | |!| |!| | }}<br />
{{familytree | | | D01 | | D02 | | D03 | | D04 | |D01=[[Constipation]]|D02=Functional dyspepsia|D03=Non-constipation IBS|D04=Bloating alone}}<br />
{{familytree | | | |`|-|-|-|^|-|-|+|-|-|-|-|-|'|}}<br />
{{familytree | | | | | | | | | | |!| | | | | | | | | }}<br />
{{familytree | | | | | | | | | | A02 | | | | | |A02= Lifestyle and nonspecific dietary advice.<br><br />
*Education about low FODMAP diet <br><br />
* Treat constipation aggressively and minimize bowel distention<br><br />
*Consider the use of [[Rifaximin]]<br />
*Consider probiotics, Psychological therapy, [[CBT]], and/or [[antidepressants]]<br><br />
*Consider Biodfeedback neuromodulation }}<br />
{{familytree/end}}<br />
<br />
==Do's==<br />
<br />
*Use of [[probiotics]] can help reduce [[bloating]].<br />
*Antidepressants can help to reduce the symptoms of [[IBS]] but the data is unclear over the reduction of bloating.<br />
*[[Hypnotherapy]] has been reported to be useful in reducing symptoms of bloating.<br />
*Bowel training and [[diaphragmatic breathing]] have been useful in the management of [[bloating]] however the data is unclear.<br />
<br />
==Don'ts==<br />
<br />
*Artificial sweeteners containing [[sorbitol]], [[mannitol]], [[xylitol]] should be avoided.<br />
*Medications ([[anticholinergics]], [[opiates]], [[calcium channel blockers]], antidepressants) should also be avoided as they have an effect on [[bloating]].<br />
*Twenty percent of [[carbohydrates]] in baked beans and 7–10% in [[wheat]], oats, potatoes, and corn, and 1% in white rice are not absorbed well in the [[intestine]] and they can produce [[bloating]].<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
[[Category:Projects]]<br />
[[Category:Resident survival guide]]<br />
[[Category:Gastroenterology]]</div>
Usmanaliakbar
https://www.wikidoc.org/index.php?title=Bloating_resident_survival_guide&diff=1690309
Bloating resident survival guide
2021-02-17T19:57:34Z
<p>Usmanaliakbar: /* Don'ts */</p>
<hr />
<div>__NOTOC__<br />
<br />
{{CMG}} {{AE}} {{Usman Ali Akbar}}<br />
<br />
{{SK}}<br />
<br />
{| class="infobox" style="margin: 0 0 0 0; border: 0; float: right; width: 100px; background: #A8A8A8; position: fixed; top: 250px; right: 21px; border-radius: 0 0 10px 10px;" cellpadding="0" cellspacing="0" ;<br />
|-<br />
! style="padding: 0 5px; font-size: 85%; background: #A8A8A8" align="center" |{{fontcolor|#2B3B44|Bloating resident survival guide Microchapters}}<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Overview|Overview]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Causes|Causes]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#FIRE: Focused Initial Rapid Evaluation|FIRE]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Complete Diagnostic Approach|Diagnosis]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Treatment|Treatment]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Do's|Do's]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Don'ts|Don'ts]]<br />
|}<br />
<br />
==Overview==<br />
[[Bloating]] is one of the most common gastrointestinal complaints that is attributed by the patient as the subjective sensation of incorrectly perceived excess [[gas]]. There are multiple non-functional etiologies of abdominal bloating and distention. Primary functional abdominal distention (FABD) should be diagnosed as a single entity and it doesn't overlap with other functional gastrointestinal disorders. Rome IV diagnostic criteria mention the co-existence of mild abdominal pain and/or minor bowel movements. FABD can be treated with [[antispasmodic]] along with [[peppermint oil]] in [[randomized controlled trials]]. A stepwise approach is usually needed that counter the dietary interventions, [[microbiome]] modulation, and medical therapy in the management of FABD.<br />
<br />
==Causes==<br />
The causes of abdominal bloating are numerous and are managed according to the etiology.<br />
<br />
*<br />
<br />
{| class="wikitable"<br />
|+<br />
Causes of Abdominal Bloating<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Intestinal Disorders<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Motility Disorders<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Malabsorption disorders<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Infectious causes<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Dietary causes<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Misc.<br />
|-<br />
|[[Adhesions]]<br />
[[Malignancy]]<br />
|[[Diabetes]]<br />
<br />
[[Scleroderma]]<br />
<br />
Pseudo-obstruction<br />
<br />
Medications<br />
|[[Lactose intolerance]]<br />
[[Fructose intolerance]]<br />
<br />
[[Celiac disease]]<br />
<br />
[[Pancreatic insufficiency]]<br />
|[[Small intestinal bacterial overgrowth]]<br />
[[Giardiasis]]<br />
|Gas-producing foods<br />
FODMAPs<br />
|[[Irritable bowel syndrome]] <br /><br />
|}<br />
<br />
*<br />
<br />
==Complete Diagnostic Approach==<br />
Shown below is an algorithm summarizing the diagnosis of <nowiki>[[disease name]]</nowiki> according to [...] guidelines.<br />
{{familytree/start |summary=PE diagnosis Algorithm.}}<br />
{{familytree | | | | A01 | | | A01= Patient with abdominal bloating and Distention }}<br />
{{familytree | | | | |!| | | | }}<br />
{{familytree | | | | B01 | | | B01= Look for the <br><br />
* Alarm signs<br />
*Overlapping functional gastrointestinal disorders<br />
*[[Bacterial overgrowth]] (Small intestine bacterial overgrowth)<br />
* Dietary intolerances<br />
*[[Celiac Disease]]<br />
* Weight gain <br />
*[[Constipation]] <br />
*[[Hydrogen breath test]] <br />
*Any pyschological comorbidities}}<br />
{{familytree | | |,|-|^|-|.| | }}<br />
{{familytree | | C01 | | C02 | C01= Yes | C02=No}}<br />
{{familytree | | |!| | | |!| | }}<br />
{{familytree | | C01 | | C02 | C01=<br />
* Reassurance the patient, recommend [[diaphragmatic breathing]]<br />
*Diet intervention: Low FODMAP diet <br />
*Iniate sympotmatic treatment such as [[peppermint oil]] or [[Simethicone]] | C02= Treat Accordingly}}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= *Trial of [[Rifaximin]]/[[Probiotics]] }}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= No Response }}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= [[Antidepressants]]<br />
*[[Psychological therapy]]<br />
*Hypnotherapy, [[Cognitive behavioral therapy]] (CBT)}}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= No Response }}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= <br />
*Referral to specialized Neurogastroenterology center <br />
*Referral for the CT/MRI [[Electromyography]]<br />
*Referral for the abdominal biofeedback therapy)}}<br />
{{familytree/end}}<br />
<br />
==Treatment==<br />
Shown below is an algorithm summarizing the treatment of <nowiki>[[disease name]]</nowiki> according the the [...] guidelines.<br />
{{familytree/start |summary=PE diagnosis Algorithm.}}<br />
{{familytree | | | | | | | | A01 |A01= Treatment of bloating is based on etiology of bloating.}} <br />
{{familytree | | | | | | | | |!| | | | | |}}<br />
{{familytree | | | | | | | |C01| | | | | |C01= Dietary changes are suggested for bloating <br />
*Diet<br />
*[[Exercise]] and [[posture]]<br />
*Over-the-counter medications<br />
*[[Probiotics]]<br />
*[[Antibiotics]]<br />
*Smooth muscle [[antispasmodics]]<br />
*Osmotic laxatives<br />
*Prokinetic agents<br />
*Chloride channel activators<br />
*[[Tricyclic antidepressants]]<br />
<br />
Are any warning signs present?<br />
*anemia,GI bleeding, weight loss>10% of the body weight, and family history of GI malignancy. }}<br />
{{familytree | | | | | | | | |!| | | | | | }}<br />
{{Family tree | | | | | |,|-|-|^|-|-|.| | }}<br />
{{Family tree | | | | | C01 | | | | C02 |C01= Yes| C02= No}}<br />
{{familytree | | | | | |!| | | | | |!| | | | }}<br />
{{familytree | | | | | |F01| | | |F02| | |F01= Treat accordingly<br><br />
*Labs<br />
*[[Endoscopy]]<br />
*Imaging|F02=Functional?}}<br />
{{familytree | | | | | | | | | | | | |!| | | }}<br />
{{familytree | | | | | | | | | | | | |!| | | | | | | }}<br />
{{familytree | | | |,|-|-|-|v|-|-|-|-|+|-|.| | }}<br />
{{familytree | | | |!| | | |!| | | | |!| |!| | }}<br />
{{familytree | | | D01 | | D02 | | D03 | | D04 | |D01=[[Constipation]]|D02=Functional dyspepsia|D03=Non-constipation IBS|D04=Bloating alone}}<br />
{{familytree | | | |`|-|-|-|^|-|-|+|-|-|-|-|-|'|}}<br />
{{familytree | | | | | | | | | | |!| | | | | | | | | }}<br />
{{familytree | | | | | | | | | | A02 | | | | | |A02= Lifestyle and nonspecific dietary advice.<br><br />
*Education about low FODMAP diet <br><br />
* Treat constipation aggressively and minimize bowel distention<br><br />
*Consider the use of [[Rifaximin]]<br />
*Consider probiotics, Psychological therapy, [[CBT]], and/or [[antidepressants]]<br><br />
*Consider Biodfeedback neuromodulation }}<br />
{{familytree/end}}<br />
<br />
==Do's==<br />
<br />
*Use of [[probiotics]] can help reduce [[bloating]].<br />
*Antidepressants can help to reduce the symptoms of [[IBS]] but the data is unclear over the reduction of bloating.<br />
*[[Hypnotherapy]] has been reported to be useful in reducing symptoms of bloating.<br />
*Bowel training and [[diaphragmatic breathing]] have been useful in the management of [[bloating]] however the data is unclear.<br />
<br />
==Don'ts==<br />
<br />
*Artificial sweeteners containing [[sorbitol]], [[mannitol]], [[xylitol]] should be avoided.<br />
*Medications ([[anticholinergics]], [[opiates]], [[calcium channel blockers]], antidepressants) should also be avoided as they have an effect on [[bloating]].<br />
*Twenty percent of [[carbohydrates]] in baked beans and 7–10% in [[wheat]], oats, potatoes, and corn, and 1% in white rice are not absorbed well in the [[intestine]] and they can produce [[bloating]].<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
[[Category:Projects]]<br />
[[Category:Resident survival guide]]<br />
[[Category:Gastroenterology]]</div>
Usmanaliakbar
https://www.wikidoc.org/index.php?title=Bloating_resident_survival_guide&diff=1690308
Bloating resident survival guide
2021-02-17T19:55:53Z
<p>Usmanaliakbar: /* Do's */</p>
<hr />
<div>__NOTOC__<br />
<br />
{{CMG}} {{AE}} {{Usman Ali Akbar}}<br />
<br />
{{SK}}<br />
<br />
{| class="infobox" style="margin: 0 0 0 0; border: 0; float: right; width: 100px; background: #A8A8A8; position: fixed; top: 250px; right: 21px; border-radius: 0 0 10px 10px;" cellpadding="0" cellspacing="0" ;<br />
|-<br />
! style="padding: 0 5px; font-size: 85%; background: #A8A8A8" align="center" |{{fontcolor|#2B3B44|Bloating resident survival guide Microchapters}}<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Overview|Overview]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Causes|Causes]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#FIRE: Focused Initial Rapid Evaluation|FIRE]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Complete Diagnostic Approach|Diagnosis]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Treatment|Treatment]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Do's|Do's]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Don'ts|Don'ts]]<br />
|}<br />
<br />
==Overview==<br />
[[Bloating]] is one of the most common gastrointestinal complaints that is attributed by the patient as the subjective sensation of incorrectly perceived excess [[gas]]. There are multiple non-functional etiologies of abdominal bloating and distention. Primary functional abdominal distention (FABD) should be diagnosed as a single entity and it doesn't overlap with other functional gastrointestinal disorders. Rome IV diagnostic criteria mention the co-existence of mild abdominal pain and/or minor bowel movements. FABD can be treated with [[antispasmodic]] along with [[peppermint oil]] in [[randomized controlled trials]]. A stepwise approach is usually needed that counter the dietary interventions, [[microbiome]] modulation, and medical therapy in the management of FABD.<br />
<br />
==Causes==<br />
The causes of abdominal bloating are numerous and are managed according to the etiology.<br />
<br />
*<br />
<br />
{| class="wikitable"<br />
|+<br />
Causes of Abdominal Bloating<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Intestinal Disorders<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Motility Disorders<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Malabsorption disorders<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Infectious causes<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Dietary causes<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Misc.<br />
|-<br />
|[[Adhesions]]<br />
[[Malignancy]]<br />
|[[Diabetes]]<br />
<br />
[[Scleroderma]]<br />
<br />
Pseudo-obstruction<br />
<br />
Medications<br />
|[[Lactose intolerance]]<br />
[[Fructose intolerance]]<br />
<br />
[[Celiac disease]]<br />
<br />
[[Pancreatic insufficiency]]<br />
|[[Small intestinal bacterial overgrowth]]<br />
[[Giardiasis]]<br />
|Gas-producing foods<br />
FODMAPs<br />
|[[Irritable bowel syndrome]] <br /><br />
|}<br />
<br />
*<br />
<br />
==Complete Diagnostic Approach==<br />
Shown below is an algorithm summarizing the diagnosis of <nowiki>[[disease name]]</nowiki> according to [...] guidelines.<br />
{{familytree/start |summary=PE diagnosis Algorithm.}}<br />
{{familytree | | | | A01 | | | A01= Patient with abdominal bloating and Distention }}<br />
{{familytree | | | | |!| | | | }}<br />
{{familytree | | | | B01 | | | B01= Look for the <br><br />
* Alarm signs<br />
*Overlapping functional gastrointestinal disorders<br />
*[[Bacterial overgrowth]] (Small intestine bacterial overgrowth)<br />
* Dietary intolerances<br />
*[[Celiac Disease]]<br />
* Weight gain <br />
*[[Constipation]] <br />
*[[Hydrogen breath test]] <br />
*Any pyschological comorbidities}}<br />
{{familytree | | |,|-|^|-|.| | }}<br />
{{familytree | | C01 | | C02 | C01= Yes | C02=No}}<br />
{{familytree | | |!| | | |!| | }}<br />
{{familytree | | C01 | | C02 | C01=<br />
* Reassurance the patient, recommend [[diaphragmatic breathing]]<br />
*Diet intervention: Low FODMAP diet <br />
*Iniate sympotmatic treatment such as [[peppermint oil]] or [[Simethicone]] | C02= Treat Accordingly}}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= *Trial of [[Rifaximin]]/[[Probiotics]] }}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= No Response }}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= [[Antidepressants]]<br />
*[[Psychological therapy]]<br />
*Hypnotherapy, [[Cognitive behavioral therapy]] (CBT)}}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= No Response }}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= <br />
*Referral to specialized Neurogastroenterology center <br />
*Referral for the CT/MRI [[Electromyography]]<br />
*Referral for the abdominal biofeedback therapy)}}<br />
{{familytree/end}}<br />
<br />
==Treatment==<br />
Shown below is an algorithm summarizing the treatment of <nowiki>[[disease name]]</nowiki> according the the [...] guidelines.<br />
{{familytree/start |summary=PE diagnosis Algorithm.}}<br />
{{familytree | | | | | | | | A01 |A01= Treatment of bloating is based on etiology of bloating.}} <br />
{{familytree | | | | | | | | |!| | | | | |}}<br />
{{familytree | | | | | | | |C01| | | | | |C01= Dietary changes are suggested for bloating <br />
*Diet<br />
*[[Exercise]] and [[posture]]<br />
*Over-the-counter medications<br />
*[[Probiotics]]<br />
*[[Antibiotics]]<br />
*Smooth muscle [[antispasmodics]]<br />
*Osmotic laxatives<br />
*Prokinetic agents<br />
*Chloride channel activators<br />
*[[Tricyclic antidepressants]]<br />
<br />
Are any warning signs present?<br />
*anemia,GI bleeding, weight loss>10% of the body weight, and family history of GI malignancy. }}<br />
{{familytree | | | | | | | | |!| | | | | | }}<br />
{{Family tree | | | | | |,|-|-|^|-|-|.| | }}<br />
{{Family tree | | | | | C01 | | | | C02 |C01= Yes| C02= No}}<br />
{{familytree | | | | | |!| | | | | |!| | | | }}<br />
{{familytree | | | | | |F01| | | |F02| | |F01= Treat accordingly<br><br />
*Labs<br />
*[[Endoscopy]]<br />
*Imaging|F02=Functional?}}<br />
{{familytree | | | | | | | | | | | | |!| | | }}<br />
{{familytree | | | | | | | | | | | | |!| | | | | | | }}<br />
{{familytree | | | |,|-|-|-|v|-|-|-|-|+|-|.| | }}<br />
{{familytree | | | |!| | | |!| | | | |!| |!| | }}<br />
{{familytree | | | D01 | | D02 | | D03 | | D04 | |D01=[[Constipation]]|D02=Functional dyspepsia|D03=Non-constipation IBS|D04=Bloating alone}}<br />
{{familytree | | | |`|-|-|-|^|-|-|+|-|-|-|-|-|'|}}<br />
{{familytree | | | | | | | | | | |!| | | | | | | | | }}<br />
{{familytree | | | | | | | | | | A02 | | | | | |A02= Lifestyle and nonspecific dietary advice.<br><br />
*Education about low FODMAP diet <br><br />
* Treat constipation aggressively and minimize bowel distention<br><br />
*Consider the use of [[Rifaximin]]<br />
*Consider probiotics, Psychological therapy, [[CBT]], and/or [[antidepressants]]<br><br />
*Consider Biodfeedback neuromodulation }}<br />
{{familytree/end}}<br />
<br />
==Do's==<br />
<br />
*Use of [[probiotics]] can help reduce [[bloating]].<br />
*Antidepressants can help to reduce the symptoms of [[IBS]] but the data is unclear over the reduction of bloating.<br />
*[[Hypnotherapy]] has been reported to be useful in reducing symptoms of bloating.<br />
*Bowel training and [[diaphragmatic breathing]] have been useful in the management of [[bloating]] however the data is unclear.<br />
<br />
==Don'ts==<br />
<br />
*Artificial sweeteners containing sorbitol, mannitol, xylitol should be avoided.<br />
*Medications (anticholinergics, opiates, calcium blockers, antidepressants) should also be avoided as they have an effect on bloating.<br />
*Twenty percent of carbohydrates in baked beans and 7–10% in wheat, oats, potatoes, and corn, and 1% in white rice are not absorbed well in the intestine and they can produce bloating.<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
[[Category:Projects]]<br />
[[Category:Resident survival guide]]<br />
[[Category:Gastroenterology]]</div>
Usmanaliakbar
https://www.wikidoc.org/index.php?title=Bloating_resident_survival_guide&diff=1690307
Bloating resident survival guide
2021-02-17T19:55:02Z
<p>Usmanaliakbar: /* Treatment */</p>
<hr />
<div>__NOTOC__<br />
<br />
{{CMG}} {{AE}} {{Usman Ali Akbar}}<br />
<br />
{{SK}}<br />
<br />
{| class="infobox" style="margin: 0 0 0 0; border: 0; float: right; width: 100px; background: #A8A8A8; position: fixed; top: 250px; right: 21px; border-radius: 0 0 10px 10px;" cellpadding="0" cellspacing="0" ;<br />
|-<br />
! style="padding: 0 5px; font-size: 85%; background: #A8A8A8" align="center" |{{fontcolor|#2B3B44|Bloating resident survival guide Microchapters}}<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Overview|Overview]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Causes|Causes]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#FIRE: Focused Initial Rapid Evaluation|FIRE]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Complete Diagnostic Approach|Diagnosis]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Treatment|Treatment]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Do's|Do's]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Don'ts|Don'ts]]<br />
|}<br />
<br />
==Overview==<br />
[[Bloating]] is one of the most common gastrointestinal complaints that is attributed by the patient as the subjective sensation of incorrectly perceived excess [[gas]]. There are multiple non-functional etiologies of abdominal bloating and distention. Primary functional abdominal distention (FABD) should be diagnosed as a single entity and it doesn't overlap with other functional gastrointestinal disorders. Rome IV diagnostic criteria mention the co-existence of mild abdominal pain and/or minor bowel movements. FABD can be treated with [[antispasmodic]] along with [[peppermint oil]] in [[randomized controlled trials]]. A stepwise approach is usually needed that counter the dietary interventions, [[microbiome]] modulation, and medical therapy in the management of FABD.<br />
<br />
==Causes==<br />
The causes of abdominal bloating are numerous and are managed according to the etiology.<br />
<br />
*<br />
<br />
{| class="wikitable"<br />
|+<br />
Causes of Abdominal Bloating<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Intestinal Disorders<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Motility Disorders<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Malabsorption disorders<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Infectious causes<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Dietary causes<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Misc.<br />
|-<br />
|[[Adhesions]]<br />
[[Malignancy]]<br />
|[[Diabetes]]<br />
<br />
[[Scleroderma]]<br />
<br />
Pseudo-obstruction<br />
<br />
Medications<br />
|[[Lactose intolerance]]<br />
[[Fructose intolerance]]<br />
<br />
[[Celiac disease]]<br />
<br />
[[Pancreatic insufficiency]]<br />
|[[Small intestinal bacterial overgrowth]]<br />
[[Giardiasis]]<br />
|Gas-producing foods<br />
FODMAPs<br />
|[[Irritable bowel syndrome]] <br /><br />
|}<br />
<br />
*<br />
<br />
==Complete Diagnostic Approach==<br />
Shown below is an algorithm summarizing the diagnosis of <nowiki>[[disease name]]</nowiki> according to [...] guidelines.<br />
{{familytree/start |summary=PE diagnosis Algorithm.}}<br />
{{familytree | | | | A01 | | | A01= Patient with abdominal bloating and Distention }}<br />
{{familytree | | | | |!| | | | }}<br />
{{familytree | | | | B01 | | | B01= Look for the <br><br />
* Alarm signs<br />
*Overlapping functional gastrointestinal disorders<br />
*[[Bacterial overgrowth]] (Small intestine bacterial overgrowth)<br />
* Dietary intolerances<br />
*[[Celiac Disease]]<br />
* Weight gain <br />
*[[Constipation]] <br />
*[[Hydrogen breath test]] <br />
*Any pyschological comorbidities}}<br />
{{familytree | | |,|-|^|-|.| | }}<br />
{{familytree | | C01 | | C02 | C01= Yes | C02=No}}<br />
{{familytree | | |!| | | |!| | }}<br />
{{familytree | | C01 | | C02 | C01=<br />
* Reassurance the patient, recommend [[diaphragmatic breathing]]<br />
*Diet intervention: Low FODMAP diet <br />
*Iniate sympotmatic treatment such as [[peppermint oil]] or [[Simethicone]] | C02= Treat Accordingly}}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= *Trial of [[Rifaximin]]/[[Probiotics]] }}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= No Response }}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= [[Antidepressants]]<br />
*[[Psychological therapy]]<br />
*Hypnotherapy, [[Cognitive behavioral therapy]] (CBT)}}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= No Response }}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= <br />
*Referral to specialized Neurogastroenterology center <br />
*Referral for the CT/MRI [[Electromyography]]<br />
*Referral for the abdominal biofeedback therapy)}}<br />
{{familytree/end}}<br />
<br />
==Treatment==<br />
Shown below is an algorithm summarizing the treatment of <nowiki>[[disease name]]</nowiki> according the the [...] guidelines.<br />
{{familytree/start |summary=PE diagnosis Algorithm.}}<br />
{{familytree | | | | | | | | A01 |A01= Treatment of bloating is based on etiology of bloating.}} <br />
{{familytree | | | | | | | | |!| | | | | |}}<br />
{{familytree | | | | | | | |C01| | | | | |C01= Dietary changes are suggested for bloating <br />
*Diet<br />
*[[Exercise]] and [[posture]]<br />
*Over-the-counter medications<br />
*[[Probiotics]]<br />
*[[Antibiotics]]<br />
*Smooth muscle [[antispasmodics]]<br />
*Osmotic laxatives<br />
*Prokinetic agents<br />
*Chloride channel activators<br />
*[[Tricyclic antidepressants]]<br />
<br />
Are any warning signs present?<br />
*anemia,GI bleeding, weight loss>10% of the body weight, and family history of GI malignancy. }}<br />
{{familytree | | | | | | | | |!| | | | | | }}<br />
{{Family tree | | | | | |,|-|-|^|-|-|.| | }}<br />
{{Family tree | | | | | C01 | | | | C02 |C01= Yes| C02= No}}<br />
{{familytree | | | | | |!| | | | | |!| | | | }}<br />
{{familytree | | | | | |F01| | | |F02| | |F01= Treat accordingly<br><br />
*Labs<br />
*[[Endoscopy]]<br />
*Imaging|F02=Functional?}}<br />
{{familytree | | | | | | | | | | | | |!| | | }}<br />
{{familytree | | | | | | | | | | | | |!| | | | | | | }}<br />
{{familytree | | | |,|-|-|-|v|-|-|-|-|+|-|.| | }}<br />
{{familytree | | | |!| | | |!| | | | |!| |!| | }}<br />
{{familytree | | | D01 | | D02 | | D03 | | D04 | |D01=[[Constipation]]|D02=Functional dyspepsia|D03=Non-constipation IBS|D04=Bloating alone}}<br />
{{familytree | | | |`|-|-|-|^|-|-|+|-|-|-|-|-|'|}}<br />
{{familytree | | | | | | | | | | |!| | | | | | | | | }}<br />
{{familytree | | | | | | | | | | A02 | | | | | |A02= Lifestyle and nonspecific dietary advice.<br><br />
*Education about low FODMAP diet <br><br />
* Treat constipation aggressively and minimize bowel distention<br><br />
*Consider the use of [[Rifaximin]]<br />
*Consider probiotics, Psychological therapy, [[CBT]], and/or [[antidepressants]]<br><br />
*Consider Biodfeedback neuromodulation }}<br />
{{familytree/end}}<br />
<br />
==Do's==<br />
<br />
*Use of probiotics can help reduce bloating.<br />
*Antidepressants can help reducing the symptoms of IBS but the data is unclear over the reduction of bloating.<br />
*Hypnotherapy has been reported be useful in reducing symptoms of bloating .<br />
*Bowel training and diaphragmatic breathing have been useful in the management of bloating however the data is unclear.<br />
<br />
==Don'ts==<br />
<br />
*Artificial sweeteners containing sorbitol, mannitol, xylitol should be avoided.<br />
*Medications (anticholinergics, opiates, calcium blockers, antidepressants) should also be avoided as they have an effect on bloating.<br />
*Twenty percent of carbohydrates in baked beans and 7–10% in wheat, oats, potatoes, and corn, and 1% in white rice are not absorbed well in the intestine and they can produce bloating.<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
[[Category:Projects]]<br />
[[Category:Resident survival guide]]<br />
[[Category:Gastroenterology]]</div>
Usmanaliakbar
https://www.wikidoc.org/index.php?title=Bloating_resident_survival_guide&diff=1690306
Bloating resident survival guide
2021-02-17T19:35:20Z
<p>Usmanaliakbar: /* Complete Diagnostic Approach */</p>
<hr />
<div>__NOTOC__<br />
<br />
{{CMG}} {{AE}} {{Usman Ali Akbar}}<br />
<br />
{{SK}}<br />
<br />
{| class="infobox" style="margin: 0 0 0 0; border: 0; float: right; width: 100px; background: #A8A8A8; position: fixed; top: 250px; right: 21px; border-radius: 0 0 10px 10px;" cellpadding="0" cellspacing="0" ;<br />
|-<br />
! style="padding: 0 5px; font-size: 85%; background: #A8A8A8" align="center" |{{fontcolor|#2B3B44|Bloating resident survival guide Microchapters}}<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Overview|Overview]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Causes|Causes]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#FIRE: Focused Initial Rapid Evaluation|FIRE]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Complete Diagnostic Approach|Diagnosis]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Treatment|Treatment]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Do's|Do's]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Don'ts|Don'ts]]<br />
|}<br />
<br />
==Overview==<br />
[[Bloating]] is one of the most common gastrointestinal complaints that is attributed by the patient as the subjective sensation of incorrectly perceived excess [[gas]]. There are multiple non-functional etiologies of abdominal bloating and distention. Primary functional abdominal distention (FABD) should be diagnosed as a single entity and it doesn't overlap with other functional gastrointestinal disorders. Rome IV diagnostic criteria mention the co-existence of mild abdominal pain and/or minor bowel movements. FABD can be treated with [[antispasmodic]] along with [[peppermint oil]] in [[randomized controlled trials]]. A stepwise approach is usually needed that counter the dietary interventions, [[microbiome]] modulation, and medical therapy in the management of FABD.<br />
<br />
==Causes==<br />
The causes of abdominal bloating are numerous and are managed according to the etiology.<br />
<br />
*<br />
<br />
{| class="wikitable"<br />
|+<br />
Causes of Abdominal Bloating<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Intestinal Disorders<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Motility Disorders<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Malabsorption disorders<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Infectious causes<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Dietary causes<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Misc.<br />
|-<br />
|[[Adhesions]]<br />
[[Malignancy]]<br />
|[[Diabetes]]<br />
<br />
[[Scleroderma]]<br />
<br />
Pseudo-obstruction<br />
<br />
Medications<br />
|[[Lactose intolerance]]<br />
[[Fructose intolerance]]<br />
<br />
[[Celiac disease]]<br />
<br />
[[Pancreatic insufficiency]]<br />
|[[Small intestinal bacterial overgrowth]]<br />
[[Giardiasis]]<br />
|Gas-producing foods<br />
FODMAPs<br />
|[[Irritable bowel syndrome]] <br /><br />
|}<br />
<br />
*<br />
<br />
==Complete Diagnostic Approach==<br />
Shown below is an algorithm summarizing the diagnosis of <nowiki>[[disease name]]</nowiki> according to [...] guidelines.<br />
{{familytree/start |summary=PE diagnosis Algorithm.}}<br />
{{familytree | | | | A01 | | | A01= Patient with abdominal bloating and Distention }}<br />
{{familytree | | | | |!| | | | }}<br />
{{familytree | | | | B01 | | | B01= Look for the <br><br />
* Alarm signs<br />
*Overlapping functional gastrointestinal disorders<br />
*[[Bacterial overgrowth]] (Small intestine bacterial overgrowth)<br />
* Dietary intolerances<br />
*[[Celiac Disease]]<br />
* Weight gain <br />
*[[Constipation]] <br />
*[[Hydrogen breath test]] <br />
*Any pyschological comorbidities}}<br />
{{familytree | | |,|-|^|-|.| | }}<br />
{{familytree | | C01 | | C02 | C01= Yes | C02=No}}<br />
{{familytree | | |!| | | |!| | }}<br />
{{familytree | | C01 | | C02 | C01=<br />
* Reassurance the patient, recommend [[diaphragmatic breathing]]<br />
*Diet intervention: Low FODMAP diet <br />
*Iniate sympotmatic treatment such as [[peppermint oil]] or [[Simethicone]] | C02= Treat Accordingly}}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= *Trial of [[Rifaximin]]/[[Probiotics]] }}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= No Response }}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= [[Antidepressants]]<br />
*[[Psychological therapy]]<br />
*Hypnotherapy, [[Cognitive behavioral therapy]] (CBT)}}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= No Response }}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= <br />
*Referral to specialized Neurogastroenterology center <br />
*Referral for the CT/MRI [[Electromyography]]<br />
*Referral for the abdominal biofeedback therapy)}}<br />
{{familytree/end}}<br />
<br />
==Treatment==<br />
Shown below is an algorithm summarizing the treatment of <nowiki>[[disease name]]</nowiki> according the the [...] guidelines.<br />
{{familytree/start |summary=PE diagnosis Algorithm.}}<br />
{{familytree | | | | | | | | A01 |A01= Treatment of bloating is based on etiology of bloating.}} <br />
{{familytree | | | | | | | | |!| | | | | |}}<br />
{{familytree | | | | | | | |C01| | | | | |C01= Dietary changes are suggested for bloating <br />
*Diet<br />
*Exercise and posture<br />
*Over-the-counter medications<br />
*Probiotics<br />
*Antibiotics<br />
*Smooth muscle antispasmodics<br />
*Osmotic laxatives<br />
*Prokinetic agents<br />
*Chloride channel activators<br />
*Tricyclic antidepressants<br />
<br />
Are any warning signs present?<br />
*anemia,GI bleeding, weight loss>10% of the body weight, and family history of GI malignancy. }}<br />
{{familytree | | | | | | | | |!| | | | | | }}<br />
{{Family tree | | | | | |,|-|-|^|-|-|.| | }}<br />
{{Family tree | | | | | C01 | | | | C02 |C01= Yes| C02= No}}<br />
{{familytree | | | | | |!| | | | | |!| | | | }}<br />
{{familytree | | | | | |F01| | | |F02| | |F01= Treat accordingly<br><br />
*Labs<br />
*Endoscopy<br />
*Imaging|F02=Functional?}}<br />
{{familytree | | | | | | | | | | | | |!| | | }}<br />
{{familytree | | | | | | | | | | | | |!| | | | | | | }}<br />
{{familytree | | | |,|-|-|-|v|-|-|-|-|+|-|.| | }}<br />
{{familytree | | | |!| | | |!| | | | |!| |!| | }}<br />
{{familytree | | | D01 | | D02 | | D03 | | D04 | |D01=Constipation|D02=Functional dyspepsia|D03=Non-constipation IBS|D04=Bloating alone}}<br />
{{familytree | | | |`|-|-|-|^|-|-|+|-|-|-|-|-|'|}}<br />
{{familytree | | | | | | | | | | |!| | | | | | | | | }}<br />
{{familytree | | | | | | | | | | A02 | | | | | |A02= Lifestyle and nonspecific dietary advice.<br><br />
*Education about low FODMAP diet <br><br />
* Treat constipation aggressively and minimize bowel distention<br><br />
*Consider the use of Rifaximin<br />
*Consider probiotics, Psychological therapy, CBT and/or antidepressants<br><br />
*Consider Biodfeedback neuromodulation }}<br />
{{familytree/end}}<br />
<br />
==Do's==<br />
<br />
*Use of probiotics can help reduce bloating.<br />
*Antidepressants can help reducing the symptoms of IBS but the data is unclear over the reduction of bloating.<br />
*Hypnotherapy has been reported be useful in reducing symptoms of bloating .<br />
*Bowel training and diaphragmatic breathing have been useful in the management of bloating however the data is unclear.<br />
<br />
==Don'ts==<br />
<br />
*Artificial sweeteners containing sorbitol, mannitol, xylitol should be avoided.<br />
*Medications (anticholinergics, opiates, calcium blockers, antidepressants) should also be avoided as they have an effect on bloating.<br />
*Twenty percent of carbohydrates in baked beans and 7–10% in wheat, oats, potatoes, and corn, and 1% in white rice are not absorbed well in the intestine and they can produce bloating.<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
[[Category:Projects]]<br />
[[Category:Resident survival guide]]<br />
[[Category:Gastroenterology]]</div>
Usmanaliakbar
https://www.wikidoc.org/index.php?title=Bloating_resident_survival_guide&diff=1690305
Bloating resident survival guide
2021-02-17T19:33:44Z
<p>Usmanaliakbar: /* Causes */</p>
<hr />
<div>__NOTOC__<br />
<br />
{{CMG}} {{AE}} {{Usman Ali Akbar}}<br />
<br />
{{SK}}<br />
<br />
{| class="infobox" style="margin: 0 0 0 0; border: 0; float: right; width: 100px; background: #A8A8A8; position: fixed; top: 250px; right: 21px; border-radius: 0 0 10px 10px;" cellpadding="0" cellspacing="0" ;<br />
|-<br />
! style="padding: 0 5px; font-size: 85%; background: #A8A8A8" align="center" |{{fontcolor|#2B3B44|Bloating resident survival guide Microchapters}}<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Overview|Overview]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Causes|Causes]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#FIRE: Focused Initial Rapid Evaluation|FIRE]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Complete Diagnostic Approach|Diagnosis]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Treatment|Treatment]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Do's|Do's]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Don'ts|Don'ts]]<br />
|}<br />
<br />
==Overview==<br />
[[Bloating]] is one of the most common gastrointestinal complaints that is attributed by the patient as the subjective sensation of incorrectly perceived excess [[gas]]. There are multiple non-functional etiologies of abdominal bloating and distention. Primary functional abdominal distention (FABD) should be diagnosed as a single entity and it doesn't overlap with other functional gastrointestinal disorders. Rome IV diagnostic criteria mention the co-existence of mild abdominal pain and/or minor bowel movements. FABD can be treated with [[antispasmodic]] along with [[peppermint oil]] in [[randomized controlled trials]]. A stepwise approach is usually needed that counter the dietary interventions, [[microbiome]] modulation, and medical therapy in the management of FABD.<br />
<br />
==Causes==<br />
The causes of abdominal bloating are numerous and are managed according to the etiology.<br />
<br />
*<br />
<br />
{| class="wikitable"<br />
|+<br />
Causes of Abdominal Bloating<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Intestinal Disorders<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Motility Disorders<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Malabsorption disorders<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Infectious causes<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Dietary causes<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Misc.<br />
|-<br />
|[[Adhesions]]<br />
[[Malignancy]]<br />
|[[Diabetes]]<br />
<br />
[[Scleroderma]]<br />
<br />
Pseudo-obstruction<br />
<br />
Medications<br />
|[[Lactose intolerance]]<br />
[[Fructose intolerance]]<br />
<br />
[[Celiac disease]]<br />
<br />
[[Pancreatic insufficiency]]<br />
|[[Small intestinal bacterial overgrowth]]<br />
[[Giardiasis]]<br />
|Gas-producing foods<br />
FODMAPs<br />
|[[Irritable bowel syndrome]] <br /><br />
|}<br />
<br />
*<br />
<br />
==Complete Diagnostic Approach==<br />
Shown below is an algorithm summarizing the diagnosis of <nowiki>[[disease name]]</nowiki> according [...] guidelines.<br />
{{familytree/start |summary=PE diagnosis Algorithm.}}<br />
{{familytree | | | | A01 | | | A01= Patient with abdominal bloating and Distention }}<br />
{{familytree | | | | |!| | | | }}<br />
{{familytree | | | | B01 | | | B01= Look for the <br><br />
* Alarm signs<br />
*Overlapping functional gastrointestinal disorders<br />
*Bacterial overgrowth (Small intestine bacterial overgrowth)<br />
* Dietary intolerances<br />
*Celiac Disease<br />
* Weight gain <br />
*Constipation <br />
*Hydrogen breath test <br />
*Any pyschological comorbidities}}<br />
{{familytree | | |,|-|^|-|.| | }}<br />
{{familytree | | C01 | | C02 | C01= Yes | C02=No}}<br />
{{familytree | | |!| | | |!| | }}<br />
{{familytree | | C01 | | C02 | C01=<br />
* Reassurance the patient, recommend diaphragmatic breathing<br />
*Diet intervention: Low FODMAP diet <br />
*Iniate sympotmatic treatment such as peppermint oil or Simethicone | C02= Treat Accordingly}}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= *Trial of Rifaximin/Probiotics }}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= No Response }}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= Antidepressants<br />
*Psychological therapy<br />
*Hypnotherapy, Cognitive behavioral therapy (CBT)}}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= No Response }}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= <br />
*Referral to specialized Neurogastroenterology center <br />
*Referral for the CT/MRI Electromyography<br />
*Referral for the abdominal biofeedback therapy)}}<br />
{{familytree/end}}<br />
<br />
==Treatment==<br />
Shown below is an algorithm summarizing the treatment of <nowiki>[[disease name]]</nowiki> according the the [...] guidelines.<br />
{{familytree/start |summary=PE diagnosis Algorithm.}}<br />
{{familytree | | | | | | | | A01 |A01= Treatment of bloating is based on etiology of bloating.}} <br />
{{familytree | | | | | | | | |!| | | | | |}}<br />
{{familytree | | | | | | | |C01| | | | | |C01= Dietary changes are suggested for bloating <br />
*Diet<br />
*Exercise and posture<br />
*Over-the-counter medications<br />
*Probiotics<br />
*Antibiotics<br />
*Smooth muscle antispasmodics<br />
*Osmotic laxatives<br />
*Prokinetic agents<br />
*Chloride channel activators<br />
*Tricyclic antidepressants<br />
<br />
Are any warning signs present?<br />
*anemia,GI bleeding, weight loss>10% of the body weight, and family history of GI malignancy. }}<br />
{{familytree | | | | | | | | |!| | | | | | }}<br />
{{Family tree | | | | | |,|-|-|^|-|-|.| | }}<br />
{{Family tree | | | | | C01 | | | | C02 |C01= Yes| C02= No}}<br />
{{familytree | | | | | |!| | | | | |!| | | | }}<br />
{{familytree | | | | | |F01| | | |F02| | |F01= Treat accordingly<br><br />
*Labs<br />
*Endoscopy<br />
*Imaging|F02=Functional?}}<br />
{{familytree | | | | | | | | | | | | |!| | | }}<br />
{{familytree | | | | | | | | | | | | |!| | | | | | | }}<br />
{{familytree | | | |,|-|-|-|v|-|-|-|-|+|-|.| | }}<br />
{{familytree | | | |!| | | |!| | | | |!| |!| | }}<br />
{{familytree | | | D01 | | D02 | | D03 | | D04 | |D01=Constipation|D02=Functional dyspepsia|D03=Non-constipation IBS|D04=Bloating alone}}<br />
{{familytree | | | |`|-|-|-|^|-|-|+|-|-|-|-|-|'|}}<br />
{{familytree | | | | | | | | | | |!| | | | | | | | | }}<br />
{{familytree | | | | | | | | | | A02 | | | | | |A02= Lifestyle and nonspecific dietary advice.<br><br />
*Education about low FODMAP diet <br><br />
* Treat constipation aggressively and minimize bowel distention<br><br />
*Consider the use of Rifaximin<br />
*Consider probiotics, Psychological therapy, CBT and/or antidepressants<br><br />
*Consider Biodfeedback neuromodulation }}<br />
{{familytree/end}}<br />
<br />
==Do's==<br />
<br />
*Use of probiotics can help reduce bloating.<br />
*Antidepressants can help reducing the symptoms of IBS but the data is unclear over the reduction of bloating.<br />
*Hypnotherapy has been reported be useful in reducing symptoms of bloating .<br />
*Bowel training and diaphragmatic breathing have been useful in the management of bloating however the data is unclear.<br />
<br />
==Don'ts==<br />
<br />
*Artificial sweeteners containing sorbitol, mannitol, xylitol should be avoided.<br />
*Medications (anticholinergics, opiates, calcium blockers, antidepressants) should also be avoided as they have an effect on bloating.<br />
*Twenty percent of carbohydrates in baked beans and 7–10% in wheat, oats, potatoes, and corn, and 1% in white rice are not absorbed well in the intestine and they can produce bloating.<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
[[Category:Projects]]<br />
[[Category:Resident survival guide]]<br />
[[Category:Gastroenterology]]</div>
Usmanaliakbar
https://www.wikidoc.org/index.php?title=Bloating_resident_survival_guide&diff=1690304
Bloating resident survival guide
2021-02-17T19:32:42Z
<p>Usmanaliakbar: /* Overview */</p>
<hr />
<div>__NOTOC__<br />
<br />
{{CMG}} {{AE}} {{Usman Ali Akbar}}<br />
<br />
{{SK}}<br />
<br />
{| class="infobox" style="margin: 0 0 0 0; border: 0; float: right; width: 100px; background: #A8A8A8; position: fixed; top: 250px; right: 21px; border-radius: 0 0 10px 10px;" cellpadding="0" cellspacing="0" ;<br />
|-<br />
! style="padding: 0 5px; font-size: 85%; background: #A8A8A8" align="center" |{{fontcolor|#2B3B44|Bloating resident survival guide Microchapters}}<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Overview|Overview]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Causes|Causes]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#FIRE: Focused Initial Rapid Evaluation|FIRE]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Complete Diagnostic Approach|Diagnosis]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Treatment|Treatment]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Do's|Do's]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Don'ts|Don'ts]]<br />
|}<br />
<br />
==Overview==<br />
[[Bloating]] is one of the most common gastrointestinal complaints that is attributed by the patient as the subjective sensation of incorrectly perceived excess [[gas]]. There are multiple non-functional etiologies of abdominal bloating and distention. Primary functional abdominal distention (FABD) should be diagnosed as a single entity and it doesn't overlap with other functional gastrointestinal disorders. Rome IV diagnostic criteria mention the co-existence of mild abdominal pain and/or minor bowel movements. FABD can be treated with [[antispasmodic]] along with [[peppermint oil]] in [[randomized controlled trials]]. A stepwise approach is usually needed that counter the dietary interventions, [[microbiome]] modulation, and medical therapy in the management of FABD.<br />
<br />
==Causes==<br />
The causes of abdominal bloating are numerous and are managed according to the etiology.<br />
<br />
*<br />
<br />
{| class="wikitable"<br />
|+<br />
Causes of Abdominal Bloating<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Intestinal Disorders<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Motility Disorders<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Malabsorption disorders<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Infectious causes<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Dietary causes<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Misc.<br />
|-<br />
|Adhesions<br />
Malignancy<br />
|Diabetes<br />
<br />
Scleroderma<br />
<br />
Pseudo-obstruction<br />
<br />
Medications<br />
|Lactose intolerance<br />
Fructose intolerance<br />
<br />
Celiac disease<br />
<br />
Pancreatic insufficiency<br />
|Small intestinal bacterial overgrowth<br />
Giardiasis<br />
|Gas-producing foods<br />
FODMAPs<br />
|Irritable bowel syndrome <br /><br />
|}<br />
<br />
*<br />
<br />
==Complete Diagnostic Approach==<br />
Shown below is an algorithm summarizing the diagnosis of <nowiki>[[disease name]]</nowiki> according [...] guidelines.<br />
{{familytree/start |summary=PE diagnosis Algorithm.}}<br />
{{familytree | | | | A01 | | | A01= Patient with abdominal bloating and Distention }}<br />
{{familytree | | | | |!| | | | }}<br />
{{familytree | | | | B01 | | | B01= Look for the <br><br />
* Alarm signs<br />
*Overlapping functional gastrointestinal disorders<br />
*Bacterial overgrowth (Small intestine bacterial overgrowth)<br />
* Dietary intolerances<br />
*Celiac Disease<br />
* Weight gain <br />
*Constipation <br />
*Hydrogen breath test <br />
*Any pyschological comorbidities}}<br />
{{familytree | | |,|-|^|-|.| | }}<br />
{{familytree | | C01 | | C02 | C01= Yes | C02=No}}<br />
{{familytree | | |!| | | |!| | }}<br />
{{familytree | | C01 | | C02 | C01=<br />
* Reassurance the patient, recommend diaphragmatic breathing<br />
*Diet intervention: Low FODMAP diet <br />
*Iniate sympotmatic treatment such as peppermint oil or Simethicone | C02= Treat Accordingly}}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= *Trial of Rifaximin/Probiotics }}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= No Response }}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= Antidepressants<br />
*Psychological therapy<br />
*Hypnotherapy, Cognitive behavioral therapy (CBT)}}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= No Response }}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= <br />
*Referral to specialized Neurogastroenterology center <br />
*Referral for the CT/MRI Electromyography<br />
*Referral for the abdominal biofeedback therapy)}}<br />
{{familytree/end}}<br />
<br />
==Treatment==<br />
Shown below is an algorithm summarizing the treatment of <nowiki>[[disease name]]</nowiki> according the the [...] guidelines.<br />
{{familytree/start |summary=PE diagnosis Algorithm.}}<br />
{{familytree | | | | | | | | A01 |A01= Treatment of bloating is based on etiology of bloating.}} <br />
{{familytree | | | | | | | | |!| | | | | |}}<br />
{{familytree | | | | | | | |C01| | | | | |C01= Dietary changes are suggested for bloating <br />
*Diet<br />
*Exercise and posture<br />
*Over-the-counter medications<br />
*Probiotics<br />
*Antibiotics<br />
*Smooth muscle antispasmodics<br />
*Osmotic laxatives<br />
*Prokinetic agents<br />
*Chloride channel activators<br />
*Tricyclic antidepressants<br />
<br />
Are any warning signs present?<br />
*anemia,GI bleeding, weight loss>10% of the body weight, and family history of GI malignancy. }}<br />
{{familytree | | | | | | | | |!| | | | | | }}<br />
{{Family tree | | | | | |,|-|-|^|-|-|.| | }}<br />
{{Family tree | | | | | C01 | | | | C02 |C01= Yes| C02= No}}<br />
{{familytree | | | | | |!| | | | | |!| | | | }}<br />
{{familytree | | | | | |F01| | | |F02| | |F01= Treat accordingly<br><br />
*Labs<br />
*Endoscopy<br />
*Imaging|F02=Functional?}}<br />
{{familytree | | | | | | | | | | | | |!| | | }}<br />
{{familytree | | | | | | | | | | | | |!| | | | | | | }}<br />
{{familytree | | | |,|-|-|-|v|-|-|-|-|+|-|.| | }}<br />
{{familytree | | | |!| | | |!| | | | |!| |!| | }}<br />
{{familytree | | | D01 | | D02 | | D03 | | D04 | |D01=Constipation|D02=Functional dyspepsia|D03=Non-constipation IBS|D04=Bloating alone}}<br />
{{familytree | | | |`|-|-|-|^|-|-|+|-|-|-|-|-|'|}}<br />
{{familytree | | | | | | | | | | |!| | | | | | | | | }}<br />
{{familytree | | | | | | | | | | A02 | | | | | |A02= Lifestyle and nonspecific dietary advice.<br><br />
*Education about low FODMAP diet <br><br />
* Treat constipation aggressively and minimize bowel distention<br><br />
*Consider the use of Rifaximin<br />
*Consider probiotics, Psychological therapy, CBT and/or antidepressants<br><br />
*Consider Biodfeedback neuromodulation }}<br />
{{familytree/end}}<br />
<br />
==Do's==<br />
<br />
*Use of probiotics can help reduce bloating.<br />
*Antidepressants can help reducing the symptoms of IBS but the data is unclear over the reduction of bloating.<br />
*Hypnotherapy has been reported be useful in reducing symptoms of bloating .<br />
*Bowel training and diaphragmatic breathing have been useful in the management of bloating however the data is unclear.<br />
<br />
==Don'ts==<br />
<br />
*Artificial sweeteners containing sorbitol, mannitol, xylitol should be avoided.<br />
*Medications (anticholinergics, opiates, calcium blockers, antidepressants) should also be avoided as they have an effect on bloating.<br />
*Twenty percent of carbohydrates in baked beans and 7–10% in wheat, oats, potatoes, and corn, and 1% in white rice are not absorbed well in the intestine and they can produce bloating.<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
[[Category:Projects]]<br />
[[Category:Resident survival guide]]<br />
[[Category:Gastroenterology]]</div>
Usmanaliakbar
https://www.wikidoc.org/index.php?title=Bloating_resident_survival_guide&diff=1690291
Bloating resident survival guide
2021-02-17T18:59:39Z
<p>Usmanaliakbar: /* Complete Diagnostic Approach */</p>
<hr />
<div>__NOTOC__<br />
<br />
{{CMG}} {{AE}} {{Usman Ali Akbar}}<br />
<br />
{{SK}}<br />
<br />
{| class="infobox" style="margin: 0 0 0 0; border: 0; float: right; width: 100px; background: #A8A8A8; position: fixed; top: 250px; right: 21px; border-radius: 0 0 10px 10px;" cellpadding="0" cellspacing="0" ;<br />
|-<br />
! style="padding: 0 5px; font-size: 85%; background: #A8A8A8" align="center" |{{fontcolor|#2B3B44|Bloating resident survival guide Microchapters}}<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Overview|Overview]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Causes|Causes]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#FIRE: Focused Initial Rapid Evaluation|FIRE]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Complete Diagnostic Approach|Diagnosis]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Treatment|Treatment]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Do's|Do's]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Don'ts|Don'ts]]<br />
|}<br />
<br />
==Overview==<br />
Bloating is one of the most common gastrointestinal complaint that is attributed by the patient as subjective sensation of incorrectly perceived excess gas. There are multiple non-functional etiologies of abdominal bloating and distention. Primary functional abdominal distention (FABD) should be diagnosed as single entity and it doesn't overlap with other functional gastro-intestinal disorders. Rome IV diagnostic criteria mentions the co-existence of mild abdominal pain and/or minor bowel movements. FABD can be treated with antispasmodic along with peppermint oil in randomized controlled trials. A stepwise approach is usually needed that counter the dietary interventions,microbiome modulation and medical therapy in the management of FABD.<br />
<br />
==Causes==<br />
The causes of abdominal bloating are numerous and are managed according to the etiology.<br />
<br />
*<br />
<br />
{| class="wikitable"<br />
|+<br />
Causes of Abdominal Bloating<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Intestinal Disorders<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Motility Disorders<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Malabsorption disorders<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Infectious causes<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Dietary causes<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Misc.<br />
|-<br />
|Adhesions<br />
Malignancy<br />
|Diabetes<br />
<br />
Scleroderma<br />
<br />
Pseudo-obstruction<br />
<br />
Medications<br />
|Lactose intolerance<br />
Fructose intolerance<br />
<br />
Celiac disease<br />
<br />
Pancreatic insufficiency<br />
|Small intestinal bacterial overgrowth<br />
Giardiasis<br />
|Gas-producing foods<br />
FODMAPs<br />
|Irritable bowel syndrome <br /><br />
|}<br />
<br />
*<br />
<br />
==Complete Diagnostic Approach==<br />
Shown below is an algorithm summarizing the diagnosis of <nowiki>[[disease name]]</nowiki> according [...] guidelines.<br />
{{familytree/start |summary=PE diagnosis Algorithm.}}<br />
{{familytree | | | | A01 | | | A01= Patient with abdominal bloating and Distention }}<br />
{{familytree | | | | |!| | | | }}<br />
{{familytree | | | | B01 | | | B01= Look for the <br><br />
* Alarm signs<br />
*Overlapping functional gastrointestinal disorders<br />
*Bacterial overgrowth (Small intestine bacterial overgrowth)<br />
* Dietary intolerances<br />
*Celiac Disease<br />
* Weight gain <br />
*Constipation <br />
*Hydrogen breath test <br />
*Any pyschological comorbidities}}<br />
{{familytree | | |,|-|^|-|.| | }}<br />
{{familytree | | C01 | | C02 | C01= Yes | C02=No}}<br />
{{familytree | | |!| | | |!| | }}<br />
{{familytree | | C01 | | C02 | C01=<br />
* Reassurance the patient, recommend diaphragmatic breathing<br />
*Diet intervention: Low FODMAP diet <br />
*Iniate sympotmatic treatment such as peppermint oil or Simethicone | C02= Treat Accordingly}}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= *Trial of Rifaximin/Probiotics }}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= No Response }}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= Antidepressants<br />
*Psychological therapy<br />
*Hypnotherapy, Cognitive behavioral therapy (CBT)}}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= No Response }}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= <br />
*Referral to specialized Neurogastroenterology center <br />
*Referral for the CT/MRI Electromyography<br />
*Referral for the abdominal biofeedback therapy)}}<br />
{{familytree/end}}<br />
<br />
==Treatment==<br />
Shown below is an algorithm summarizing the treatment of <nowiki>[[disease name]]</nowiki> according the the [...] guidelines.<br />
{{familytree/start |summary=PE diagnosis Algorithm.}}<br />
{{familytree | | | | | | | | A01 |A01= Treatment of bloating is based on etiology of bloating.}} <br />
{{familytree | | | | | | | | |!| | | | | |}}<br />
{{familytree | | | | | | | |C01| | | | | |C01= Dietary changes are suggested for bloating <br />
*Diet<br />
*Exercise and posture<br />
*Over-the-counter medications<br />
*Probiotics<br />
*Antibiotics<br />
*Smooth muscle antispasmodics<br />
*Osmotic laxatives<br />
*Prokinetic agents<br />
*Chloride channel activators<br />
*Tricyclic antidepressants<br />
<br />
Are any warning signs present?<br />
*anemia,GI bleeding, weight loss>10% of the body weight, and family history of GI malignancy. }}<br />
{{familytree | | | | | | | | |!| | | | | | }}<br />
{{Family tree | | | | | |,|-|-|^|-|-|.| | }}<br />
{{Family tree | | | | | C01 | | | | C02 |C01= Yes| C02= No}}<br />
{{familytree | | | | | |!| | | | | |!| | | | }}<br />
{{familytree | | | | | |F01| | | |F02| | |F01= Treat accordingly<br><br />
*Labs<br />
*Endoscopy<br />
*Imaging|F02=Functional?}}<br />
{{familytree | | | | | | | | | | | | |!| | | }}<br />
{{familytree | | | | | | | | | | | | |!| | | | | | | }}<br />
{{familytree | | | |,|-|-|-|v|-|-|-|-|+|-|.| | }}<br />
{{familytree | | | |!| | | |!| | | | |!| |!| | }}<br />
{{familytree | | | D01 | | D02 | | D03 | | D04 | |D01=Constipation|D02=Functional dyspepsia|D03=Non-constipation IBS|D04=Bloating alone}}<br />
{{familytree | | | |`|-|-|-|^|-|-|+|-|-|-|-|-|'|}}<br />
{{familytree | | | | | | | | | | |!| | | | | | | | | }}<br />
{{familytree | | | | | | | | | | A02 | | | | | |A02= Lifestyle and nonspecific dietary advice.<br><br />
*Education about low FODMAP diet <br><br />
* Treat constipation aggressively and minimize bowel distention<br><br />
*Consider the use of Rifaximin<br />
*Consider probiotics, Psychological therapy, CBT and/or antidepressants<br><br />
*Consider Biodfeedback neuromodulation }}<br />
{{familytree/end}}<br />
<br />
==Do's==<br />
<br />
*Use of probiotics can help reduce bloating.<br />
*Antidepressants can help reducing the symptoms of IBS but the data is unclear over the reduction of bloating.<br />
*Hypnotherapy has been reported be useful in reducing symptoms of bloating .<br />
*Bowel training and diaphragmatic breathing have been useful in the management of bloating however the data is unclear.<br />
<br />
==Don'ts==<br />
<br />
*Artificial sweeteners containing sorbitol, mannitol, xylitol should be avoided.<br />
*Medications (anticholinergics, opiates, calcium blockers, antidepressants) should also be avoided as they have an effect on bloating.<br />
*Twenty percent of carbohydrates in baked beans and 7–10% in wheat, oats, potatoes, and corn, and 1% in white rice are not absorbed well in the intestine and they can produce bloating.<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
[[Category:Projects]]<br />
[[Category:Resident survival guide]]<br />
[[Category:Gastroenterology]]</div>
Usmanaliakbar
https://www.wikidoc.org/index.php?title=Bloating_resident_survival_guide&diff=1689122
Bloating resident survival guide
2021-02-08T16:12:14Z
<p>Usmanaliakbar: /* Don'ts */</p>
<hr />
<div>__NOTOC__<br />
<br />
{{CMG}} {{AE}} {{Usman Ali Akbar}}<br />
<br />
{{SK}}<br />
<br />
{| class="infobox" style="margin: 0 0 0 0; border: 0; float: right; width: 100px; background: #A8A8A8; position: fixed; top: 250px; right: 21px; border-radius: 0 0 10px 10px;" cellpadding="0" cellspacing="0" ;<br />
|-<br />
! style="padding: 0 5px; font-size: 85%; background: #A8A8A8" align="center" |{{fontcolor|#2B3B44|Bloating resident survival guide Microchapters}}<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Overview|Overview]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Causes|Causes]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#FIRE: Focused Initial Rapid Evaluation|FIRE]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Complete Diagnostic Approach|Diagnosis]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Treatment|Treatment]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Do's|Do's]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Don'ts|Don'ts]]<br />
|}<br />
<br />
==Overview==<br />
Bloating is one of the most common gastrointestinal complaint that is attributed by the patient as subjective sensation of incorrectly perceived excess gas. There are multiple non-functional etiologies of abdominal bloating and distention. Primary functional abdominal distention (FABD) should be diagnosed as single entity and it doesn't overlap with other functional gastro-intestinal disorders. Rome IV diagnostic criteria mentions the co-existence of mild abdominal pain and/or minor bowel movements. FABD can be treated with antispasmodic along with peppermint oil in randomized controlled trials. A stepwise approach is usually needed that counter the dietary interventions,microbiome modulation and medical therapy in the management of FABD.<br />
<br />
==Causes==<br />
The causes of abdominal bloating are numerous and are managed according to the etiology.<br />
<br />
*<br />
<br />
{| class="wikitable"<br />
|+<br />
Causes of Abdominal Bloating<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Intestinal Disorders<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Motility Disorders<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Malabsorption disorders<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Infectious causes<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Dietary causes<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Misc.<br />
|-<br />
|Adhesions<br />
Malignancy<br />
|Diabetes<br />
<br />
Scleroderma<br />
<br />
Pseudo-obstruction<br />
<br />
Medications<br />
|Lactose intolerance<br />
Fructose intolerance<br />
<br />
Celiac disease<br />
<br />
Pancreatic insufficiency<br />
|Small intestinal bacterial overgrowth<br />
Giardiasis<br />
|Gas-producing foods<br />
FODMAPs<br />
|Irritable bowel syndrome <br /><br />
|}<br />
<br />
*<br />
<br />
==Complete Diagnostic Approach==<br />
Shown below is an algorithm summarizing the diagnosis of <nowiki>[[disease name]]</nowiki> according [...] guidelines.<br />
{{familytree/start |summary=PE diagnosis Algorithm.}}<br />
{{familytree | | | | A01 | | | A01= Patient with abdominal bloating and Distention }}<br />
{{familytree | | | | |!| | | | }}<br />
{{familytree | | | | B01 | | | B01= Look for the <br><br />
* Alarm signs<br />
*Overlapping functional gastrointestinal disorders<br />
*Bacterial overgrowth (Small intestine bacterial overgrowth)<br />
* Dietary intolerances<br />
*Celiac Disease<br />
* Weight gain <br />
*Constipation <br />
*Any pyschological comorbidities}}<br />
{{familytree | | |,|-|^|-|.| | }}<br />
{{familytree | | C01 | | C02 | C01= Yes | C02=No}}<br />
{{familytree | | |!| | | |!| | }}<br />
{{familytree | | C01 | | C02 | C01=<br />
* Reassurance the patient, recommend diaphragmatic breathing<br />
*Diet intervention: Low FODMAP diet <br />
*Iniate sympotmatic treatment such as peppermint oil or Simethicone | C02= Treat Accordingly}}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= *Trial of Rifaximin/Probiotics }}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= No Response }}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= Antidepressants<br />
*Psychological therapy<br />
*Hypnotherapy, Cognitive behavioral therapy (CBT)}}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= No Response }}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= <br />
*Referral to specialized Neurogastroenterology center <br />
*Referral for the CT/MRI Electromyography<br />
*Referral for the abdominal biofeedback therapy)}}<br />
{{familytree/end}}<br />
<br />
==Treatment==<br />
Shown below is an algorithm summarizing the treatment of <nowiki>[[disease name]]</nowiki> according the the [...] guidelines.<br />
{{familytree/start |summary=PE diagnosis Algorithm.}}<br />
{{familytree | | | | | | | | A01 |A01= Treatment of bloating is based on etiology of bloating.}} <br />
{{familytree | | | | | | | | |!| | | | | |}}<br />
{{familytree | | | | | | | |C01| | | | | |C01= Dietary changes are suggested for bloating <br />
*Diet<br />
*Exercise and posture<br />
*Over-the-counter medications<br />
*Probiotics<br />
*Antibiotics<br />
*Smooth muscle antispasmodics<br />
*Osmotic laxatives<br />
*Prokinetic agents<br />
*Chloride channel activators<br />
*Tricyclic antidepressants<br />
<br />
Are any warning signs present?<br />
*anemia,GI bleeding, weight loss>10% of the body weight, and family history of GI malignancy. }}<br />
{{familytree | | | | | | | | |!| | | | | | }}<br />
{{Family tree | | | | | |,|-|-|^|-|-|.| | }}<br />
{{Family tree | | | | | C01 | | | | C02 |C01= Yes| C02= No}}<br />
{{familytree | | | | | |!| | | | | |!| | | | }}<br />
{{familytree | | | | | |F01| | | |F02| | |F01= Treat accordingly<br><br />
*Labs<br />
*Endoscopy<br />
*Imaging|F02=Functional?}}<br />
{{familytree | | | | | | | | | | | | |!| | | }}<br />
{{familytree | | | | | | | | | | | | |!| | | | | | | }}<br />
{{familytree | | | |,|-|-|-|v|-|-|-|-|+|-|.| | }}<br />
{{familytree | | | |!| | | |!| | | | |!| |!| | }}<br />
{{familytree | | | D01 | | D02 | | D03 | | D04 | |D01=Constipation|D02=Functional dyspepsia|D03=Non-constipation IBS|D04=Bloating alone}}<br />
{{familytree | | | |`|-|-|-|^|-|-|+|-|-|-|-|-|'|}}<br />
{{familytree | | | | | | | | | | |!| | | | | | | | | }}<br />
{{familytree | | | | | | | | | | A02 | | | | | |A02= Lifestyle and nonspecific dietary advice.<br><br />
*Education about low FODMAP diet <br><br />
* Treat constipation aggressively and minimize bowel distention<br><br />
*Consider the use of Rifaximin<br />
*Consider probiotics, Psychological therapy, CBT and/or antidepressants<br><br />
*Consider Biodfeedback neuromodulation }}<br />
{{familytree/end}}<br />
<br />
==Do's==<br />
<br />
*Use of probiotics can help reduce bloating.<br />
*Antidepressants can help reducing the symptoms of IBS but the data is unclear over the reduction of bloating.<br />
*Hypnotherapy has been reported be useful in reducing symptoms of bloating .<br />
*Bowel training and diaphragmatic breathing have been useful in the management of bloating however the data is unclear.<br />
<br />
==Don'ts==<br />
<br />
*Artificial sweeteners containing sorbitol, mannitol, xylitol should be avoided.<br />
*Medications (anticholinergics, opiates, calcium blockers, antidepressants) should also be avoided as they have an effect on bloating.<br />
*Twenty percent of carbohydrates in baked beans and 7–10% in wheat, oats, potatoes, and corn, and 1% in white rice are not absorbed well in the intestine and they can produce bloating.<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
[[Category:Projects]]<br />
[[Category:Resident survival guide]]<br />
[[Category:Gastroenterology]]</div>
Usmanaliakbar
https://www.wikidoc.org/index.php?title=Bloating_resident_survival_guide&diff=1689121
Bloating resident survival guide
2021-02-08T16:08:21Z
<p>Usmanaliakbar: /* Do's */</p>
<hr />
<div>__NOTOC__<br />
<br />
{{CMG}} {{AE}} {{Usman Ali Akbar}}<br />
<br />
{{SK}}<br />
<br />
{| class="infobox" style="margin: 0 0 0 0; border: 0; float: right; width: 100px; background: #A8A8A8; position: fixed; top: 250px; right: 21px; border-radius: 0 0 10px 10px;" cellpadding="0" cellspacing="0" ;<br />
|-<br />
! style="padding: 0 5px; font-size: 85%; background: #A8A8A8" align="center" |{{fontcolor|#2B3B44|Bloating resident survival guide Microchapters}}<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Overview|Overview]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Causes|Causes]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#FIRE: Focused Initial Rapid Evaluation|FIRE]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Complete Diagnostic Approach|Diagnosis]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Treatment|Treatment]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Do's|Do's]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Don'ts|Don'ts]]<br />
|}<br />
<br />
==Overview==<br />
Bloating is one of the most common gastrointestinal complaint that is attributed by the patient as subjective sensation of incorrectly perceived excess gas. There are multiple non-functional etiologies of abdominal bloating and distention. Primary functional abdominal distention (FABD) should be diagnosed as single entity and it doesn't overlap with other functional gastro-intestinal disorders. Rome IV diagnostic criteria mentions the co-existence of mild abdominal pain and/or minor bowel movements. FABD can be treated with antispasmodic along with peppermint oil in randomized controlled trials. A stepwise approach is usually needed that counter the dietary interventions,microbiome modulation and medical therapy in the management of FABD.<br />
<br />
==Causes==<br />
The causes of abdominal bloating are numerous and are managed according to the etiology.<br />
<br />
*<br />
<br />
{| class="wikitable"<br />
|+<br />
Causes of Abdominal Bloating<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Intestinal Disorders<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Motility Disorders<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Malabsorption disorders<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Infectious causes<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Dietary causes<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Misc.<br />
|-<br />
|Adhesions<br />
Malignancy<br />
|Diabetes<br />
<br />
Scleroderma<br />
<br />
Pseudo-obstruction<br />
<br />
Medications<br />
|Lactose intolerance<br />
Fructose intolerance<br />
<br />
Celiac disease<br />
<br />
Pancreatic insufficiency<br />
|Small intestinal bacterial overgrowth<br />
Giardiasis<br />
|Gas-producing foods<br />
FODMAPs<br />
|Irritable bowel syndrome <br /><br />
|}<br />
<br />
*<br />
<br />
==Complete Diagnostic Approach==<br />
Shown below is an algorithm summarizing the diagnosis of <nowiki>[[disease name]]</nowiki> according [...] guidelines.<br />
{{familytree/start |summary=PE diagnosis Algorithm.}}<br />
{{familytree | | | | A01 | | | A01= Patient with abdominal bloating and Distention }}<br />
{{familytree | | | | |!| | | | }}<br />
{{familytree | | | | B01 | | | B01= Look for the <br><br />
* Alarm signs<br />
*Overlapping functional gastrointestinal disorders<br />
*Bacterial overgrowth (Small intestine bacterial overgrowth)<br />
* Dietary intolerances<br />
*Celiac Disease<br />
* Weight gain <br />
*Constipation <br />
*Any pyschological comorbidities}}<br />
{{familytree | | |,|-|^|-|.| | }}<br />
{{familytree | | C01 | | C02 | C01= Yes | C02=No}}<br />
{{familytree | | |!| | | |!| | }}<br />
{{familytree | | C01 | | C02 | C01=<br />
* Reassurance the patient, recommend diaphragmatic breathing<br />
*Diet intervention: Low FODMAP diet <br />
*Iniate sympotmatic treatment such as peppermint oil or Simethicone | C02= Treat Accordingly}}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= *Trial of Rifaximin/Probiotics }}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= No Response }}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= Antidepressants<br />
*Psychological therapy<br />
*Hypnotherapy, Cognitive behavioral therapy (CBT)}}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= No Response }}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= <br />
*Referral to specialized Neurogastroenterology center <br />
*Referral for the CT/MRI Electromyography<br />
*Referral for the abdominal biofeedback therapy)}}<br />
{{familytree/end}}<br />
<br />
==Treatment==<br />
Shown below is an algorithm summarizing the treatment of <nowiki>[[disease name]]</nowiki> according the the [...] guidelines.<br />
{{familytree/start |summary=PE diagnosis Algorithm.}}<br />
{{familytree | | | | | | | | A01 |A01= Treatment of bloating is based on etiology of bloating.}} <br />
{{familytree | | | | | | | | |!| | | | | |}}<br />
{{familytree | | | | | | | |C01| | | | | |C01= Dietary changes are suggested for bloating <br />
*Diet<br />
*Exercise and posture<br />
*Over-the-counter medications<br />
*Probiotics<br />
*Antibiotics<br />
*Smooth muscle antispasmodics<br />
*Osmotic laxatives<br />
*Prokinetic agents<br />
*Chloride channel activators<br />
*Tricyclic antidepressants<br />
<br />
Are any warning signs present?<br />
*anemia,GI bleeding, weight loss>10% of the body weight, and family history of GI malignancy. }}<br />
{{familytree | | | | | | | | |!| | | | | | }}<br />
{{Family tree | | | | | |,|-|-|^|-|-|.| | }}<br />
{{Family tree | | | | | C01 | | | | C02 |C01= Yes| C02= No}}<br />
{{familytree | | | | | |!| | | | | |!| | | | }}<br />
{{familytree | | | | | |F01| | | |F02| | |F01= Treat accordingly<br><br />
*Labs<br />
*Endoscopy<br />
*Imaging|F02=Functional?}}<br />
{{familytree | | | | | | | | | | | | |!| | | }}<br />
{{familytree | | | | | | | | | | | | |!| | | | | | | }}<br />
{{familytree | | | |,|-|-|-|v|-|-|-|-|+|-|.| | }}<br />
{{familytree | | | |!| | | |!| | | | |!| |!| | }}<br />
{{familytree | | | D01 | | D02 | | D03 | | D04 | |D01=Constipation|D02=Functional dyspepsia|D03=Non-constipation IBS|D04=Bloating alone}}<br />
{{familytree | | | |`|-|-|-|^|-|-|+|-|-|-|-|-|'|}}<br />
{{familytree | | | | | | | | | | |!| | | | | | | | | }}<br />
{{familytree | | | | | | | | | | A02 | | | | | |A02= Lifestyle and nonspecific dietary advice.<br><br />
*Education about low FODMAP diet <br><br />
* Treat constipation aggressively and minimize bowel distention<br><br />
*Consider the use of Rifaximin<br />
*Consider probiotics, Psychological therapy, CBT and/or antidepressants<br><br />
*Consider Biodfeedback neuromodulation }}<br />
{{familytree/end}}<br />
<br />
==Do's==<br />
<br />
*Use of probiotics can help reduce bloating.<br />
*Antidepressants can help reducing the symptoms of IBS but the data is unclear over the reduction of bloating.<br />
*Hypnotherapy has been reported be useful in reducing symptoms of bloating .<br />
*Bowel training and diaphragmatic breathing have been useful in the management of bloating however the data is unclear. <br />
<br />
==Don'ts==<br />
<br />
*Artificial sweeteners containing sorbitol, mannitol, xylitol should be avoided<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
[[Category:Projects]]<br />
[[Category:Resident survival guide]]<br />
[[Category:Gastroenterology]]</div>
Usmanaliakbar
https://www.wikidoc.org/index.php?title=Bloating_resident_survival_guide&diff=1689120
Bloating resident survival guide
2021-02-08T15:57:06Z
<p>Usmanaliakbar: /* Treatment */</p>
<hr />
<div>__NOTOC__<br />
<br />
{{CMG}} {{AE}} {{Usman Ali Akbar}}<br />
<br />
{{SK}}<br />
<br />
{| class="infobox" style="margin: 0 0 0 0; border: 0; float: right; width: 100px; background: #A8A8A8; position: fixed; top: 250px; right: 21px; border-radius: 0 0 10px 10px;" cellpadding="0" cellspacing="0" ;<br />
|-<br />
! style="padding: 0 5px; font-size: 85%; background: #A8A8A8" align="center" |{{fontcolor|#2B3B44|Bloating resident survival guide Microchapters}}<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Overview|Overview]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Causes|Causes]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#FIRE: Focused Initial Rapid Evaluation|FIRE]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Complete Diagnostic Approach|Diagnosis]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Treatment|Treatment]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Do's|Do's]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Don'ts|Don'ts]]<br />
|}<br />
<br />
==Overview==<br />
Bloating is one of the most common gastrointestinal complaint that is attributed by the patient as subjective sensation of incorrectly perceived excess gas. There are multiple non-functional etiologies of abdominal bloating and distention. Primary functional abdominal distention (FABD) should be diagnosed as single entity and it doesn't overlap with other functional gastro-intestinal disorders. Rome IV diagnostic criteria mentions the co-existence of mild abdominal pain and/or minor bowel movements. FABD can be treated with antispasmodic along with peppermint oil in randomized controlled trials. A stepwise approach is usually needed that counter the dietary interventions,microbiome modulation and medical therapy in the management of FABD.<br />
<br />
==Causes==<br />
The causes of abdominal bloating are numerous and are managed according to the etiology.<br />
<br />
*<br />
<br />
{| class="wikitable"<br />
|+<br />
Causes of Abdominal Bloating<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" +|Intestinal Disorders<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" +|Motility Disorders<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" +|Malabsorption disorders<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" +|Infectious causes<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" +|Dietary causes<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" +|Misc.<br />
|-<br />
|Adhesions<br />
Malignancy<br />
|Diabetes<br />
<br />
Scleroderma<br />
<br />
Pseudo-obstruction<br />
<br />
Medications<br />
|Lactose intolerance<br />
Fructose intolerance<br />
<br />
Celiac disease<br />
<br />
Pancreatic insufficiency<br />
|Small intestinal bacterial overgrowth<br />
Giardiasis<br />
|Gas-producing foods<br />
FODMAPs<br />
|Irritable bowel syndrome <br /><br />
|}<br />
<br />
*<br />
==Complete Diagnostic Approach==<br />
Shown below is an algorithm summarizing the diagnosis of <nowiki>[[disease name]]</nowiki> according [...] guidelines.<br />
{{familytree/start |summary=PE diagnosis Algorithm.}}<br />
{{familytree | | | | A01 | | | A01= Patient with abdominal bloating and Distention }}<br />
{{familytree | | | | |!| | | | }}<br />
{{familytree | | | | B01 | | | B01= Look for the <br><br />
* Alarm signs<br />
*Overlapping functional gastrointestinal disorders<br />
*Bacterial overgrowth (Small intestine bacterial overgrowth)<br />
* Dietary intolerances<br />
*Celiac Disease<br />
* Weight gain <br />
*Constipation <br />
*Any pyschological comorbidities}}<br />
{{familytree | | |,|-|^|-|.| | }}<br />
{{familytree | | C01 | | C02 | C01= Yes | C02=No}}<br />
{{familytree | | |!| | | |!| | }}<br />
{{familytree | | C01 | | C02 | C01=<br />
* Reassurance the patient, recommend diaphragmatic breathing<br />
*Diet intervention: Low FODMAP diet <br />
*Iniate sympotmatic treatment such as peppermint oil or Simethicone | C02= Treat Accordingly}}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= *Trial of Rifaximin/Probiotics }}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= No Response }}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= Antidepressants<br />
*Psychological therapy<br />
*Hypnotherapy, Cognitive behavioral therapy (CBT)}}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= No Response }}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= <br />
*Referral to specialized Neurogastroenterology center <br />
*Referral for the CT/MRI Electromyography<br />
*Referral for the abdominal biofeedback therapy)}}<br />
{{familytree/end}}<br />
<br />
==Treatment==<br />
Shown below is an algorithm summarizing the treatment of <nowiki>[[disease name]]</nowiki> according the the [...] guidelines.<br />
{{familytree/start |summary=PE diagnosis Algorithm.}}<br />
{{familytree | | | | | | | | A01 |A01= Treatment of bloating is based on etiology of bloating.}} <br />
{{familytree | | | | | | | | |!| | | | | |}}<br />
{{familytree | | | | | | | |C01| | | | | |C01= Dietary changes are suggested for bloating <br />
*Diet<br />
*Exercise and posture<br />
*Over-the-counter medications<br />
*Probiotics<br />
*Antibiotics<br />
*Smooth muscle antispasmodics<br />
*Osmotic laxatives<br />
*Prokinetic agents<br />
*Chloride channel activators<br />
*Tricyclic antidepressants<br />
<br />
Are any warning signs present?<br />
*anemia,GI bleeding, weight loss>10% of the body weight, and family history of GI malignancy. }}<br />
{{familytree | | | | | | | | |!| | | | | | }}<br />
{{Family tree | | | | | |,|-|-|^|-|-|.| | }}<br />
{{Family tree | | | | | C01 | | | | C02 |C01= Yes| C02= No}}<br />
{{familytree | | | | | |!| | | | | |!| | | | }}<br />
{{familytree | | | | | |F01| | | |F02| | |F01= Treat accordingly<br><br />
*Labs<br />
*Endoscopy<br />
*Imaging|F02=Functional?}}<br />
{{familytree | | | | | | | | | | | | |!| | | }}<br />
{{familytree | | | | | | | | | | | | |!| | | | | | | }}<br />
{{familytree | | | |,|-|-|-|v|-|-|-|-|+|-|.| | }}<br />
{{familytree | | | |!| | | |!| | | | |!| |!| | }}<br />
{{familytree | | | D01 | | D02 | | D03 | | D04 | |D01=Constipation|D02=Functional dyspepsia|D03=Non-constipation IBS|D04=Bloating alone}}<br />
{{familytree | | | |`|-|-|-|^|-|-|+|-|-|-|-|-|'|}}<br />
{{familytree | | | | | | | | | | |!| | | | | | | | | }}<br />
{{familytree | | | | | | | | | | A02 | | | | | |A02= Lifestyle and nonspecific dietary advice.<br><br />
*Education about low FODMAP diet <br><br />
* Treat constipation aggressively and minimize bowel distention<br><br />
*Consider the use of Rifaximin<br />
*Consider probiotics, Psychological therapy, CBT and/or antidepressants<br><br />
*Consider Biodfeedback neuromodulation }}<br />
{{familytree/end}}<br />
<br />
==Do's==<br />
<br />
*The content in this section is in bullet points.<br />
<br />
==Don'ts==<br />
<br />
*The content in this section is in bullet points.<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
[[Category:Projects]]<br />
[[Category:Resident survival guide]]<br />
[[Category:Gastroenterology]]</div>
Usmanaliakbar
https://www.wikidoc.org/index.php?title=Bloating_resident_survival_guide&diff=1688300
Bloating resident survival guide
2021-02-02T14:33:20Z
<p>Usmanaliakbar: /* Treatment */</p>
<hr />
<div>__NOTOC__<br />
<br />
{{CMG}} {{AE}} {{Usman Ali Akbar}}<br />
<br />
{{SK}}<br />
<br />
{| class="infobox" style="margin: 0 0 0 0; border: 0; float: right; width: 100px; background: #A8A8A8; position: fixed; top: 250px; right: 21px; border-radius: 0 0 10px 10px;" cellpadding="0" cellspacing="0" ;<br />
|-<br />
! style="padding: 0 5px; font-size: 85%; background: #A8A8A8" align="center" |{{fontcolor|#2B3B44|Bloating resident survival guide Microchapters}}<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Overview|Overview]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Causes|Causes]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#FIRE: Focused Initial Rapid Evaluation|FIRE]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Complete Diagnostic Approach|Diagnosis]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Treatment|Treatment]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Do's|Do's]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Don'ts|Don'ts]]<br />
|}<br />
<br />
==Overview==<br />
Bloating is one of the most common gastrointestinal complaint that is attributed by the patient as subjective sensation of incorrectly perceived excess gas. There are multiple non-functional etiologies of abdominal bloating and distention. Primary functional abdominal distention (FABD) should be diagnosed as single entity and it doesn't overlap with other functional gastro-intestinal disorders. Rome IV diagnostic criteria mentions the co-existence of mild abdominal pain and/or minor bowel movements. FABD can be treated with antispasmodic along with peppermint oil in randomized controlled trials. A stepwise approach is usually needed that counter the dietary interventions,microbiome modulation and medical therapy in the management of FABD.<br />
<br />
==Causes==<br />
The causes of abdominal bloating are numerous and are managed according to the etiology.<br />
<br />
*<br />
<br />
{| class="wikitable"<br />
|+<br />
Causes of Abdominal Bloating<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" +|Intestinal Disorders<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" +|Motility Disorders<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" +|Malabsorption disorders<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" +|Infectious causes<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" +|Dietary causes<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" +|Misc.<br />
|-<br />
|Adhesions<br />
Malignancy<br />
|Diabetes<br />
<br />
Scleroderma<br />
<br />
Pseudo-obstruction<br />
<br />
Medications<br />
|Lactose intolerance<br />
Fructose intolerance<br />
<br />
Celiac disease<br />
<br />
Pancreatic insufficiency<br />
|Small intestinal bacterial overgrowth<br />
Giardiasis<br />
|Gas-producing foods<br />
FODMAPs<br />
|Irritable bowel syndrome <br /><br />
|}<br />
<br />
*<br />
==Complete Diagnostic Approach==<br />
Shown below is an algorithm summarizing the diagnosis of <nowiki>[[disease name]]</nowiki> according [...] guidelines.<br />
{{familytree/start |summary=PE diagnosis Algorithm.}}<br />
{{familytree | | | | A01 | | | A01= Patient with abdominal bloating and Distention }}<br />
{{familytree | | | | |!| | | | }}<br />
{{familytree | | | | B01 | | | B01= Look for the <br><br />
* Alarm signs<br />
*Overlapping functional gastrointestinal disorders<br />
*Bacterial overgrowth (Small intestine bacterial overgrowth)<br />
* Dietary intolerances<br />
*Celiac Disease<br />
* Weight gain <br />
*Constipation <br />
*Any pyschological comorbidities}}<br />
{{familytree | | |,|-|^|-|.| | }}<br />
{{familytree | | C01 | | C02 | C01= Yes | C02=No}}<br />
{{familytree | | |!| | | |!| | }}<br />
{{familytree | | C01 | | C02 | C01=<br />
* Reassurance the patient, recommend diaphragmatic breathing<br />
*Diet intervention: Low FODMAP diet <br />
*Iniate sympotmatic treatment such as peppermint oil or Simethicone | C02= Treat Accordingly}}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= *Trial of Rifaximin/Probiotics }}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= No Response }}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= Antidepressants<br />
*Psychological therapy<br />
*Hypnotherapy, Cognitive behavioral therapy (CBT)}}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= No Response }}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= <br />
*Referral to specialized Neurogastroenterology center <br />
*Referral for the CT/MRI Electromyography<br />
*Referral for the abdominal biofeedback therapy)}}<br />
{{familytree/end}}<br />
<br />
==Treatment==<br />
Shown below is an algorithm summarizing the treatment of <nowiki>[[disease name]]</nowiki> according the the [...] guidelines.<br />
{{familytree/start |summary=PE diagnosis Algorithm.}}<br />
{{familytree | | | | | | | | A01 |A01= Treatment of bloating is based on etiology of bloating.}} <br />
{{familytree | | | | | | | | |!| | | | | | }}<br />
{{familytree | | | | | | | |C01| | | | | |C01= Dietary changes are suggested for bloating <br />
*Diet<br />
*Exercise and posture<br />
*Over-the-counter medications<br />
*Probiotics<br />
*Antibiotics<br />
*Smooth muscle antispasmodics<br />
*Osmotic laxatives<br />
*Prokinetic agents<br />
*Chloride channel activators<br />
*Tricyclic antidepressants}}<br />
<br />
{{familytree/end}}<br />
<br />
==Do's==<br />
<br />
*The content in this section is in bullet points.<br />
<br />
==Don'ts==<br />
<br />
*The content in this section is in bullet points.<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
[[Category:Projects]]<br />
[[Category:Resident survival guide]]<br />
[[Category:Gastroenterology]]</div>
Usmanaliakbar
https://www.wikidoc.org/index.php?title=Bloating_resident_survival_guide&diff=1688299
Bloating resident survival guide
2021-02-02T14:32:27Z
<p>Usmanaliakbar: /* Treatment */</p>
<hr />
<div>__NOTOC__<br />
<br />
{{CMG}} {{AE}} {{Usman Ali Akbar}}<br />
<br />
{{SK}}<br />
<br />
{| class="infobox" style="margin: 0 0 0 0; border: 0; float: right; width: 100px; background: #A8A8A8; position: fixed; top: 250px; right: 21px; border-radius: 0 0 10px 10px;" cellpadding="0" cellspacing="0" ;<br />
|-<br />
! style="padding: 0 5px; font-size: 85%; background: #A8A8A8" align="center" |{{fontcolor|#2B3B44|Bloating resident survival guide Microchapters}}<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Overview|Overview]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Causes|Causes]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#FIRE: Focused Initial Rapid Evaluation|FIRE]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Complete Diagnostic Approach|Diagnosis]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Treatment|Treatment]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Do's|Do's]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Don'ts|Don'ts]]<br />
|}<br />
<br />
==Overview==<br />
Bloating is one of the most common gastrointestinal complaint that is attributed by the patient as subjective sensation of incorrectly perceived excess gas. There are multiple non-functional etiologies of abdominal bloating and distention. Primary functional abdominal distention (FABD) should be diagnosed as single entity and it doesn't overlap with other functional gastro-intestinal disorders. Rome IV diagnostic criteria mentions the co-existence of mild abdominal pain and/or minor bowel movements. FABD can be treated with antispasmodic along with peppermint oil in randomized controlled trials. A stepwise approach is usually needed that counter the dietary interventions,microbiome modulation and medical therapy in the management of FABD.<br />
<br />
==Causes==<br />
The causes of abdominal bloating are numerous and are managed according to the etiology.<br />
<br />
*<br />
<br />
{| class="wikitable"<br />
|+<br />
Causes of Abdominal Bloating<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" +|Intestinal Disorders<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" +|Motility Disorders<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" +|Malabsorption disorders<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" +|Infectious causes<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" +|Dietary causes<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" +|Misc.<br />
|-<br />
|Adhesions<br />
Malignancy<br />
|Diabetes<br />
<br />
Scleroderma<br />
<br />
Pseudo-obstruction<br />
<br />
Medications<br />
|Lactose intolerance<br />
Fructose intolerance<br />
<br />
Celiac disease<br />
<br />
Pancreatic insufficiency<br />
|Small intestinal bacterial overgrowth<br />
Giardiasis<br />
|Gas-producing foods<br />
FODMAPs<br />
|Irritable bowel syndrome <br /><br />
|}<br />
<br />
*<br />
==Complete Diagnostic Approach==<br />
Shown below is an algorithm summarizing the diagnosis of <nowiki>[[disease name]]</nowiki> according [...] guidelines.<br />
{{familytree/start |summary=PE diagnosis Algorithm.}}<br />
{{familytree | | | | A01 | | | A01= Patient with abdominal bloating and Distention }}<br />
{{familytree | | | | |!| | | | }}<br />
{{familytree | | | | B01 | | | B01= Look for the <br><br />
* Alarm signs<br />
*Overlapping functional gastrointestinal disorders<br />
*Bacterial overgrowth (Small intestine bacterial overgrowth)<br />
* Dietary intolerances<br />
*Celiac Disease<br />
* Weight gain <br />
*Constipation <br />
*Any pyschological comorbidities}}<br />
{{familytree | | |,|-|^|-|.| | }}<br />
{{familytree | | C01 | | C02 | C01= Yes | C02=No}}<br />
{{familytree | | |!| | | |!| | }}<br />
{{familytree | | C01 | | C02 | C01=<br />
* Reassurance the patient, recommend diaphragmatic breathing<br />
*Diet intervention: Low FODMAP diet <br />
*Iniate sympotmatic treatment such as peppermint oil or Simethicone | C02= Treat Accordingly}}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= *Trial of Rifaximin/Probiotics }}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= No Response }}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= Antidepressants<br />
*Psychological therapy<br />
*Hypnotherapy, Cognitive behavioral therapy (CBT)}}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= No Response }}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= <br />
*Referral to specialized Neurogastroenterology center <br />
*Referral for the CT/MRI Electromyography<br />
*Referral for the abdominal biofeedback therapy)}}<br />
{{familytree/end}}<br />
<br />
==Treatment==<br />
Shown below is an algorithm summarizing the treatment of <nowiki>[[disease name]]</nowiki> according the the [...] guidelines.<br />
{{familytree/start |summary=PE diagnosis Algorithm.}}<br />
{{familytree | | | | | | | | A01 |A01= Treatment of bloating is based on etiology of bloating.}} <br />
{{familytree | | | | | | | | |!| | | | | | }}<br />
{{familytree | | | C01 | | | | | | | | | | |C01= Dietary changes are suggested for bloating <br />
*Diet<br />
*Exercise and posture<br />
*Over-the-counter medications<br />
*Probiotics<br />
*Antibiotics<br />
*Smooth muscle antispasmodics<br />
*Osmotic laxatives<br />
*Prokinetic agents<br />
*Chloride channel activators<br />
*Tricyclic antidepressants}}<br />
<br />
{{familytree/end}}<br />
<br />
==Do's==<br />
<br />
*The content in this section is in bullet points.<br />
<br />
==Don'ts==<br />
<br />
*The content in this section is in bullet points.<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
[[Category:Projects]]<br />
[[Category:Resident survival guide]]<br />
[[Category:Gastroenterology]]</div>
Usmanaliakbar
https://www.wikidoc.org/index.php?title=Bloating_resident_survival_guide&diff=1688298
Bloating resident survival guide
2021-02-02T14:26:31Z
<p>Usmanaliakbar: </p>
<hr />
<div>__NOTOC__<br />
<br />
{{CMG}} {{AE}} {{Usman Ali Akbar}}<br />
<br />
{{SK}}<br />
<br />
{| class="infobox" style="margin: 0 0 0 0; border: 0; float: right; width: 100px; background: #A8A8A8; position: fixed; top: 250px; right: 21px; border-radius: 0 0 10px 10px;" cellpadding="0" cellspacing="0" ;<br />
|-<br />
! style="padding: 0 5px; font-size: 85%; background: #A8A8A8" align="center" |{{fontcolor|#2B3B44|Bloating resident survival guide Microchapters}}<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Overview|Overview]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Causes|Causes]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#FIRE: Focused Initial Rapid Evaluation|FIRE]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Complete Diagnostic Approach|Diagnosis]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Treatment|Treatment]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Do's|Do's]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Don'ts|Don'ts]]<br />
|}<br />
<br />
==Overview==<br />
Bloating is one of the most common gastrointestinal complaint that is attributed by the patient as subjective sensation of incorrectly perceived excess gas. There are multiple non-functional etiologies of abdominal bloating and distention. Primary functional abdominal distention (FABD) should be diagnosed as single entity and it doesn't overlap with other functional gastro-intestinal disorders. Rome IV diagnostic criteria mentions the co-existence of mild abdominal pain and/or minor bowel movements. FABD can be treated with antispasmodic along with peppermint oil in randomized controlled trials. A stepwise approach is usually needed that counter the dietary interventions,microbiome modulation and medical therapy in the management of FABD.<br />
<br />
==Causes==<br />
The causes of abdominal bloating are numerous and are managed according to the etiology.<br />
<br />
*<br />
<br />
{| class="wikitable"<br />
|+<br />
Causes of Abdominal Bloating<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" +|Intestinal Disorders<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" +|Motility Disorders<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" +|Malabsorption disorders<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" +|Infectious causes<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" +|Dietary causes<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" +|Misc.<br />
|-<br />
|Adhesions<br />
Malignancy<br />
|Diabetes<br />
<br />
Scleroderma<br />
<br />
Pseudo-obstruction<br />
<br />
Medications<br />
|Lactose intolerance<br />
Fructose intolerance<br />
<br />
Celiac disease<br />
<br />
Pancreatic insufficiency<br />
|Small intestinal bacterial overgrowth<br />
Giardiasis<br />
|Gas-producing foods<br />
FODMAPs<br />
|Irritable bowel syndrome <br /><br />
|}<br />
<br />
*<br />
==Complete Diagnostic Approach==<br />
Shown below is an algorithm summarizing the diagnosis of <nowiki>[[disease name]]</nowiki> according [...] guidelines.<br />
{{familytree/start |summary=PE diagnosis Algorithm.}}<br />
{{familytree | | | | A01 | | | A01= Patient with abdominal bloating and Distention }}<br />
{{familytree | | | | |!| | | | }}<br />
{{familytree | | | | B01 | | | B01= Look for the <br><br />
* Alarm signs<br />
*Overlapping functional gastrointestinal disorders<br />
*Bacterial overgrowth (Small intestine bacterial overgrowth)<br />
* Dietary intolerances<br />
*Celiac Disease<br />
* Weight gain <br />
*Constipation <br />
*Any pyschological comorbidities}}<br />
{{familytree | | |,|-|^|-|.| | }}<br />
{{familytree | | C01 | | C02 | C01= Yes | C02=No}}<br />
{{familytree | | |!| | | |!| | }}<br />
{{familytree | | C01 | | C02 | C01=<br />
* Reassurance the patient, recommend diaphragmatic breathing<br />
*Diet intervention: Low FODMAP diet <br />
*Iniate sympotmatic treatment such as peppermint oil or Simethicone | C02= Treat Accordingly}}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= *Trial of Rifaximin/Probiotics }}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= No Response }}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= Antidepressants<br />
*Psychological therapy<br />
*Hypnotherapy, Cognitive behavioral therapy (CBT)}}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= No Response }}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= <br />
*Referral to specialized Neurogastroenterology center <br />
*Referral for the CT/MRI Electromyography<br />
*Referral for the abdominal biofeedback therapy)}}<br />
{{familytree/end}}<br />
<br />
==Treatment==<br />
Shown below is an algorithm summarizing the treatment of <nowiki>[[disease name]]</nowiki> according the the [...] guidelines.<br />
{{familytree/start |summary=PE diagnosis Algorithm.}}<br />
{{familytree | | | | | | | | A01 |A01= }} <br />
{{familytree | | | | |,|-|-|-|^|-|-|-|-|.| | | }}<br />
{{familytree | | | B01 | | | | | | | | B02 | | |B01= |B02= }}<br />
{{familytree | | | |!| | | | | | | | | |!| }}<br />
{{familytree | | | C01 | | | | | | | | |!| |C01= }}<br />
{{familytree | |,|-|^|.| | | | | | | | |!| }}<br />
{{familytree | D01 | | D02 | | | | | | D03 |D01= |D02= |D03= }}<br />
{{familytree | |!| | | | | | | | | |,|-|^|.| }}<br />
{{familytree | E01 | | | | | | | E02 | | | E03 |E01= |E02= |E03= }}<br />
{{familytree | | | | | | | | | | |!| | | | |!| }}<br />
{{familytree | | | | | | | | | | F01 | | | F02 |F01= |F02= }}<br />
{{familytree/end}}<br />
<br />
==Do's==<br />
<br />
*The content in this section is in bullet points.<br />
<br />
==Don'ts==<br />
<br />
*The content in this section is in bullet points.<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
[[Category:Projects]]<br />
[[Category:Resident survival guide]]<br />
[[Category:Gastroenterology]]</div>
Usmanaliakbar
https://www.wikidoc.org/index.php?title=Bloating_resident_survival_guide&diff=1688297
Bloating resident survival guide
2021-02-02T14:12:41Z
<p>Usmanaliakbar: /* Complete Diagnostic Approach */</p>
<hr />
<div>__NOTOC__<br />
<br />
{{CMG}} {{AE}} {{Usman Ali Akbar}}<br />
<br />
{{SK}}<br />
<br />
{| class="infobox" style="margin: 0 0 0 0; border: 0; float: right; width: 100px; background: #A8A8A8; position: fixed; top: 250px; right: 21px; border-radius: 0 0 10px 10px;" cellpadding="0" cellspacing="0" ;<br />
|-<br />
! style="padding: 0 5px; font-size: 85%; background: #A8A8A8" align="center" |{{fontcolor|#2B3B44|Bloating resident survival guide Microchapters}}<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Overview|Overview]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Causes|Causes]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#FIRE: Focused Initial Rapid Evaluation|FIRE]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Complete Diagnostic Approach|Diagnosis]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Treatment|Treatment]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Do's|Do's]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Don'ts|Don'ts]]<br />
|}<br />
<br />
==Overview==<br />
Bloating is one of the most common gastrointestinal complaint that is attributed by the patient as subjective sensation of incorrectly perceived excess gas. There are multiple non-functional etiologies of abdominal bloating and distention. Primary functional abdominal distention (FABD) should be diagnosed as single entity and it doesn't overlap with other functional gastro-intestinal disorders. Rome IV diagnostic criteria mentions the co-existence of mild abdominal pain and/or minor bowel movements. FABD can be treated with antispasmodic along with peppermint oil in randomized controlled trials. A stepwise approach is usually needed that counter the dietary interventions,microbiome modulation and medical therapy in the management of FABD.<br />
<br />
==Causes==<br />
The causes of abdominal bloating are numerous and are managed according to the etiology.<br />
<br />
*<br />
<br />
{| class="wikitable"<br />
|+<br />
Causes of Abdominal Bloating<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" +|Intestinal Disorders<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" +|Motility Disorders<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" +|Malabsorption disorders<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" +|Infectious causes<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" +|Dietary causes<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" +|Misc.<br />
|-<br />
|Adhesions<br />
Malignancy<br />
|Diabetes<br />
<br />
Scleroderma<br />
<br />
Pseudo-obstruction<br />
<br />
Medications<br />
|Lactose intolerance<br />
Fructose intolerance<br />
<br />
Celiac disease<br />
<br />
Pancreatic insufficiency<br />
|Small intestinal bacterial overgrowth<br />
Giardiasis<br />
|Gas-producing foods<br />
FODMAPs<br />
|Irritable bowel syndrome <br /><br />
|}<br />
<br />
*<br />
<br />
==FIRE: Focused Initial Rapid Evaluation==<br />
<br />
==Complete Diagnostic Approach==<br />
Shown below is an algorithm summarizing the diagnosis of <nowiki>[[disease name]]</nowiki> according [...] guidelines.<br />
{{familytree/start |summary=PE diagnosis Algorithm.}}<br />
{{familytree | | | | A01 | | | A01= Patient with abdominal bloating and Distention }}<br />
{{familytree | | | | |!| | | | }}<br />
{{familytree | | | | B01 | | | B01= Look for the <br><br />
* Alarm signs<br />
*Overlapping functional gastrointestinal disorders<br />
*Bacterial overgrowth (Small intestine bacterial overgrowth)<br />
* Dietary intolerances<br />
*Celiac Disease<br />
* Weight gain <br />
*Constipation <br />
*Any pyschological comorbidities}}<br />
{{familytree | | |,|-|^|-|.| | }}<br />
{{familytree | | C01 | | C02 | C01= Yes | C02=No}}<br />
{{familytree | | |!| | | |!| | }}<br />
{{familytree | | C01 | | C02 | C01=<br />
* Reassurance the patient, recommend diaphragmatic breathing<br />
*Diet intervention: Low FODMAP diet <br />
*Iniate sympotmatic treatment such as peppermint oil or Simethicone | C02= Treat Accordingly}}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= *Trial of Rifaximin/Probiotics }}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= No Response }}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= Antidepressants<br />
*Psychological therapy<br />
*Hypnotherapy, Cognitive behavioral therapy (CBT)}}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= No Response }}<br />
{{familytree | | |!| | | | | | }}<br />
{{familytree | | C01 | | | C01= <br />
*Referral to specialized neurogastroenterology center <br />
*Referral for the CT/MRI Electromyography<br />
*Referral for the abdominal biofeedback therapy)}}<br />
{{familytree/end}}<br />
<br />
==Treatment==<br />
Shown below is an algorithm summarizing the treatment of <nowiki>[[disease name]]</nowiki> according the the [...] guidelines.<br />
{{familytree/start |summary=PE diagnosis Algorithm.}}<br />
{{familytree | | | | | | | | A01 |A01= }} <br />
{{familytree | | | | |,|-|-|-|^|-|-|-|-|.| | | }}<br />
{{familytree | | | B01 | | | | | | | | B02 | | |B01= |B02= }}<br />
{{familytree | | | |!| | | | | | | | | |!| }}<br />
{{familytree | | | C01 | | | | | | | | |!| |C01= }}<br />
{{familytree | |,|-|^|.| | | | | | | | |!| }}<br />
{{familytree | D01 | | D02 | | | | | | D03 |D01= |D02= |D03= }}<br />
{{familytree | |!| | | | | | | | | |,|-|^|.| }}<br />
{{familytree | E01 | | | | | | | E02 | | | E03 |E01= |E02= |E03= }}<br />
{{familytree | | | | | | | | | | |!| | | | |!| }}<br />
{{familytree | | | | | | | | | | F01 | | | F02 |F01= |F02= }}<br />
{{familytree/end}}<br />
<br />
==Do's==<br />
<br />
*The content in this section is in bullet points.<br />
<br />
==Don'ts==<br />
<br />
*The content in this section is in bullet points.<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
[[Category:Projects]]<br />
[[Category:Resident survival guide]]<br />
[[Category:Gastroenterology]]</div>
Usmanaliakbar
https://www.wikidoc.org/index.php?title=Bloating_resident_survival_guide&diff=1688296
Bloating resident survival guide
2021-02-02T14:05:52Z
<p>Usmanaliakbar: /* Complete Diagnostic Approach */</p>
<hr />
<div>__NOTOC__<br />
<br />
{{CMG}} {{AE}} {{Usman Ali Akbar}}<br />
<br />
{{SK}}<br />
<br />
{| class="infobox" style="margin: 0 0 0 0; border: 0; float: right; width: 100px; background: #A8A8A8; position: fixed; top: 250px; right: 21px; border-radius: 0 0 10px 10px;" cellpadding="0" cellspacing="0" ;<br />
|-<br />
! style="padding: 0 5px; font-size: 85%; background: #A8A8A8" align="center" |{{fontcolor|#2B3B44|Bloating resident survival guide Microchapters}}<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Overview|Overview]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Causes|Causes]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#FIRE: Focused Initial Rapid Evaluation|FIRE]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Complete Diagnostic Approach|Diagnosis]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Treatment|Treatment]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Do's|Do's]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Don'ts|Don'ts]]<br />
|}<br />
<br />
==Overview==<br />
Bloating is one of the most common gastrointestinal complaint that is attributed by the patient as subjective sensation of incorrectly perceived excess gas. There are multiple non-functional etiologies of abdominal bloating and distention. Primary functional abdominal distention (FABD) should be diagnosed as single entity and it doesn't overlap with other functional gastro-intestinal disorders. Rome IV diagnostic criteria mentions the co-existence of mild abdominal pain and/or minor bowel movements. FABD can be treated with antispasmodic along with peppermint oil in randomized controlled trials. A stepwise approach is usually needed that counter the dietary interventions,microbiome modulation and medical therapy in the management of FABD.<br />
<br />
==Causes==<br />
The causes of abdominal bloating are numerous and are managed according to the etiology.<br />
<br />
*<br />
<br />
{| class="wikitable"<br />
|+<br />
Causes of Abdominal Bloating<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" +|Intestinal Disorders<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" +|Motility Disorders<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" +|Malabsorption disorders<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" +|Infectious causes<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" +|Dietary causes<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" +|Misc.<br />
|-<br />
|Adhesions<br />
Malignancy<br />
|Diabetes<br />
<br />
Scleroderma<br />
<br />
Pseudo-obstruction<br />
<br />
Medications<br />
|Lactose intolerance<br />
Fructose intolerance<br />
<br />
Celiac disease<br />
<br />
Pancreatic insufficiency<br />
|Small intestinal bacterial overgrowth<br />
Giardiasis<br />
|Gas-producing foods<br />
FODMAPs<br />
|Irritable bowel syndrome <br /><br />
|}<br />
<br />
*<br />
<br />
==FIRE: Focused Initial Rapid Evaluation==<br />
<br />
==Complete Diagnostic Approach==<br />
Shown below is an algorithm summarizing the diagnosis of <nowiki>[[disease name]]</nowiki> according the the [...] guidelines.<br />
{{familytree/start |summary=PE diagnosis Algorithm.}}<br />
{{familytree | | | | A01 | | | A01= Patient with abdominal bloating and Distention }}<br />
{{familytree | | | | |!| | | | }}<br />
{{familytree | | | | B01 | | | B01= Look for the <br><br />
* Alarm signs<br />
*Overlapping functional gastrointestinal disorders<br />
*Bacterial overgrowth (Small intestine bacterial overgrowth)<br />
* Dietary intolerances<br />
*Celiac Diseas<br />
* Weight gain <br />
*Constipation <br />
*Any pyschological comorbidities}}<br />
{{familytree | | |,|-|^|-|.| | }}<br />
{{familytree | | C01 | | C02 | C01= Yes | C02=No}}<br />
{{familytree | | |!| | | |!| | }}<br />
{{familytree | | C01 | | C02 | C01=<br />
* Reassurance the patient, recommend diaphragmatic breathing<br />
*Diet intervention : Low FODMAP diet <br />
*Iniate sympotmatic treatment such as peppermint oil or Simethicone | C02=No}}<br />
{{familytree/end}}<br />
<br />
==Treatment==<br />
Shown below is an algorithm summarizing the treatment of <nowiki>[[disease name]]</nowiki> according the the [...] guidelines.<br />
{{familytree/start |summary=PE diagnosis Algorithm.}}<br />
{{familytree | | | | | | | | A01 |A01= }} <br />
{{familytree | | | | |,|-|-|-|^|-|-|-|-|.| | | }}<br />
{{familytree | | | B01 | | | | | | | | B02 | | |B01= |B02= }}<br />
{{familytree | | | |!| | | | | | | | | |!| }}<br />
{{familytree | | | C01 | | | | | | | | |!| |C01= }}<br />
{{familytree | |,|-|^|.| | | | | | | | |!| }}<br />
{{familytree | D01 | | D02 | | | | | | D03 |D01= |D02= |D03= }}<br />
{{familytree | |!| | | | | | | | | |,|-|^|.| }}<br />
{{familytree | E01 | | | | | | | E02 | | | E03 |E01= |E02= |E03= }}<br />
{{familytree | | | | | | | | | | |!| | | | |!| }}<br />
{{familytree | | | | | | | | | | F01 | | | F02 |F01= |F02= }}<br />
{{familytree/end}}<br />
<br />
==Do's==<br />
<br />
*The content in this section is in bullet points.<br />
<br />
==Don'ts==<br />
<br />
*The content in this section is in bullet points.<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
[[Category:Projects]]<br />
[[Category:Resident survival guide]]<br />
[[Category:Gastroenterology]]</div>
Usmanaliakbar
https://www.wikidoc.org/index.php?title=Bloating_resident_survival_guide&diff=1688295
Bloating resident survival guide
2021-02-02T13:50:11Z
<p>Usmanaliakbar: /* Causes */</p>
<hr />
<div>__NOTOC__<br />
<br />
{{CMG}} {{AE}} {{Usman Ali Akbar}}<br />
<br />
{{SK}}<br />
<br />
{| class="infobox" style="margin: 0 0 0 0; border: 0; float: right; width: 100px; background: #A8A8A8; position: fixed; top: 250px; right: 21px; border-radius: 0 0 10px 10px;" cellpadding="0" cellspacing="0" ;<br />
|-<br />
! style="padding: 0 5px; font-size: 85%; background: #A8A8A8" align="center" |{{fontcolor|#2B3B44|Bloating resident survival guide Microchapters}}<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Overview|Overview]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Causes|Causes]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#FIRE: Focused Initial Rapid Evaluation|FIRE]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Complete Diagnostic Approach|Diagnosis]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Treatment|Treatment]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Do's|Do's]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Don'ts|Don'ts]]<br />
|}<br />
<br />
==Overview==<br />
Bloating is one of the most common gastrointestinal complaint that is attributed by the patient as subjective sensation of incorrectly perceived excess gas. There are multiple non-functional etiologies of abdominal bloating and distention. Primary functional abdominal distention (FABD) should be diagnosed as single entity and it doesn't overlap with other functional gastro-intestinal disorders. Rome IV diagnostic criteria mentions the co-existence of mild abdominal pain and/or minor bowel movements. FABD can be treated with antispasmodic along with peppermint oil in randomized controlled trials. A stepwise approach is usually needed that counter the dietary interventions,microbiome modulation and medical therapy in the management of FABD.<br />
<br />
==Causes==<br />
The causes of abdominal bloating are numerous and are managed according to the etiology.<br />
<br />
*<br />
<br />
{| class="wikitable"<br />
|+<br />
Causes of Abdominal Bloating<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" +|Intestinal Disorders<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" +|Motility Disorders<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" +|Malabsorption disorders<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" +|Infectious causes<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" +|Dietary causes<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" +|Misc.<br />
|-<br />
|Adhesions<br />
Malignancy<br />
|Diabetes<br />
<br />
Scleroderma<br />
<br />
Pseudo-obstruction<br />
<br />
Medications<br />
|Lactose intolerance<br />
Fructose intolerance<br />
<br />
Celiac disease<br />
<br />
Pancreatic insufficiency<br />
|Small intestinal bacterial overgrowth<br />
Giardiasis<br />
|Gas-producing foods<br />
FODMAPs<br />
|Irritable bowel syndrome <br /><br />
|}<br />
<br />
*<br />
<br />
==FIRE: Focused Initial Rapid Evaluation==<br />
<br />
==Complete Diagnostic Approach==<br />
Shown below is an algorithm summarizing the diagnosis of <nowiki>[[disease name]]</nowiki> according the the [...] guidelines.<br />
{{familytree/start |summary=PE diagnosis Algorithm.}}<br />
{{familytree | | | | A01 | | | A01= }}<br />
{{familytree | | | | |!| | | | }}<br />
{{familytree | | | | B01 | | | B01= }}<br />
{{familytree | | |,|-|^|-|.| | }}<br />
{{familytree | | C01 | | C02 | C01= | C02= }}<br />
<br />
{{familytree/end}}<br />
<br />
==Treatment==<br />
Shown below is an algorithm summarizing the treatment of <nowiki>[[disease name]]</nowiki> according the the [...] guidelines.<br />
{{familytree/start |summary=PE diagnosis Algorithm.}}<br />
{{familytree | | | | | | | | A01 |A01= }} <br />
{{familytree | | | | |,|-|-|-|^|-|-|-|-|.| | | }}<br />
{{familytree | | | B01 | | | | | | | | B02 | | |B01= |B02= }}<br />
{{familytree | | | |!| | | | | | | | | |!| }}<br />
{{familytree | | | C01 | | | | | | | | |!| |C01= }}<br />
{{familytree | |,|-|^|.| | | | | | | | |!| }}<br />
{{familytree | D01 | | D02 | | | | | | D03 |D01= |D02= |D03= }}<br />
{{familytree | |!| | | | | | | | | |,|-|^|.| }}<br />
{{familytree | E01 | | | | | | | E02 | | | E03 |E01= |E02= |E03= }}<br />
{{familytree | | | | | | | | | | |!| | | | |!| }}<br />
{{familytree | | | | | | | | | | F01 | | | F02 |F01= |F02= }}<br />
{{familytree/end}}<br />
<br />
==Do's==<br />
<br />
*The content in this section is in bullet points.<br />
<br />
==Don'ts==<br />
<br />
*The content in this section is in bullet points.<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
[[Category:Projects]]<br />
[[Category:Resident survival guide]]<br />
[[Category:Gastroenterology]]</div>
Usmanaliakbar
https://www.wikidoc.org/index.php?title=Bloating_resident_survival_guide&diff=1688292
Bloating resident survival guide
2021-02-02T13:48:01Z
<p>Usmanaliakbar: /* Causes */</p>
<hr />
<div>__NOTOC__<br />
<br />
{{CMG}} {{AE}} {{Usman Ali Akbar}}<br />
<br />
{{SK}}<br />
<br />
{| class="infobox" style="margin: 0 0 0 0; border: 0; float: right; width: 100px; background: #A8A8A8; position: fixed; top: 250px; right: 21px; border-radius: 0 0 10px 10px;" cellpadding="0" cellspacing="0" ;<br />
|-<br />
! style="padding: 0 5px; font-size: 85%; background: #A8A8A8" align="center" |{{fontcolor|#2B3B44|Bloating resident survival guide Microchapters}}<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Overview|Overview]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Causes|Causes]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#FIRE: Focused Initial Rapid Evaluation|FIRE]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Complete Diagnostic Approach|Diagnosis]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Treatment|Treatment]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Do's|Do's]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Don'ts|Don'ts]]<br />
|}<br />
<br />
==Overview==<br />
Bloating is one of the most common gastrointestinal complaint that is attributed by the patient as subjective sensation of incorrectly perceived excess gas. There are multiple non-functional etiologies of abdominal bloating and distention. Primary functional abdominal distention (FABD) should be diagnosed as single entity and it doesn't overlap with other functional gastro-intestinal disorders. Rome IV diagnostic criteria mentions the co-existence of mild abdominal pain and/or minor bowel movements. FABD can be treated with antispasmodic along with peppermint oil in randomized controlled trials. A stepwise approach is usually needed that counter the dietary interventions,microbiome modulation and medical therapy in the management of FABD.<br />
<br />
==Causes==<br />
The causes of abdominal bloating are numerous and are managed according to the etiology.<br />
<br />
*<br />
<br />
{| class="wikitable"<br />
|+<br />
Causes of Abdominal Bloating<br />
!Intestinal Disorders<br />
!Motility Disorders<br />
!Malabsorption disorders<br />
!Infectious causes<br />
!Dietary causes<br />
!Misc.<br />
|-<br />
|Adhesions<br />
Malignancy<br />
|Diabetes<br />
<br />
Scleroderma<br />
<br />
Pseudo-obstruction<br />
<br />
Medications<br />
|Lactose intolerance<br />
Fructose intolerance<br />
<br />
Celiac disease<br />
<br />
Pancreatic insufficiency<br />
|Small intestinal bacterial overgrowth<br />
Giardiasis<br />
|Gas-producing foods<br />
FODMAPs<br />
|Irritable bowel syndrome <br /><br />
|}<br />
<br />
*<br />
<br />
==FIRE: Focused Initial Rapid Evaluation==<br />
<br />
==Complete Diagnostic Approach==<br />
Shown below is an algorithm summarizing the diagnosis of <nowiki>[[disease name]]</nowiki> according the the [...] guidelines.<br />
{{familytree/start |summary=PE diagnosis Algorithm.}}<br />
{{familytree | | | | A01 | | | A01= }}<br />
{{familytree | | | | |!| | | | }}<br />
{{familytree | | | | B01 | | | B01= }}<br />
{{familytree | | |,|-|^|-|.| | }}<br />
{{familytree | | C01 | | C02 | C01= | C02= }}<br />
<br />
{{familytree/end}}<br />
<br />
==Treatment==<br />
Shown below is an algorithm summarizing the treatment of <nowiki>[[disease name]]</nowiki> according the the [...] guidelines.<br />
{{familytree/start |summary=PE diagnosis Algorithm.}}<br />
{{familytree | | | | | | | | A01 |A01= }} <br />
{{familytree | | | | |,|-|-|-|^|-|-|-|-|.| | | }}<br />
{{familytree | | | B01 | | | | | | | | B02 | | |B01= |B02= }}<br />
{{familytree | | | |!| | | | | | | | | |!| }}<br />
{{familytree | | | C01 | | | | | | | | |!| |C01= }}<br />
{{familytree | |,|-|^|.| | | | | | | | |!| }}<br />
{{familytree | D01 | | D02 | | | | | | D03 |D01= |D02= |D03= }}<br />
{{familytree | |!| | | | | | | | | |,|-|^|.| }}<br />
{{familytree | E01 | | | | | | | E02 | | | E03 |E01= |E02= |E03= }}<br />
{{familytree | | | | | | | | | | |!| | | | |!| }}<br />
{{familytree | | | | | | | | | | F01 | | | F02 |F01= |F02= }}<br />
{{familytree/end}}<br />
<br />
==Do's==<br />
<br />
*The content in this section is in bullet points.<br />
<br />
==Don'ts==<br />
<br />
*The content in this section is in bullet points.<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
[[Category:Projects]]<br />
[[Category:Resident survival guide]]<br />
[[Category:Gastroenterology]]</div>
Usmanaliakbar
https://www.wikidoc.org/index.php?title=Bloating_resident_survival_guide&diff=1688291
Bloating resident survival guide
2021-02-02T13:46:58Z
<p>Usmanaliakbar: /* Causes */</p>
<hr />
<div>__NOTOC__<br />
<br />
{{CMG}} {{AE}} {{Usman Ali Akbar}}<br />
<br />
{{SK}}<br />
<br />
{| class="infobox" style="margin: 0 0 0 0; border: 0; float: right; width: 100px; background: #A8A8A8; position: fixed; top: 250px; right: 21px; border-radius: 0 0 10px 10px;" cellpadding="0" cellspacing="0" ;<br />
|-<br />
! style="padding: 0 5px; font-size: 85%; background: #A8A8A8" align="center" |{{fontcolor|#2B3B44|Bloating resident survival guide Microchapters}}<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Overview|Overview]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Causes|Causes]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#FIRE: Focused Initial Rapid Evaluation|FIRE]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Complete Diagnostic Approach|Diagnosis]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Treatment|Treatment]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Do's|Do's]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Don'ts|Don'ts]]<br />
|}<br />
<br />
==Overview==<br />
Bloating is one of the most common gastrointestinal complaint that is attributed by the patient as subjective sensation of incorrectly perceived excess gas. There are multiple non-functional etiologies of abdominal bloating and distention. Primary functional abdominal distention (FABD) should be diagnosed as single entity and it doesn't overlap with other functional gastro-intestinal disorders. Rome IV diagnostic criteria mentions the co-existence of mild abdominal pain and/or minor bowel movements. FABD can be treated with antispasmodic along with peppermint oil in randomized controlled trials. A stepwise approach is usually needed that counter the dietary interventions,microbiome modulation and medical therapy in the management of FABD.<br />
<br />
==Causes==<br />
<br />
*<br />
<br />
{| class="wikitable"<br />
|+<br />
Causes of Abdominal Bloating<br />
!Intestinal Disorders<br />
!Motility Disorders<br />
!Malabsorption disorders<br />
!Infectious causes<br />
!Dietary causes<br />
!Misc.<br />
|-<br />
|Adhesions<br />
Malignancy<br />
|Diabetes<br />
<br />
Scleroderma<br />
<br />
Pseudo-obstruction<br />
<br />
Medications<br />
|Lactose intolerance<br />
Fructose intolerance<br />
<br />
Celiac disease<br />
<br />
Pancreatic insufficiency<br />
|Small intestinal bacterial overgrowth<br />
Giardiasis<br />
|Gas-producing foods<br />
FODMAPs<br />
|Irritable bowel syndrome <br /><br />
|}<br />
<br />
*<br />
<br />
==FIRE: Focused Initial Rapid Evaluation==<br />
<br />
==Complete Diagnostic Approach==<br />
Shown below is an algorithm summarizing the diagnosis of <nowiki>[[disease name]]</nowiki> according the the [...] guidelines.<br />
{{familytree/start |summary=PE diagnosis Algorithm.}}<br />
{{familytree | | | | A01 | | | A01= }}<br />
{{familytree | | | | |!| | | | }}<br />
{{familytree | | | | B01 | | | B01= }}<br />
{{familytree | | |,|-|^|-|.| | }}<br />
{{familytree | | C01 | | C02 | C01= | C02= }}<br />
<br />
{{familytree/end}}<br />
<br />
==Treatment==<br />
Shown below is an algorithm summarizing the treatment of <nowiki>[[disease name]]</nowiki> according the the [...] guidelines.<br />
{{familytree/start |summary=PE diagnosis Algorithm.}}<br />
{{familytree | | | | | | | | A01 |A01= }} <br />
{{familytree | | | | |,|-|-|-|^|-|-|-|-|.| | | }}<br />
{{familytree | | | B01 | | | | | | | | B02 | | |B01= |B02= }}<br />
{{familytree | | | |!| | | | | | | | | |!| }}<br />
{{familytree | | | C01 | | | | | | | | |!| |C01= }}<br />
{{familytree | |,|-|^|.| | | | | | | | |!| }}<br />
{{familytree | D01 | | D02 | | | | | | D03 |D01= |D02= |D03= }}<br />
{{familytree | |!| | | | | | | | | |,|-|^|.| }}<br />
{{familytree | E01 | | | | | | | E02 | | | E03 |E01= |E02= |E03= }}<br />
{{familytree | | | | | | | | | | |!| | | | |!| }}<br />
{{familytree | | | | | | | | | | F01 | | | F02 |F01= |F02= }}<br />
{{familytree/end}}<br />
<br />
==Do's==<br />
<br />
*The content in this section is in bullet points.<br />
<br />
==Don'ts==<br />
<br />
*The content in this section is in bullet points.<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
[[Category:Projects]]<br />
[[Category:Resident survival guide]]<br />
[[Category:Gastroenterology]]</div>
Usmanaliakbar
https://www.wikidoc.org/index.php?title=Bloating_resident_survival_guide&diff=1688288
Bloating resident survival guide
2021-02-02T13:41:39Z
<p>Usmanaliakbar: /* Causes */</p>
<hr />
<div>__NOTOC__<br />
<br />
{{CMG}} {{AE}} {{Usman Ali Akbar}}<br />
<br />
{{SK}}<br />
<br />
{| class="infobox" style="margin: 0 0 0 0; border: 0; float: right; width: 100px; background: #A8A8A8; position: fixed; top: 250px; right: 21px; border-radius: 0 0 10px 10px;" cellpadding="0" cellspacing="0" ;<br />
|-<br />
! style="padding: 0 5px; font-size: 85%; background: #A8A8A8" align="center" |{{fontcolor|#2B3B44|Bloating resident survival guide Microchapters}}<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Overview|Overview]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Causes|Causes]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#FIRE: Focused Initial Rapid Evaluation|FIRE]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Complete Diagnostic Approach|Diagnosis]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Treatment|Treatment]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Do's|Do's]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Don'ts|Don'ts]]<br />
|}<br />
<br />
==Overview==<br />
Bloating is one of the most common gastrointestinal complaint that is attributed by the patient as subjective sensation of incorrectly perceived excess gas. There are multiple non-functional etiologies of abdominal bloating and distention. Primary functional abdominal distention (FABD) should be diagnosed as single entity and it doesn't overlap with other functional gastro-intestinal disorders. Rome IV diagnostic criteria mentions the co-existence of mild abdominal pain and/or minor bowel movements. FABD can be treated with antispasmodic along with peppermint oil in randomized controlled trials. A stepwise approach is usually needed that counter the dietary interventions,microbiome modulation and medical therapy in the management of FABD.<br />
<br />
==Causes==<br />
<br />
*<br />
<br />
{| class="wikitable"<br />
|+<br />
!Intestinal Disorders <br />
!Motility Disorders<br />
!Malabsorption disorders <br />
!Infectious causes<br />
!Dietary causes <br />
!Misc.<br />
|-<br />
|Adhesions<br />
Malignancy<br />
|Diabetes<br />
<br />
Scleroderma<br />
<br />
Pseudo-obstruction<br />
<br />
Medications<br />
|Lactose intolerance<br />
Fructose intolerance<br />
<br />
Celiac disease<br />
<br />
Pancreatic insufficiency<br />
|Small intestinal bacterial overgrowth<br />
Giardiasis<br />
|Gas-producing foods<br />
FODMAPs<br />
|Irritable bowel syndrome <br /><br />
|}<br />
<br />
*<br />
<br />
==FIRE: Focused Initial Rapid Evaluation==<br />
<br />
==Complete Diagnostic Approach==<br />
Shown below is an algorithm summarizing the diagnosis of <nowiki>[[disease name]]</nowiki> according the the [...] guidelines.<br />
{{familytree/start |summary=PE diagnosis Algorithm.}}<br />
{{familytree | | | | A01 | | | A01= }}<br />
{{familytree | | | | |!| | | | }}<br />
{{familytree | | | | B01 | | | B01= }}<br />
{{familytree | | |,|-|^|-|.| | }}<br />
{{familytree | | C01 | | C02 | C01= | C02= }}<br />
<br />
{{familytree/end}}<br />
<br />
==Treatment==<br />
Shown below is an algorithm summarizing the treatment of <nowiki>[[disease name]]</nowiki> according the the [...] guidelines.<br />
{{familytree/start |summary=PE diagnosis Algorithm.}}<br />
{{familytree | | | | | | | | A01 |A01= }} <br />
{{familytree | | | | |,|-|-|-|^|-|-|-|-|.| | | }}<br />
{{familytree | | | B01 | | | | | | | | B02 | | |B01= |B02= }}<br />
{{familytree | | | |!| | | | | | | | | |!| }}<br />
{{familytree | | | C01 | | | | | | | | |!| |C01= }}<br />
{{familytree | |,|-|^|.| | | | | | | | |!| }}<br />
{{familytree | D01 | | D02 | | | | | | D03 |D01= |D02= |D03= }}<br />
{{familytree | |!| | | | | | | | | |,|-|^|.| }}<br />
{{familytree | E01 | | | | | | | E02 | | | E03 |E01= |E02= |E03= }}<br />
{{familytree | | | | | | | | | | |!| | | | |!| }}<br />
{{familytree | | | | | | | | | | F01 | | | F02 |F01= |F02= }}<br />
{{familytree/end}}<br />
<br />
==Do's==<br />
<br />
*The content in this section is in bullet points.<br />
<br />
==Don'ts==<br />
<br />
*The content in this section is in bullet points.<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
[[Category:Projects]]<br />
[[Category:Resident survival guide]]<br />
[[Category:Gastroenterology]]</div>
Usmanaliakbar
https://www.wikidoc.org/index.php?title=Bloating_resident_survival_guide&diff=1685810
Bloating resident survival guide
2021-01-25T20:32:30Z
<p>Usmanaliakbar: /* Overview */</p>
<hr />
<div>__NOTOC__<br />
<br />
{{CMG}} {{AE}} {{Usman Ali Akbar}}<br />
<br />
{{SK}}<br />
<br />
{| class="infobox" style="margin: 0 0 0 0; border: 0; float: right; width: 100px; background: #A8A8A8; position: fixed; top: 250px; right: 21px; border-radius: 0 0 10px 10px;" cellpadding="0" cellspacing="0" ;<br />
|-<br />
! style="padding: 0 5px; font-size: 85%; background: #A8A8A8" align="center" |{{fontcolor|#2B3B44|Bloating resident survival guide Microchapters}}<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Overview|Overview]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Causes|Causes]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#FIRE: Focused Initial Rapid Evaluation|FIRE]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Complete Diagnostic Approach|Diagnosis]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Treatment|Treatment]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Do's|Do's]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Don'ts|Don'ts]]<br />
|}<br />
<br />
==Overview==<br />
Bloating is one of the most common gastrointestinal complaint that is attributed by the patient as subjective sensation of incorrectly perceived excess gas. There are multiple non-functional etiologies of abdominal bloating and distention. Primary functional abdominal distention (FABD) should be diagnosed as single entity and it doesn't overlap with other functional gastro-intestinal disorders. Rome IV diagnostic criteria mentions the co-existence of mild abdominal pain and/or minor bowel movements. FABD can be treated with antispasmodic along with peppermint oil in randomized controlled trials. A stepwise approach is usually needed that counter the dietary interventions,microbiome modulation and medical therapy in the management of FABD.<br />
<br />
==Causes==<br />
===Life Threatening Causes===<br />
Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated.<br />
<br />
*[[Life threatening cause 1]]<br />
*[[Life threatening cause 2]]<br />
*[[Life threatening cause 3]]<br />
<br />
===Common Causes===<br />
<br />
*[[Common cause 1]]<br />
*[[Common cause 2]]<br />
*[[Common cause 3]]<br />
*[[Common cause 4]]<br />
*[[Common cause 5]]<br />
<br />
==FIRE: Focused Initial Rapid Evaluation==<br />
<br />
==Complete Diagnostic Approach==<br />
Shown below is an algorithm summarizing the diagnosis of <nowiki>[[disease name]]</nowiki> according the the [...] guidelines.<br />
{{familytree/start |summary=PE diagnosis Algorithm.}}<br />
{{familytree | | | | A01 | | | A01= }}<br />
{{familytree | | | | |!| | | | }}<br />
{{familytree | | | | B01 | | | B01= }}<br />
{{familytree | | |,|-|^|-|.| | }}<br />
{{familytree | | C01 | | C02 | C01= | C02= }}<br />
<br />
{{familytree/end}}<br />
<br />
==Treatment==<br />
Shown below is an algorithm summarizing the treatment of <nowiki>[[disease name]]</nowiki> according the the [...] guidelines.<br />
{{familytree/start |summary=PE diagnosis Algorithm.}}<br />
{{familytree | | | | | | | | A01 |A01= }} <br />
{{familytree | | | | |,|-|-|-|^|-|-|-|-|.| | | }}<br />
{{familytree | | | B01 | | | | | | | | B02 | | |B01= |B02= }}<br />
{{familytree | | | |!| | | | | | | | | |!| }}<br />
{{familytree | | | C01 | | | | | | | | |!| |C01= }}<br />
{{familytree | |,|-|^|.| | | | | | | | |!| }}<br />
{{familytree | D01 | | D02 | | | | | | D03 |D01= |D02= |D03= }}<br />
{{familytree | |!| | | | | | | | | |,|-|^|.| }}<br />
{{familytree | E01 | | | | | | | E02 | | | E03 |E01= |E02= |E03= }}<br />
{{familytree | | | | | | | | | | |!| | | | |!| }}<br />
{{familytree | | | | | | | | | | F01 | | | F02 |F01= |F02= }}<br />
{{familytree/end}}<br />
<br />
==Do's==<br />
<br />
*The content in this section is in bullet points.<br />
<br />
==Don'ts==<br />
<br />
*The content in this section is in bullet points.<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
[[Category:Projects]]<br />
[[Category:Resident survival guide]]<br />
[[Category:Gastroenterology]]</div>
Usmanaliakbar
https://www.wikidoc.org/index.php?title=User:Usman_Ali_Akbar&diff=1685532
User:Usman Ali Akbar
2021-01-24T20:20:44Z
<p>Usmanaliakbar: /* Work Experience */</p>
<hr />
<div>__NOTOC__<br />
==Usman Ali Akbar==<br />
Contact: Email: usmanaliakbar992@live.com<br />
<br />
==Medical Education==<br />
November 2011-February 2017<br />
<br />
*Bachelor of Medicine and Bachelor of Surgery (M.B.B.S.) from Nishtar Medical University, Multan,Punjab,Pakistan<br />
<br />
==Professional Affiliation==<br />
<br />
*Medical Officer ( BPS-17) at Department of Health, Government of Punjab,Pakistan<br />
<br />
==Work Experience==<br />
May 2020-till present</div>
Usmanaliakbar
https://www.wikidoc.org/index.php?title=Diarrhea_resident_survival_guide_(pediatrics)&diff=1681526
Diarrhea resident survival guide (pediatrics)
2021-01-05T17:01:55Z
<p>Usmanaliakbar: /* Don'ts */</p>
<hr />
<div>__NOTOC__<br />
<br />
{{CMG}} {{AE}} {{Usman Ali Akbar}}<br />
<br />
{{SK}} Approach to [[diarrhea]] in [[pediatric]] [[patients]], Approach to [[infectious]] [[causes]] of [[diarrhea]], [[Oral]] [[Rehydration]] [[therapy]] in [[children]]<br />
<br />
{| class="infobox" style="margin: 0 0 0 0; border: 0; float: right; width: 100px; background: #A8A8A8; position: fixed; top: 250px; right: 21px; border-radius: 0 0 10px 10px;" cellpadding="0" cellspacing="0" ;<br />
|-<br />
! style="padding: 0 5px; font-size: 85%; background: #A8A8A8" align="center" |{{fontcolor|#2B3B44|Diarrhea resident survival guide (pediatrics) Microchapters}}<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Diarrhea resident survival guide (pediatrics)#Overview|Overview]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Diarrhea resident survival guide (pediatrics)#Causes|Causes]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Diarrhea resident survival guide (pediatrics)#FIRE: Focused Initial Rapid Evaluation|FIRE]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Diarrhea resident survival guide (pediatrics)#Complete Diagnostic Approach|Diagnosis]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Diarrhea resident survival guide (pediatrics)#Treatment|Treatment]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Diarrhea resident survival guide (pediatrics)#Do's|Do's]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Diarrhea resident survival guide (pediatrics)#Don'ts|Don'ts]]<br />
|}<br />
<br />
==Overview==<br />
[[Diarrhea]] remains one of the [[Lead|leading]] [[causes]] of [[Prevention|preventable]] death in developing countries, especially among [[children]] under 5 [[Year|years]] of [[age]]. [[Diarrhea]] is defined as an increase in the number of [[stools]] such as more than three [[Bowel movement|bowel movements]] each day or the [[Presenting symptom|presence]] of [[loose stools]] comparative to [[normal]] [[stool]] [[Consistency (statistics)|consistency]]. [[Acute diarrhea]] is when [[diarrhea]] occurs for less than 3 weeks in total and it is [[chronic]] when it lasts longer than three weeks. [[Hydration]] status plays an important role in the management of [[pediatric]] [[diarrheal]] [[illness]]. The [[RiskMetrics|risk]] of [[dehydration]] due to [[fluid]] and [[Electrolyte imbalance|electrolyte losses]] is inversely proportional to the [[child]]'s [[age]] hence, the younger the [[child]], the greater is the [[RiskMetrics|risk]] of [[dehydration]]. The type of [[dehydration]] whether it is [[isotonic]], [[hypotonic]], or [[hypertonic]] is usually independent of the responsible agent. [[Fluid loss]] due to [[diarrhea]] and [[vomiting]] can be life-threatening if it is as high as three times the [[Circulation|circulating]] [[blood volume]] (80–125–250 mL per [[Kilogram|kg]] [[body weight]] per day). To keep the [[blood volume]] [[constant]], the [[body]] usually [[Extraction|extracts]] [[fluid]] from the [[intracellular]] space which can predispose it to [[dehydration]]. [[Complications]] and [[hospitalization]] due to [[dehydration]] can usually be [[Prevention|prevented]] by the early and adequate [[oral]] administration of a [[rehydration]] [[solution]] ([[glucose]]-[[electrolyte]] [[solution]]) and [[normal]] [[food]] for the [[child]]’s [[age]].<br />
<br />
==Causes==<br />
<br />
*The [[causes]] of [[diarrhea]] can [[Range (statistics)|range]] from [[life]]-threatening to mild and self-[[Resolving power|resolving]] [[causes]]:<ref name="WHO">{{cite web | title=Diarrhoeal disease | website=WHO | url=https://www.who.int/news-room/fact-sheets/detail/diarrhoeal-disease#:~:text=There%20are%20three%20clinical%20types,lasts%2014%20days%20or%20longer. | language=af | access-date=2020-12-15}}</ref><br />
<br />
{| class="wikitable"<br />
|+<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Life Threatening Causes<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Common Causes<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Miscellaneous<br />
|-<br />
|<br />
*[[Cholera]]<br />
*''[[Entamoeba histolytica]]''<br />
*[[Enterohemorrhagic Escherichica coli|Enterohemorrhagic ''Escherichia coli'']] ([[EHEC]])<br />
*[[Enteroinvasive Escherichia coli|Enteroinvasive ''Escherichia coli'']] ([[EIEC]])<br />
*[[Campylobacter]] spp.<br />
*[[Salmonella enterica|Nontyphoidal ''Salmonella enterica'']]<br />
|<br />
*[[Rotavirus]]<br />
*[[Enterotoxigenic Escherichia coli]] ([[ETEC]])<br />
*[[Cryptosporidium]]<br />
*[[Shigella|Shigella spp.]]<br />
|<br />
*[[Parenteral]] [[causes]] include [[infections]] elsewhere in the [[body]]: [[UTI]], [[Acute otitis media]], [[Sepsis]].<br />
*[[Inflammatory ]] [[causes]] include: [[IBD]], [[Allergy]] to cow's [[milk]], [[Whipple's disease]].<br />
*[[Malabsorption|Malabsorptive]] [[causes]] include: [[Celiac disease]], [[Lactase deficiency]].<br />
*[[Endocrine]] [[causes]] include: [[Hypothyroidism]], [[Addison's disease]] , [[Hyperparathyroidism|Hyperparathyroidism]].<br />
*[[Neoplastic]] [[causes]]<br />
*[[Psychosocial]] [[causes]]<br />
|}<br />
<br />
==FIRE: Focused Initial Rapid Evaluation==<br />
<br />
*A Focused Initial Rapid Evaluation (FIRE) should be [[Performance status|performed]] to identify the [[patients]] in need of immediate intervention:<ref name="Koletzko Osterrieder 2009 p.">{{cite journal | last=Koletzko | first=Sibylle | last2=Osterrieder | first2=Stephanie | title=Acute Infectious Diarrhea in Children | journal=Deutsches Ärzteblatt International | volume=106 | issue=33 | date=2009-09-25 | pmid=19738921 | doi=10.3238/arztebl.2009.0539 | url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2737434/ | access-date=2020-12-15 | page=}}</ref><br />
{{familytree/start |summary=PE diagnosis Algorithm.}}<br />
{{familytree | | | | | | | | | | | A01 | | | A01=[[Patient]] presents with [[acute]] [[diarrhea]] in [[emergency]]}}<br />
{{familytree | | | | |,|-|-|-|-|-|-|+|-|-|-|-|.| }}<br />
{{familytree | | | | C01 | | | | | | C02 | | | C03 |C01= '''Mild [[Dehydration]]'''|C02='''Moderate [[Dehydration]]'''|C03=<div style=" background: #FA8072; text-align: center; width:15em; padding:0.7em"> {{fontcolor|#F8F8FF|'''Severe [[Dehydration]]'''}}</div> }}<br />
{{familytree | | | | |!| | | | | | | |!| | | |!| |}}<br />
{{familytree | | | | C01 | | | | | | C02 | | C03 | |C01= Home [[treatment]] with [[ORS]], [[patient]] [[prescription]], and [[dietary]] recommendations |C02=Is there any [[evidence]] of [[dehydration]] or >8 [[watery]] [[stools]] in 24 hours or >4 episodes of [[vomiting]] in 24 hours or <6 months old|C03=<div style=" background: #FA8072; text-align: center; width:15em; padding:0.7em"> {{fontcolor|#F8F8FF|'''[[Dehydration]] >9% [[Shock]] or [[Impaired]] [[consciousness]]'''}}</div>}}<br />
{{familytree | | | | | | | | | | | |!| | | | | |!| |}}<br />
{{familytree | | | | | | | | | |C01 | | | | |C02 | | | | | |C01= Give [[ORS]] by spoon or [[syringe]] according to [[age]] and [[weight]] <br><br />
* [[Infants]] 5—9 kg: 2.0 mL every minute (120 mL/hr) <br><br />
* [[Infants]] 9—12 kg: 2.5 mL every minute (150 mL/hr) <br><br />
* Toddlers 12-15 kg: 3.0 mL every minute (180 mL/hr)<br><br />
* If there is no [[vomiting]], then larger volumes at longer intervals: 10-15 mL every 5 or 20-30 mL every 10 minutes Racecadotril in 5 mL of [[water]])<br><br />
* <9 kg: 10 mg, 10-15 kg: 20 mg, 16-29 kg: 30 mg <br>|C02=<div style=" background: #FA8072; text-align: center; width:15em; padding:0.7em"> {{fontcolor|#F8F8FF|'''Intensive Care'''}}</div> }}<br />
<br />
<br />
{{familytree/end}}<br />
<br />
==Complete Diagnostic Approach==<br />
<br />
*Shown below is an [[algorithm]] [[Summarizing statistical data|summarizing]] the [[diagnosis]] of [[Acute diarrhea causes|acute diarrhea]] in [[children]] according to the [[World Health Organization|WHO]] [[Guideline (medical)|guidelines]]:<ref>https://apps.who.int/iris/bitstream/handle/10665/43209/9241593180.pdf;jsessionid=E1E068378A53790D37702AB3086551B4?sequence=1</ref><ref>http://www.doiserbia.nb.rs/img/doi/0370-8179/2015/0370-81791512755R.pdf</ref><br />
{{familytree/start |summary=PE diagnosis Algorithm.}}<br />
{{familytree | | | | | | | | | A01 | | | A01= [[Patient]] with history of [[diarrhea]] }}<br />
{{familytree | | | | | | | | | |!| | | | }}<br />
{{familytree | | | | | | | | | B01 | | | B01= '''[[Assessment]]''' <br><br />
*A [[child]] with [[diarrhea]] should be assessed for [[dehydration]] <br><br />
*[[Bloody diarrhea]], persistent [[diarrhea]] <br><br />
*[[Malnutrition]] and serious non-[[intestinal]] [[infections]] so that an appropriate [[treatment]] plan can be implemented.<br><br />
}}<br />
{{familytree | | | | | | | | | |!| | | | }}<br />
{{familytree | | | | | | | | | B01 | | | B01= '''History''' <br><br />
*Duration and severity of [[diarrhea]]<br />
*Presence of [[blood]] in [[stool]]<br />
*Number of watery [[stools]] per day<br />
*Number of episodes of [[vomiting]]<br />
*[[Diaper rash]]<br />
*Presence of [[fever]], [[cough]], or other important problems (e.g. [[convulsions]], recent [[measles]])<br />
*Pre-[[illness]] [[feeding]] practices; type and amount of [[fluids]] (including [[breast milk]]) and [[food]] taken during the [[illness]]<br />
*History of [[Medications]]<br />
*History of [[immunization]]}}<br />
{{familytree | | | | | | | | | |!| | | | }}<br />
{{familytree | | | | | | | | | B01 | | | B01= '''[[Physical Examination]]''' <br><br />
*Look for the [[signs]] and [[symptoms]] of [[dehydration]] <br><br />
*Is the [[child]] [[alert]], restless or [[irritable]]?<br><br />
*Look for the [[eyes]], are they [[normal]] or sunken?<br><br />
*Look for [[skin]] [[turgor]]?<br><br />
*Does the [[stool]] contain red [[blood]]?<br><br />
*Is the [[child]] [[malnourished]]?<br><br />
*Look for [[growth chart]], [[weight]] for [[length]] or measure the mid-[[arm]] circumference.<br><br />
*Measure the [[temperature]] of [[child]].<br><br />
}}<br />
{{familytree | | | | | | | | | |!| | | | }}<br />
{{familytree | | | | | |,|-|-|-|+|-|-|-|-|.| }}<br />
{{familytree | | | | |C01| | |C02| |C03| |C01='''Mild [[Dehydration]]'''<br><br />
There are no specific [[signs]] and [[symptoms]] <br>|C02='''Moderate [[Dehydration]]''' <br><br />
<br />
Initially, the [[signs]] and [[symptoms]] that develop include:<br><br />
- [[Thirst]] <br><br />
- Restless or [[irritable]] [[behavior]] <br><br />
- Decreased [[skin]] [[turgor]] <br><br />
- Sunken [[eyes]] <br><br />
- Sunken [[fontanelle]] <br><br />
(in [[infants]])|C03='''Severe [[Dehydration]]'''<br><ref name="Parker Unaka p=775">{{cite journal | last=Parker | first=Michelle W. | last2=Unaka | first2=Ndidi | title=Diagnosis and Management of Infectious Diarrhea | journal=JAMA pediatrics | publisher=American Medical Association (AMA) | volume=172 | issue=8 | date=2018-08-01 | issn=2168-6203 | pmid=29889925 | doi=10.1001/jamapediatrics.2018.1172 | page=775}}</ref><br />
These effects become more pronounced and the [[patient]] may develop [[evidence]] of [[hypovolaemic shock]] including: <br><br />
- Diminished [[consciousness]] <br><br />
- Lack of [[urine output]] <br><br />
- Cool moist [[extremities]] <br><br />
- Rapid and feeble [[pulse]]<br />
(the [[radial]] [[pulse]] maybe undetectable)<br><br />
- Low or undetectable [[blood pressure]] <br><br />
- Peripheral [[cyanosis]]. <br><br />
Death follows soon if [[rehydration]] is not started quickly <br> }}<br />
{{familytree/end}}<br />
<br />
==Treatment==<br />
<br />
*Shown below is an [[Algorithm (medical)|algorithm]] [[Summarizing statistical data|summarizing]] the [[treatment]] of [[Acute diarrhea causes|acute diarrhea]] in [[pediatric]] [[patients]] according to the [[World Health Organization|WHO]] [[Guideline (medical)|guidelines]]:<ref>https://apps.who.int/iris/bitstream/handle/10665/43209/9241593180.pdf;jsessionid=E1E068378A53790D37702AB3086551B4?sequence=1</ref><br />
{{familytree/start |summary=PE diagnosis Algorithm.}}<br />
{{familytree | | | | | | | | | | | A01 | | | A01=[[Patient]] presents with [[Acute diarrhea causes|acute diarrhea]] in [[emergency]]}}<br />
{{familytree | | | | |,|-|-|-|-|-|-|+|-|-|-|-|.| }}<br />
{{familytree | | | | C01 | | | | | | C02 | | | C03 |C01='''Mild [[Dehydration]]'''|C02='''Moderate [[Dehydration]]'''|C03='''Severe [[Dehydration]]'''}}<br />
{{familytree | | | | |!| | | | | | | |!| | | |!| |}}<br />
{{familytree | | | | C01 | | | | | | C02 | | C03 | |C01= [[Children]] with no [[signs]] of [[dehydration]] are given extra [[fluids]] and [[salts]] to replace losses due to [[diarrhea]].<ref name="Vega Avva 2020">{{cite web | last=Vega | first=Roy M. | last2=Avva | first2=Usha | title=Pediatric Dehydration | website=NCBI Bookshelf | date=2020-08-08 | pmid=28613793 | url=https://www.ncbi.nlm.nih.gov/books/NBK436022/ | access-date=2020-12-15}}</ref><br />
Following [[fluids]] can be given in such cases: <br />
* [[ORS]] <br><br />
* Salted drinks eg. salted rice water or salted yogurt drink <br><br />
* [[Vegetable]] or chicken soup with [[salt]] <br><br />
* Home-based [[ORS]]: 3 gm of [[table salt]] and 18 gm of common [[sugar]] in one [[liter]] of [[water]]. <br><br />
* Plain [[water]] should also be given.<br />
* Commercial carbonated beverages, fruit juices, sweetened tea, coffee, medicinal tea should be avoided.<br />
|C02=[[Oral rehydration therapy]] for [[children]] with moderate [[dehydration]]:<br />
* [[ORS]] + [[Zinc]] supplementation should be started <br><br />
* After 4 hours, reassess the [[child]] and decide what [[treatment]] needs to be given next as per the Grade of [[dehydration]].<br><br />
*[[Children]] who continue to have [[dehydration]] even after 4 hours should receive [[ORS]] by [[nasogastric tube]] or RL [[intravenously]] (75 ml/kg in 4 hours).<br><br />
*If [[abdominal distension]], then [[oral]] [[rehydration]] should be withheld and only [[IV]] [[rehydration]] should be given. <br>|C03=<br />
*Start [[IV fluids]] immediately.<br><br />
*If the [[patient]] can drink, give [[ORS]] by [[mouth]] until the drip is set up.<br><br />
* Give 100 ml/kg Ringer Lactate [[solution]] divided as follows:<br />
*First, give 30 ml/kg and then give 70 ml/kg in [[infants]] (under 12 months) in 1 hour. <br />
*Reassess the [[patient]] every 1-2 hours.<br />
* If [[hydration]] is not improving, give the [[IV]] drip more rapidly as follows: <br />
*After six hours ([[infants]]) or three hours (older [[patients]]), evaluate the [[patient]] using the assessment [[chart]]. <br />
*Then choose the appropriate [[Treatment]] Plan (A, B or C) to continue the [[treatment]].}}<br />
{{familytree/end}}<br />
<br />
==Do's==<br />
<br />
*[[Hydrate]] the [[child]] well. [[Hydration]] plays a vital role in early [[recovery]] and [[Reversal potential|reversal]] of [[symptoms]] of [[diarrhea]].<ref name="Camilleri Sellin Barrett 2017 pp. 515–532.e2">{{cite journal | last=Camilleri | first=Michael | last2=Sellin | first2=Joseph H. | last3=Barrett | first3=Kim E. | title=Pathophysiology, Evaluation, and Management of Chronic Watery Diarrhea | journal=Gastroenterology | publisher=Elsevier BV | volume=152 | issue=3 | year=2017 | issn=0016-5085 | doi=10.1053/j.gastro.2016.10.014 | pages=515–532.e2}}</ref><br />
*[[Eating]] properly: Make the [[child]] [[Eating|eat]] properly such as [[eating]] a [[diet]] consisting of [[bananas]], rice, [[applesauce]], and toast.<br />
*The use of [[probiotics]] can [[help]] shorten the duration of [[illness]].<br />
*Use [[antibiotics]] only when indicated in the case of [[pediatric]] [[diarrheal]] [[illness]].<br />
<br />
==Don'ts==<br />
<br />
*Don't try to make special [[salt]] and [[fluid]] [[Combination car|combinations]] at [[Home care|home]] unless your [[pediatrician]] [[Instructions for Administration|instructs]] you and you have the proper instruments.<ref name="Aranda-Michel Giannella 1999 pp. 670–676">{{cite journal | last=Aranda-Michel | first=Jaime | last2=Giannella | first2=Ralph A | title=Acute diarrhea: a practical review | journal=The American Journal of Medicine | publisher=Elsevier BV | volume=106 | issue=6 | year=1999 | issn=0002-9343 | doi=10.1016/s0002-9343(99)00128-x | pages=670–676}}</ref><br />
*Don't [[Prevention (medical)|prevent]] the [[child]] from [[eating]] if the [[child]] is hungry.<br />
*Don't use [[antibiotics]] unless [[Prescription|prescribed]] by your [[pediatrician]].<br />
*Don't ignore the [[Symptoms and Signs|symptoms]] and record [[temperature]] and [[hydration]] status.<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
[[Category:Needs English Review]]<br />
<br />
[[Category:Projects]]<br />
[[Category:Resident survival guide]]<br />
[[Category:Pediatrics]]</div>
Usmanaliakbar
https://www.wikidoc.org/index.php?title=Diarrhea_resident_survival_guide_(pediatrics)&diff=1681525
Diarrhea resident survival guide (pediatrics)
2021-01-05T17:01:08Z
<p>Usmanaliakbar: /* Do's */</p>
<hr />
<div>__NOTOC__<br />
<br />
{{CMG}} {{AE}} {{Usman Ali Akbar}}<br />
<br />
{{SK}} Approach to [[diarrhea]] in [[pediatric]] [[patients]], Approach to [[infectious]] [[causes]] of [[diarrhea]], [[Oral]] [[Rehydration]] [[therapy]] in [[children]]<br />
<br />
{| class="infobox" style="margin: 0 0 0 0; border: 0; float: right; width: 100px; background: #A8A8A8; position: fixed; top: 250px; right: 21px; border-radius: 0 0 10px 10px;" cellpadding="0" cellspacing="0" ;<br />
|-<br />
! style="padding: 0 5px; font-size: 85%; background: #A8A8A8" align="center" |{{fontcolor|#2B3B44|Diarrhea resident survival guide (pediatrics) Microchapters}}<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Diarrhea resident survival guide (pediatrics)#Overview|Overview]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Diarrhea resident survival guide (pediatrics)#Causes|Causes]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Diarrhea resident survival guide (pediatrics)#FIRE: Focused Initial Rapid Evaluation|FIRE]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Diarrhea resident survival guide (pediatrics)#Complete Diagnostic Approach|Diagnosis]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Diarrhea resident survival guide (pediatrics)#Treatment|Treatment]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Diarrhea resident survival guide (pediatrics)#Do's|Do's]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Diarrhea resident survival guide (pediatrics)#Don'ts|Don'ts]]<br />
|}<br />
<br />
==Overview==<br />
[[Diarrhea]] remains one of the [[Lead|leading]] [[causes]] of [[Prevention|preventable]] death in developing countries, especially among [[children]] under 5 [[Year|years]] of [[age]]. [[Diarrhea]] is defined as an increase in the number of [[stools]] such as more than three [[Bowel movement|bowel movements]] each day or the [[Presenting symptom|presence]] of [[loose stools]] comparative to [[normal]] [[stool]] [[Consistency (statistics)|consistency]]. [[Acute diarrhea]] is when [[diarrhea]] occurs for less than 3 weeks in total and it is [[chronic]] when it lasts longer than three weeks. [[Hydration]] status plays an important role in the management of [[pediatric]] [[diarrheal]] [[illness]]. The [[RiskMetrics|risk]] of [[dehydration]] due to [[fluid]] and [[Electrolyte imbalance|electrolyte losses]] is inversely proportional to the [[child]]'s [[age]] hence, the younger the [[child]], the greater is the [[RiskMetrics|risk]] of [[dehydration]]. The type of [[dehydration]] whether it is [[isotonic]], [[hypotonic]], or [[hypertonic]] is usually independent of the responsible agent. [[Fluid loss]] due to [[diarrhea]] and [[vomiting]] can be life-threatening if it is as high as three times the [[Circulation|circulating]] [[blood volume]] (80–125–250 mL per [[Kilogram|kg]] [[body weight]] per day). To keep the [[blood volume]] [[constant]], the [[body]] usually [[Extraction|extracts]] [[fluid]] from the [[intracellular]] space which can predispose it to [[dehydration]]. [[Complications]] and [[hospitalization]] due to [[dehydration]] can usually be [[Prevention|prevented]] by the early and adequate [[oral]] administration of a [[rehydration]] [[solution]] ([[glucose]]-[[electrolyte]] [[solution]]) and [[normal]] [[food]] for the [[child]]’s [[age]].<br />
<br />
==Causes==<br />
<br />
*The [[causes]] of [[diarrhea]] can [[Range (statistics)|range]] from [[life]]-threatening to mild and self-[[Resolving power|resolving]] [[causes]]:<ref name="WHO">{{cite web | title=Diarrhoeal disease | website=WHO | url=https://www.who.int/news-room/fact-sheets/detail/diarrhoeal-disease#:~:text=There%20are%20three%20clinical%20types,lasts%2014%20days%20or%20longer. | language=af | access-date=2020-12-15}}</ref><br />
<br />
{| class="wikitable"<br />
|+<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Life Threatening Causes<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Common Causes<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Miscellaneous<br />
|-<br />
|<br />
*[[Cholera]]<br />
*''[[Entamoeba histolytica]]''<br />
*[[Enterohemorrhagic Escherichica coli|Enterohemorrhagic ''Escherichia coli'']] ([[EHEC]])<br />
*[[Enteroinvasive Escherichia coli|Enteroinvasive ''Escherichia coli'']] ([[EIEC]])<br />
*[[Campylobacter]] spp.<br />
*[[Salmonella enterica|Nontyphoidal ''Salmonella enterica'']]<br />
|<br />
*[[Rotavirus]]<br />
*[[Enterotoxigenic Escherichia coli]] ([[ETEC]])<br />
*[[Cryptosporidium]]<br />
*[[Shigella|Shigella spp.]]<br />
|<br />
*[[Parenteral]] [[causes]] include [[infections]] elsewhere in the [[body]]: [[UTI]], [[Acute otitis media]], [[Sepsis]].<br />
*[[Inflammatory ]] [[causes]] include: [[IBD]], [[Allergy]] to cow's [[milk]], [[Whipple's disease]].<br />
*[[Malabsorption|Malabsorptive]] [[causes]] include: [[Celiac disease]], [[Lactase deficiency]].<br />
*[[Endocrine]] [[causes]] include: [[Hypothyroidism]], [[Addison's disease]] , [[Hyperparathyroidism|Hyperparathyroidism]].<br />
*[[Neoplastic]] [[causes]]<br />
*[[Psychosocial]] [[causes]]<br />
|}<br />
<br />
==FIRE: Focused Initial Rapid Evaluation==<br />
<br />
*A Focused Initial Rapid Evaluation (FIRE) should be [[Performance status|performed]] to identify the [[patients]] in need of immediate intervention:<ref name="Koletzko Osterrieder 2009 p.">{{cite journal | last=Koletzko | first=Sibylle | last2=Osterrieder | first2=Stephanie | title=Acute Infectious Diarrhea in Children | journal=Deutsches Ärzteblatt International | volume=106 | issue=33 | date=2009-09-25 | pmid=19738921 | doi=10.3238/arztebl.2009.0539 | url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2737434/ | access-date=2020-12-15 | page=}}</ref><br />
{{familytree/start |summary=PE diagnosis Algorithm.}}<br />
{{familytree | | | | | | | | | | | A01 | | | A01=[[Patient]] presents with [[acute]] [[diarrhea]] in [[emergency]]}}<br />
{{familytree | | | | |,|-|-|-|-|-|-|+|-|-|-|-|.| }}<br />
{{familytree | | | | C01 | | | | | | C02 | | | C03 |C01= '''Mild [[Dehydration]]'''|C02='''Moderate [[Dehydration]]'''|C03=<div style=" background: #FA8072; text-align: center; width:15em; padding:0.7em"> {{fontcolor|#F8F8FF|'''Severe [[Dehydration]]'''}}</div> }}<br />
{{familytree | | | | |!| | | | | | | |!| | | |!| |}}<br />
{{familytree | | | | C01 | | | | | | C02 | | C03 | |C01= Home [[treatment]] with [[ORS]], [[patient]] [[prescription]], and [[dietary]] recommendations |C02=Is there any [[evidence]] of [[dehydration]] or >8 [[watery]] [[stools]] in 24 hours or >4 episodes of [[vomiting]] in 24 hours or <6 months old|C03=<div style=" background: #FA8072; text-align: center; width:15em; padding:0.7em"> {{fontcolor|#F8F8FF|'''[[Dehydration]] >9% [[Shock]] or [[Impaired]] [[consciousness]]'''}}</div>}}<br />
{{familytree | | | | | | | | | | | |!| | | | | |!| |}}<br />
{{familytree | | | | | | | | | |C01 | | | | |C02 | | | | | |C01= Give [[ORS]] by spoon or [[syringe]] according to [[age]] and [[weight]] <br><br />
* [[Infants]] 5—9 kg: 2.0 mL every minute (120 mL/hr) <br><br />
* [[Infants]] 9—12 kg: 2.5 mL every minute (150 mL/hr) <br><br />
* Toddlers 12-15 kg: 3.0 mL every minute (180 mL/hr)<br><br />
* If there is no [[vomiting]], then larger volumes at longer intervals: 10-15 mL every 5 or 20-30 mL every 10 minutes Racecadotril in 5 mL of [[water]])<br><br />
* <9 kg: 10 mg, 10-15 kg: 20 mg, 16-29 kg: 30 mg <br>|C02=<div style=" background: #FA8072; text-align: center; width:15em; padding:0.7em"> {{fontcolor|#F8F8FF|'''Intensive Care'''}}</div> }}<br />
<br />
<br />
{{familytree/end}}<br />
<br />
==Complete Diagnostic Approach==<br />
<br />
*Shown below is an [[algorithm]] [[Summarizing statistical data|summarizing]] the [[diagnosis]] of [[Acute diarrhea causes|acute diarrhea]] in [[children]] according to the [[World Health Organization|WHO]] [[Guideline (medical)|guidelines]]:<ref>https://apps.who.int/iris/bitstream/handle/10665/43209/9241593180.pdf;jsessionid=E1E068378A53790D37702AB3086551B4?sequence=1</ref><ref>http://www.doiserbia.nb.rs/img/doi/0370-8179/2015/0370-81791512755R.pdf</ref><br />
{{familytree/start |summary=PE diagnosis Algorithm.}}<br />
{{familytree | | | | | | | | | A01 | | | A01= [[Patient]] with history of [[diarrhea]] }}<br />
{{familytree | | | | | | | | | |!| | | | }}<br />
{{familytree | | | | | | | | | B01 | | | B01= '''[[Assessment]]''' <br><br />
*A [[child]] with [[diarrhea]] should be assessed for [[dehydration]] <br><br />
*[[Bloody diarrhea]], persistent [[diarrhea]] <br><br />
*[[Malnutrition]] and serious non-[[intestinal]] [[infections]] so that an appropriate [[treatment]] plan can be implemented.<br><br />
}}<br />
{{familytree | | | | | | | | | |!| | | | }}<br />
{{familytree | | | | | | | | | B01 | | | B01= '''History''' <br><br />
*Duration and severity of [[diarrhea]]<br />
*Presence of [[blood]] in [[stool]]<br />
*Number of watery [[stools]] per day<br />
*Number of episodes of [[vomiting]]<br />
*[[Diaper rash]]<br />
*Presence of [[fever]], [[cough]], or other important problems (e.g. [[convulsions]], recent [[measles]])<br />
*Pre-[[illness]] [[feeding]] practices; type and amount of [[fluids]] (including [[breast milk]]) and [[food]] taken during the [[illness]]<br />
*History of [[Medications]]<br />
*History of [[immunization]]}}<br />
{{familytree | | | | | | | | | |!| | | | }}<br />
{{familytree | | | | | | | | | B01 | | | B01= '''[[Physical Examination]]''' <br><br />
*Look for the [[signs]] and [[symptoms]] of [[dehydration]] <br><br />
*Is the [[child]] [[alert]], restless or [[irritable]]?<br><br />
*Look for the [[eyes]], are they [[normal]] or sunken?<br><br />
*Look for [[skin]] [[turgor]]?<br><br />
*Does the [[stool]] contain red [[blood]]?<br><br />
*Is the [[child]] [[malnourished]]?<br><br />
*Look for [[growth chart]], [[weight]] for [[length]] or measure the mid-[[arm]] circumference.<br><br />
*Measure the [[temperature]] of [[child]].<br><br />
}}<br />
{{familytree | | | | | | | | | |!| | | | }}<br />
{{familytree | | | | | |,|-|-|-|+|-|-|-|-|.| }}<br />
{{familytree | | | | |C01| | |C02| |C03| |C01='''Mild [[Dehydration]]'''<br><br />
There are no specific [[signs]] and [[symptoms]] <br>|C02='''Moderate [[Dehydration]]''' <br><br />
<br />
Initially, the [[signs]] and [[symptoms]] that develop include:<br><br />
- [[Thirst]] <br><br />
- Restless or [[irritable]] [[behavior]] <br><br />
- Decreased [[skin]] [[turgor]] <br><br />
- Sunken [[eyes]] <br><br />
- Sunken [[fontanelle]] <br><br />
(in [[infants]])|C03='''Severe [[Dehydration]]'''<br><ref name="Parker Unaka p=775">{{cite journal | last=Parker | first=Michelle W. | last2=Unaka | first2=Ndidi | title=Diagnosis and Management of Infectious Diarrhea | journal=JAMA pediatrics | publisher=American Medical Association (AMA) | volume=172 | issue=8 | date=2018-08-01 | issn=2168-6203 | pmid=29889925 | doi=10.1001/jamapediatrics.2018.1172 | page=775}}</ref><br />
These effects become more pronounced and the [[patient]] may develop [[evidence]] of [[hypovolaemic shock]] including: <br><br />
- Diminished [[consciousness]] <br><br />
- Lack of [[urine output]] <br><br />
- Cool moist [[extremities]] <br><br />
- Rapid and feeble [[pulse]]<br />
(the [[radial]] [[pulse]] maybe undetectable)<br><br />
- Low or undetectable [[blood pressure]] <br><br />
- Peripheral [[cyanosis]]. <br><br />
Death follows soon if [[rehydration]] is not started quickly <br> }}<br />
{{familytree/end}}<br />
<br />
==Treatment==<br />
<br />
*Shown below is an [[Algorithm (medical)|algorithm]] [[Summarizing statistical data|summarizing]] the [[treatment]] of [[Acute diarrhea causes|acute diarrhea]] in [[pediatric]] [[patients]] according to the [[World Health Organization|WHO]] [[Guideline (medical)|guidelines]]:<ref>https://apps.who.int/iris/bitstream/handle/10665/43209/9241593180.pdf;jsessionid=E1E068378A53790D37702AB3086551B4?sequence=1</ref><br />
{{familytree/start |summary=PE diagnosis Algorithm.}}<br />
{{familytree | | | | | | | | | | | A01 | | | A01=[[Patient]] presents with [[Acute diarrhea causes|acute diarrhea]] in [[emergency]]}}<br />
{{familytree | | | | |,|-|-|-|-|-|-|+|-|-|-|-|.| }}<br />
{{familytree | | | | C01 | | | | | | C02 | | | C03 |C01='''Mild [[Dehydration]]'''|C02='''Moderate [[Dehydration]]'''|C03='''Severe [[Dehydration]]'''}}<br />
{{familytree | | | | |!| | | | | | | |!| | | |!| |}}<br />
{{familytree | | | | C01 | | | | | | C02 | | C03 | |C01= [[Children]] with no [[signs]] of [[dehydration]] are given extra [[fluids]] and [[salts]] to replace losses due to [[diarrhea]].<ref name="Vega Avva 2020">{{cite web | last=Vega | first=Roy M. | last2=Avva | first2=Usha | title=Pediatric Dehydration | website=NCBI Bookshelf | date=2020-08-08 | pmid=28613793 | url=https://www.ncbi.nlm.nih.gov/books/NBK436022/ | access-date=2020-12-15}}</ref><br />
Following [[fluids]] can be given in such cases: <br />
* [[ORS]] <br><br />
* Salted drinks eg. salted rice water or salted yogurt drink <br><br />
* [[Vegetable]] or chicken soup with [[salt]] <br><br />
* Home-based [[ORS]]: 3 gm of [[table salt]] and 18 gm of common [[sugar]] in one [[liter]] of [[water]]. <br><br />
* Plain [[water]] should also be given.<br />
* Commercial carbonated beverages, fruit juices, sweetened tea, coffee, medicinal tea should be avoided.<br />
|C02=[[Oral rehydration therapy]] for [[children]] with moderate [[dehydration]]:<br />
* [[ORS]] + [[Zinc]] supplementation should be started <br><br />
* After 4 hours, reassess the [[child]] and decide what [[treatment]] needs to be given next as per the Grade of [[dehydration]].<br><br />
*[[Children]] who continue to have [[dehydration]] even after 4 hours should receive [[ORS]] by [[nasogastric tube]] or RL [[intravenously]] (75 ml/kg in 4 hours).<br><br />
*If [[abdominal distension]], then [[oral]] [[rehydration]] should be withheld and only [[IV]] [[rehydration]] should be given. <br>|C03=<br />
*Start [[IV fluids]] immediately.<br><br />
*If the [[patient]] can drink, give [[ORS]] by [[mouth]] until the drip is set up.<br><br />
* Give 100 ml/kg Ringer Lactate [[solution]] divided as follows:<br />
*First, give 30 ml/kg and then give 70 ml/kg in [[infants]] (under 12 months) in 1 hour. <br />
*Reassess the [[patient]] every 1-2 hours.<br />
* If [[hydration]] is not improving, give the [[IV]] drip more rapidly as follows: <br />
*After six hours ([[infants]]) or three hours (older [[patients]]), evaluate the [[patient]] using the assessment [[chart]]. <br />
*Then choose the appropriate [[Treatment]] Plan (A, B or C) to continue the [[treatment]].}}<br />
{{familytree/end}}<br />
<br />
==Do's==<br />
<br />
*[[Hydrate]] the [[child]] well. [[Hydration]] plays a vital role in early [[recovery]] and [[Reversal potential|reversal]] of [[symptoms]] of [[diarrhea]].<ref name="Camilleri Sellin Barrett 2017 pp. 515–532.e2">{{cite journal | last=Camilleri | first=Michael | last2=Sellin | first2=Joseph H. | last3=Barrett | first3=Kim E. | title=Pathophysiology, Evaluation, and Management of Chronic Watery Diarrhea | journal=Gastroenterology | publisher=Elsevier BV | volume=152 | issue=3 | year=2017 | issn=0016-5085 | doi=10.1053/j.gastro.2016.10.014 | pages=515–532.e2}}</ref><br />
*[[Eating]] properly: Make the [[child]] [[Eating|eat]] properly such as [[eating]] a [[diet]] consisting of [[bananas]], rice, [[applesauce]], and toast.<br />
*The use of [[probiotics]] can [[help]] shorten the duration of [[illness]].<br />
*Use [[antibiotics]] only when indicated in the case of [[pediatric]] [[diarrheal]] [[illness]].<br />
<br />
==Don'ts==<br />
<br />
*Don't try to make special [[salt]] and [[fluid]] [[Combination car|combinations]] at [[Home care|home]] unless your [[pediatrician]] [[Instructions for Administration|instructs]] you and you have the proper instruments.<br />
*Don't [[Prevention (medical)|prevent]] the [[child]] from [[eating]] if the [[child]] is hungry.<br />
*Don't use [[antibiotics]] unless [[Prescription|prescribed]] by your [[pediatrician]].<br />
*Don't ignore the [[Symptoms and Signs|symptoms]] and record [[temperature]] and [[hydration]] status.<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
[[Category:Needs English Review]]<br />
<br />
[[Category:Projects]]<br />
[[Category:Resident survival guide]]<br />
[[Category:Pediatrics]]</div>
Usmanaliakbar
https://www.wikidoc.org/index.php?title=Diarrhea_resident_survival_guide_(pediatrics)&diff=1679274
Diarrhea resident survival guide (pediatrics)
2020-12-16T13:39:54Z
<p>Usmanaliakbar: /* FIRE: Focused Initial Rapid Evaluation */</p>
<hr />
<div>__NOTOC__<br />
<br />
{{CMG}} {{AE}} {{Usman Ali Akbar}}<br />
<br />
{{SK}} Approach to diarrhea in pediatric patients, Approach to infectious causes of diarrhea,Oral Rehydration therapy in children<br />
<br />
{| class="infobox" style="margin: 0 0 0 0; border: 0; float: right; width: 100px; background: #A8A8A8; position: fixed; top: 250px; right: 21px; border-radius: 0 0 10px 10px;" cellpadding="0" cellspacing="0" ;<br />
|-<br />
! style="padding: 0 5px; font-size: 85%; background: #A8A8A8" align="center" |{{fontcolor|#2B3B44|Diarrhea resident survival guide (pediatrics) Microchapters}}<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Diarrhea resident survival guide (pediatrics)#Overview|Overview]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Diarrhea resident survival guide (pediatrics)#Causes|Causes]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Diarrhea resident survival guide (pediatrics)#FIRE: Focused Initial Rapid Evaluation|FIRE]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Diarrhea resident survival guide (pediatrics)#Complete Diagnostic Approach|Diagnosis]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Diarrhea resident survival guide (pediatrics)#Treatment|Treatment]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Diarrhea resident survival guide (pediatrics)#Do's|Do's]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Diarrhea resident survival guide (pediatrics)#Don'ts|Don'ts]]<br />
|}<br />
<br />
==Overview==<br />
[[Diarrhea]] remains one of the leading causes of preventable death in developing countries, especially among children under 5 years of age. [[Diarrhea]] is defined as an increase in the number of stools or the presence of looser stools than is normal, like more than three bowel movements each day. [[Acute diarrhea]] is when [[diarrhea]] occurs for less than 3 weeks in total. When [[diarrhea]] lasts longer than three weeks, it is considered to be [[chronic]]. [[Hydration]] status plays an important role in the management of pediatric diarrheal illness. The younger the child, the greater the risk that fluid and [[Electrolyte imbalance|electrolyte losses]] will lead to dehydration. The type of [[dehydration]] whether it is [[isotonic]], [[hypotonic]], or [[hypertonic]] is usually independent of the responsible agent. Fluid losses resulting from diarrhea and vomiting can be as high as three times the circulating blood volume (80–125–250 mL per kg body weight per day) and can be life-threatening. To keep the blood volume constant, the body usually extracts fluid from the [[intracellular]] space which can predispose it to [[dehydration]]. Complications and hospitalization due to dehydration can usually be prevented by the early and adequate oral administration of a [[rehydration]] solution (glucose-electrolyte solution) and normal food for the child’s age.<br />
<br />
==Causes==<br />
The causes of diarrhea can range from life-threatening to mild and self resolving causes. <ref name="WHO">{{cite web | title=Diarrhoeal disease | website=WHO | url=https://www.who.int/news-room/fact-sheets/detail/diarrhoeal-disease#:~:text=There%20are%20three%20clinical%20types,lasts%2014%20days%20or%20longer. | language=af | access-date=2020-12-15}}</ref><br />
{| class="wikitable"<br />
|+<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Life Threatening Causes<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Common Causes<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Misc<br />
|-<br />
|<br />
*[[Cholera]]<br />
*''[[Entamoeba histolytica]]''<br />
*[[Enterohemorrhagic Escherichia coli (EHEC)|Enterohemorrhagic ''Escherichia coli'' (EHEC)]]<br />
*[[Enteroinvasive Escherichia coli (EIEC)|Enteroinvasive ''Escherichia coli'' (EIEC)]]<br />
*[[Campylobacter]] spp.<br />
*[[Salmonella enterica|Nontyphoidal ''Salmonella enterica'']]<br />
|<br />
*[[Rotavirus]]<br />
*[[Enterotoxigenic Escherichia coli]] (ETEC)<br />
*[[Cryptosporidium]]<br />
*[[Shigella|Shigella spp.]]<br />
|<br />
*Parenteral causes including infections elsewhere in the body : [[UTI]],[[Acute otitis media]], [[Sepsis]].<br />
*[[Inflammatory ]] including [[IBD]],Allergy to cow's milk , [[whipples disease]].<br />
*[[Malabsorption]] including [[celiac disease]] ,[[lactase deficiency]]<br />
*[[Endocrine]] :[[Hypothyroidism]],[[Addison's disease]] ,[[Hyperparathyroidism]]'<br />
*[[Neoplastic causes]]<br />
*[[psychosocial]]<br />
|}<br />
<br />
==FIRE: Focused Initial Rapid Evaluation==<br />
<br />
*A Focused Initial Rapid Evaluation (FIRE) should be performed to identify the [[patients]] in need of immediate [[intervention]]].<ref name="Koletzko Osterrieder 2009 p.">{{cite journal | last=Koletzko | first=Sibylle | last2=Osterrieder | first2=Stephanie | title=Acute Infectious Diarrhea in Children | journal=Deutsches Ärzteblatt International | volume=106 | issue=33 | date=2009-09-25 | pmid=19738921 | doi=10.3238/arztebl.2009.0539 | url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2737434/ | access-date=2020-12-15 | page=}}</ref><br />
{{familytree/start |summary=PE diagnosis Algorithm.}}<br />
{{familytree | | | | | | | | | | | A01 | | | A01=Patient presents with acute [[diarrhea]] in Emergency}}<br />
{{familytree | | | | |,|-|-|-|-|-|-|+|-|-|-|-|.| }}<br />
{{familytree | | | | C01 | | | | | | C02 | | | C03 |C01= '''Mild [[Dehydration]]'''|C02='''Moderate [[Dehydration]]'''|C03=<div style=" background: #FA8072; text-align: center; width:15em; padding:0.7em"> {{fontcolor|#F8F8FF|'''Severe [[Dehydration]]'''}}</div> }}<br />
{{familytree | | | | |!| | | | | | | |!| | | |!| |}}<br />
{{familytree | | | | C01 | | | | | | C02 | | C03 | |C01= Home treatment with [[ORS]], patient prescription, and dietary recommendations |C02=Is there any evidence of dehydration or > 8 watery stools in 24 hours or > 4 episodes of vomiting in 24 hours or < 6 months old|C03=<div style=" background: #FA8072; text-align: center; width:15em; padding:0.7em"> {{fontcolor|#F8F8FF|'''Dehydration > 9 % Shock or Impaired consciousness'''}}</div>}}<br />
{{familytree | | | | | | | | | | | |!| | | | | |!| |}}<br />
{{familytree | | | | | | | | | |C01 | | | | |C02 | | | | | |C01= Give [[ORS]] by spoon or syringe according to age and weight <br><br />
* Infants 5—9 kg: 2.0 mL every minute (120 mL/hr) <br><br />
* Infants 9—12 kg: 2.5 mL every minute (150 mL/hr) <br><br />
* Toddlers 12-15 kg: 3.0 mL every minute (180 mL/hr)<br><br />
* If there is no vomiting, then larger volumes at longer intervals: 10-15 mL every 5 or 20-30 mL every 10 minutes Racecadotril in 5 mL of water)<br><br />
* < 9 kg: 10 mg, 10-15 kg: 20 mg, 16-29 kg: 30 mg <br>|C02=<div style=" background: #FA8072; text-align: center; width:15em; padding:0.7em"> {{fontcolor|#F8F8FF|'''Intensive Care'''}}</div> }}<br />
<br />
<br />
{{familytree/end}}<br />
<br />
==Complete Diagnostic Approach==<br />
Shown below is an algorithm summarizing the diagnosis of acute diarrhea in children&lt;/nowiki&gt; according the the WHO guidelines.<ref name="WHO 2011">{{cite web | title=The treatment of diarrhoea | website=WHO | date=2011-12-15 | url=https://www.who.int/maternal_child_adolescent/documents/9241593180/en/ | access-date=2020-12-15}}</ref> <ref name="Radlovic Lekovic Vuletic Radlovic 2015 pp. 755–762">{{cite journal | last=Radlovic | first=Nedeljko | last2=Lekovic | first2=Zoran | last3=Vuletic | first3=Biljana | last4=Radlovic | first4=Vladimir | last5=Simic | first5=Dusica | title=Acute diarrhea in children | journal=Srpski arhiv za celokupno lekarstvo | publisher=National Library of Serbia | volume=143 | issue=11-12 | year=2015 | issn=0370-8179 | doi=10.2298/sarh1512755r | pages=755–762}}</ref><br />
{{familytree/start |summary=PE diagnosis Algorithm.}}<br />
{{familytree | | | | | | | | | A01 | | | A01= Patient with history of [[diarrhea]] }}<br />
{{familytree | | | | | | | | | |!| | | | }}<br />
{{familytree | | | | | | | | | B01 | | | B01= '''[[Assessment]]''' <br><br />
*A child with diarrhea should be assessed for [[dehydration]] <br><br />
*bloody diarrhea, persistent [[diarrhea]] <br><br />
*Malnutrition and serious non-intestinal infections so that an appropriate treatment plan can be implemented.<br><br />
}}<br />
{{familytree | | | | | | | | | |!| | | | }}<br />
{{familytree | | | | | | | | | B01 | | | B01= '''History''' <br><br />
*Duration and severity of [[diarrhea]];<br />
*Presence of blood in the stool;<br />
*Number of watery stools per day;<br />
*Number of episodes of vomiting; swollen; diaper rash<br />
*Presence of fever, cough, or other important problems (eq. convulsions, recent measles);<br />
*Pre-illness feeding practices; type and amount of [[fluids]] (including breast milk) and food taken during the illness;<br />
*History of Medications<br />
*History of [[immunization]]}}<br />
{{familytree | | | | | | | | | |!| | | | }}<br />
{{familytree | | | | | | | | | B01 | | | B01= '''Physical Examination''' <br><br />
*Look for the signs and symptoms of [[dehydration]] <br><br />
*Is the child alert, restless or [[irritable]] ?<br><br />
*Look for the eyes, are they normal or sunken?<br><br />
*Look for skin [[turgor]]?<br><br />
*Does the stool contain red blood?<br><br />
*Is the child [[malnourished]]?<br><br />
*Look for growth char, weight for length or measure the mid-arm circumference<br><br />
*Measure the temperature of child <br><br />
}}<br />
{{familytree | | | | | | | | | |!| | | | }}<br />
{{familytree | | | | | |,|-|-|-|+|-|-|-|-|.| }}<br />
{{familytree | | | | |C01| | |C02| |C03| |C01='''Mild [[Dehydration]]'''<br><br />
There are no specific signs and symptoms <br>|C02='''Moderate [[Dehydration]]''' <br><br />
<br />
Initially, the signs and symptoms that develop include:<br><br />
- [[Thirst]] <br><br />
- restless or irritable behavior <br><br />
- decreased skin turgor <br><br />
- sunken [[eyes]] <br><br />
- and a sunken fontanelle <br><br />
(in infants)|C03='''Severe [[Dehydration]]'''<br><ref name="Parker Unaka p=775">{{cite journal | last=Parker | first=Michelle W. | last2=Unaka | first2=Ndidi | title=Diagnosis and Management of Infectious Diarrhea | journal=JAMA pediatrics | publisher=American Medical Association (AMA) | volume=172 | issue=8 | date=2018-08-01 | issn=2168-6203 | pmid=29889925 | doi=10.1001/jamapediatrics.2018.1172 | page=775}}</ref><br />
these effects become more pronounced and the patient may develop evidence of [[hypovolaemic shock]] including: <br><br />
- Diminished [[consciousness]] <br><br />
- lack of urine output <br><br />
- cool moist extremities <br><br />
- a rapid and feeble [[pulse]]<br />
(the radial pulse maybe undetectable)<br><br />
- low or undetectable [[blood pressure]] <br><br />
- peripheral [[cyanosis]]. <br><br />
Death follows soon if rehydration is not started quickly <br> }}<br />
{{familytree/end}}<br />
<br />
==Treatment==<br />
Shown below is an algorithm summarizing the treatment of acute diarrhea in pediatric patients according the the WHO guidelines.<ref name="WHO 2011">{{cite web | title=The treatment of diarrhoea | website=WHO | date=2011-12-15 | url=https://www.who.int/maternal_child_adolescent/documents/9241593180/en/ | access-date=2020-12-15}}</ref><br />
{{familytree/start |summary=PE diagnosis Algorithm.}}<br />
{{familytree | | | | | | | | | | | A01 | | | A01=Patient presents with acute diarrhea in Emergency}}<br />
{{familytree | | | | |,|-|-|-|-|-|-|+|-|-|-|-|.| }}<br />
{{familytree | | | | C01 | | | | | | C02 | | | C03 |C01='''Mild [[Dehydration]]'''|C02='''Moderate [[Dehydration]]'''|C03='''Severe [[Dehydration]]'''}}<br />
{{familytree | | | | |!| | | | | | | |!| | | |!| |}}<br />
{{familytree | | | | C01 | | | | | | C02 | | C03 | |C01= Children with no signs of [[dehydration]] are given extra fluids and salts to replace losses due to [[diarrhea]].<ref name="Vega Avva 2020">{{cite web | last=Vega | first=Roy M. | last2=Avva | first2=Usha | title=Pediatric Dehydration | website=NCBI Bookshelf | date=2020-08-08 | pmid=28613793 | url=https://www.ncbi.nlm.nih.gov/books/NBK436022/ | access-date=2020-12-15}}</ref><br />
Following Fluids can be given in such cases <br />
* [[ORS]] <br><br />
* Salted drinks eg. salted rice water or salted [[yogurt]] drink <br><br />
* [[Vegetable]] or chicken soup with salt <br><br />
* Home-based ORS: 3 gm of table salt and 18 gm of common sugar in one liter of water. <br><br />
* Plain water should also be given.<br />
* Commercial carbonated beverages, fruit juices, sweetened tea, coffee, medicinal tea should be avoided.<br />
|C02=Oral rehydration therapy for children with moderate dehydration:<br />
* [[ORS]] + [[Zinc]] supplementation should be started <br><br />
* After 4 hours, reassess the child and decide what treatment to be given next as per the Grade of [[dehydration]].<br><br />
*Children who continue to have dehydration even after 4 hours should receive ORS by nasogastric tube or RL intravenously (75 ml/kg in 4 hours).<br><br />
*If abdominal distension then oral rehydration should be withheld and only IV rehydration should be given <br>|C03=<br />
*Start IV fluids immediately.<br><br />
*If the patient can drink, give ORS by mouth until the drip is set up. <br><br />
* Give 100 ml/kg [[Ringer's Lactate]] Solutions divided as follows<br />
*First, give 30 ml/kg in: Then give 70 ml/kg in Infants (under 12 months) in 1 hour <br />
*Reassess the patient every 1-2 hours.<br />
* If [[hydration]] is not improving, give the IV drip more rapidly as follows. <br />
*After six hours (infants) or three hours (older patients), evaluate the patient using the assessment chart. <br />
Then choose the appropriate Treatment Plan (A, B or C) to continue treatment. }}<br />
{{familytree/end}}<br />
<br />
==Do's==<br />
<br />
*[[Hydrate]] the child well. [[Hydration]] plays a vital role in early recovery and reversal of symptoms of [[diarrhea]].<ref name="Whinpark Medical Centre – Medical Doctors in Edinburgh">{{cite web | title=Diarrhoea and Vomiting – Dos and Don’ts – Whinpark Medical Centre | website=Whinpark Medical Centre – Medical Doctors in Edinburgh | url=https://www.whinpark.org/your-care/health-wellbeing-2/general-health-advice/diarrhoea-and-vomiting-dos-and-donts/ | access-date=2020-12-15}}</ref><br />
*Eating properly: Make the child eat properly such as eating a diet consisting of [[bananas]], rice, applesauce, and toast.<br />
*The use of [[probiotics]] can help shorten the duration of illness.<br />
*Use [[antibiotics]] only when indicated in the case of pediatric diarrheal illness.<br />
<br />
==Don'ts==<br />
<br />
*Don't try to make special salt and fluid combinations at home unless your pediatrician instructs you and you have the proper instruments.<ref name="GI Associates 2019">{{cite web | title=The Dos and Don'ts of Treating Diarrhea for Quick Relief | website=GI Associates | date=2019-09-04 | url=https://gi.md/resources/articles/the-dos-and-donts-of-treating-diarrhea | access-date=2020-12-15}}</ref><br />
*Don't prevent the child from eating if she is hungry. <ref name="Positive Parenting 2016">{{cite web | title=Dos and Don’ts of Diarrhoea | website=Positive Parenting | date=2016-03-28 | url=https://mypositiveparenting.org/2016/03/28/dos-and-donts-of-diarrhoea/ | access-date=2020-12-15}}</ref><br />
*Don't use [[antibiotics]] unless prescribed by your pediatrician.<br />
*Don't ignore the [[Symptoms and Signs|symptoms]] and record [[temperature]] and [[hydration]] status.<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
[[Category:Projects]]<br />
[[Category:Resident survival guide]]<br />
[[Category:Pediatrics]]</div>
Usmanaliakbar
https://www.wikidoc.org/index.php?title=Diarrhea_resident_survival_guide_(pediatrics)&diff=1679047
Diarrhea resident survival guide (pediatrics)
2020-12-15T19:51:13Z
<p>Usmanaliakbar: </p>
<hr />
<div>__NOTOC__<br />
<br />
{{CMG}} {{AE}} {{Usman Ali Akbar}}<br />
<br />
{{SK}} Approach to diarrhea in pediatric patients, Approach to infectious causes of diarrhea,Oral Rehydration therapy in children<br />
<br />
{| class="infobox" style="margin: 0 0 0 0; border: 0; float: right; width: 100px; background: #A8A8A8; position: fixed; top: 250px; right: 21px; border-radius: 0 0 10px 10px;" cellpadding="0" cellspacing="0" ;<br />
|-<br />
! style="padding: 0 5px; font-size: 85%; background: #A8A8A8" align="center" |{{fontcolor|#2B3B44|Diarrhea resident survival guide (pediatrics) Microchapters}}<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Diarrhea resident survival guide (pediatrics)#Overview|Overview]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Diarrhea resident survival guide (pediatrics)#Causes|Causes]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Diarrhea resident survival guide (pediatrics)#FIRE: Focused Initial Rapid Evaluation|FIRE]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Diarrhea resident survival guide (pediatrics)#Complete Diagnostic Approach|Diagnosis]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Diarrhea resident survival guide (pediatrics)#Treatment|Treatment]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Diarrhea resident survival guide (pediatrics)#Do's|Do's]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Diarrhea resident survival guide (pediatrics)#Don'ts|Don'ts]]<br />
|}<br />
<br />
==Overview==<br />
[[Diarrhea]] remains one of the leading causes of preventable death in developing countries, especially among children under 5 years of age. [[Diarrhea]] is defined as an increase in the number of stools or the presence of looser stools than is normal, like more than three bowel movements each day. [[Acute diarrhea]] is when [[diarrhea]] occurs for less than 3 weeks in total. When [[diarrhea]] lasts longer than three weeks, it is considered to be [[chronic]]. [[Hydration]] status plays an important role in the management of pediatric diarrheal illness. The younger the child, the greater the risk that fluid and [[Electrolyte imbalance|electrolyte losses]] will lead to dehydration. The type of [[dehydration]] whether it is [[isotonic]], [[hypotonic]], or [[hypertonic]] is usually independent of the responsible agent. Fluid losses resulting from diarrhea and vomiting can be as high as three times the circulating blood volume (80–125–250 mL per kg body weight per day) and can be life-threatening. To keep the blood volume constant, the body usually extracts fluid from the [[intracellular]] space which can predispose it to [[dehydration]]. Complications and hospitalization due to dehydration can usually be prevented by the early and adequate oral administration of a [[rehydration]] solution (glucose-electrolyte solution) and normal food for the child’s age.<br />
<br />
==Causes==<br />
The causes of diarrhea can range from life-threatening to mild and self resolving causes. <ref name="WHO">{{cite web | title=Diarrhoeal disease | website=WHO | url=https://www.who.int/news-room/fact-sheets/detail/diarrhoeal-disease#:~:text=There%20are%20three%20clinical%20types,lasts%2014%20days%20or%20longer. | language=af | access-date=2020-12-15}}</ref><br />
{| class="wikitable"<br />
|+<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Life Threatening Causes<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Common Causes<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Misc<br />
|-<br />
|<br />
*[[Cholera]]<br />
*''[[Entamoeba histolytica]]''<br />
*[[Enterohemorrhagic Escherichia coli (EHEC)|Enterohemorrhagic ''Escherichia coli'' (EHEC)]]<br />
*[[Enteroinvasive Escherichia coli (EIEC)|Enteroinvasive ''Escherichia coli'' (EIEC)]]<br />
*[[Campylobacter]] spp.<br />
*[[Salmonella enterica|Nontyphoidal ''Salmonella enterica'']]<br />
|<br />
*[[Rotavirus]]<br />
*[[Enterotoxigenic Escherichia coli]] (ETEC)<br />
*[[Cryptosporidium]]<br />
*[[Shigella|Shigella spp.]]<br />
|<br />
*Parenteral causes including infections elsewhere in the body : [[UTI]],[[Acute otitis media]], [[Sepsis]].<br />
*[[Inflammatory ]] including [[IBD]],Allergy to cow's milk , [[whipples disease]].<br />
*[[Malabsorption]] including [[celiac disease]] ,[[lactase deficiency]]<br />
*[[Endocrine]] :[[Hypothyroidism]],[[Addison's disease]] ,[[Hyperparathyroidism]]'<br />
*[[Neoplastic causes]]<br />
*[[psychosocial]]<br />
|}<br />
<br />
==FIRE: Focused Initial Rapid Evaluation==<br />
<br />
*A Focused Initial Rapid Evaluation (FIRE) should be performed to identify the [[patients]] in need of immediate [[intervention]]].<ref name="Koletzko Osterrieder 2009 p.">{{cite journal | last=Koletzko | first=Sibylle | last2=Osterrieder | first2=Stephanie | title=Acute Infectious Diarrhea in Children | journal=Deutsches Ärzteblatt International | volume=106 | issue=33 | date=2009-09-25 | pmid=19738921 | doi=10.3238/arztebl.2009.0539 | url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2737434/ | access-date=2020-12-15 | page=}}</ref><br />
{{familytree/start |summary=PE diagnosis Algorithm.}}<br />
{{familytree | | | | | | | | | | | A01 | | | A01=Patient presents with acute [[diarrhea]] in Emergency}}<br />
{{familytree | | | | |,|-|-|-|-|-|-|+|-|-|-|-|.| }}<br />
{{familytree | | | | C01 | | | | | | C02 | | | C03 |C01= '''Mild [[Dehydration]]'''|C02='''Moderate [[Dehydration]]'''|C03=<div style=" background: #FA8072; text-align: center; width:15em; padding:0.7em"> {{fontcolor|#F8F8FF|'''Severe [[Dehydration]]'''}}</div> }}<br />
{{familytree | | | | |!| | | | | | | |!| | | |!| |}}<br />
{{familytree | | | | C01 | | | | | | C02 | | C03 | |C01= Home treatment with [[ORS]], patient prescription, and dietary recommendations |C02=Is there any evidence of dehydration or > 8 watery stools in 24 hours or > 4 episodes of vomiting in 24 hours or < 6 months old|C03=<div style=" background: #FA8072; text-align: center; width:15em; padding:0.7em"> {{fontcolor|#F8F8FF|'''> Dehydration > 9 % Shock, Impaired consciousness''}}</div>}}<br />
{{familytree | | | | | | | | | | | |!| | | | | |!| |}}<br />
{{familytree | | | | | | | | | |C01 | | | | |C02 | | | | | |C01= Give [[ORS]] by spoon or syringe according to age and weight <br><br />
* Infants 5—9 kg: 2.0 mL every minute (120 mL/hr) <br><br />
* Infants 9—12 kg: 2.5 mL every minute (150 mL/hr) <br><br />
* Toddlers 12-15 kg: 3.0 mL every minute (180 mL/hr)<br><br />
* If there is no vomiting, then larger volumes at longer intervals: 10-15 mL every 5 or 20-30 mL every 10 minutes Racecadotril in 5 mL of water)<br><br />
* < 9 kg: 10 mg, 10-15 kg: 20 mg, 16-29 kg: 30 mg <br>|C02=<div style=" background: #FA8072; text-align: center; width:15em; padding:0.7em"> {{fontcolor|#F8F8FF|'''Intensive Care'''}}</div> }}<br />
<br />
<br />
{{familytree/end}}<br />
<br />
==Complete Diagnostic Approach==<br />
Shown below is an algorithm summarizing the diagnosis of acute diarrhea in children&lt;/nowiki&gt; according the the WHO guidelines.<ref name="WHO 2011">{{cite web | title=The treatment of diarrhoea | website=WHO | date=2011-12-15 | url=https://www.who.int/maternal_child_adolescent/documents/9241593180/en/ | access-date=2020-12-15}}</ref> <ref name="Radlovic Lekovic Vuletic Radlovic 2015 pp. 755–762">{{cite journal | last=Radlovic | first=Nedeljko | last2=Lekovic | first2=Zoran | last3=Vuletic | first3=Biljana | last4=Radlovic | first4=Vladimir | last5=Simic | first5=Dusica | title=Acute diarrhea in children | journal=Srpski arhiv za celokupno lekarstvo | publisher=National Library of Serbia | volume=143 | issue=11-12 | year=2015 | issn=0370-8179 | doi=10.2298/sarh1512755r | pages=755–762}}</ref><br />
{{familytree/start |summary=PE diagnosis Algorithm.}}<br />
{{familytree | | | | | | | | | A01 | | | A01= Patient with history of [[diarrhea]] }}<br />
{{familytree | | | | | | | | | |!| | | | }}<br />
{{familytree | | | | | | | | | B01 | | | B01= '''[[Assessment]]''' <br><br />
*A child with diarrhea should be assessed for [[dehydration]] <br><br />
*bloody diarrhea, persistent [[diarrhea]] <br><br />
*Malnutrition and serious non-intestinal infections so that an appropriate treatment plan can be implemented.<br><br />
}}<br />
{{familytree | | | | | | | | | |!| | | | }}<br />
{{familytree | | | | | | | | | B01 | | | B01= '''History''' <br><br />
*Duration and severity of [[diarrhea]];<br />
*Presence of blood in the stool;<br />
*Number of watery stools per day;<br />
*Number of episodes of vomiting; swollen; diaper rash<br />
*Presence of fever, cough, or other important problems (eq. convulsions, recent measles);<br />
*Pre-illness feeding practices; type and amount of [[fluids]] (including breast milk) and food taken during the illness;<br />
*History of Medications<br />
*History of [[immunization]]}}<br />
{{familytree | | | | | | | | | |!| | | | }}<br />
{{familytree | | | | | | | | | B01 | | | B01= '''Physical Examination''' <br><br />
*Look for the signs and symptoms of [[dehydration]] <br><br />
*Is the child alert, restless or [[irritable]] ?<br><br />
*Look for the eyes, are they normal or sunken?<br><br />
*Look for skin [[turgor]]?<br><br />
*Does the stool contain red blood?<br><br />
*Is the child [[malnourished]]?<br><br />
*Look for growth char, weight for length or measure the mid-arm circumference<br><br />
*Measure the temperature of child <br><br />
}}<br />
{{familytree | | | | | | | | | |!| | | | }}<br />
{{familytree | | | | | |,|-|-|-|+|-|-|-|-|.| }}<br />
{{familytree | | | | |C01| | |C02| |C03| |C01='''Mild [[Dehydration]]'''<br><br />
There are no specific signs and symptoms <br>|C02='''Moderate [[Dehydration]]''' <br><br />
<br />
Initially, the signs and symptoms that develop include:<br><br />
- [[Thirst]] <br><br />
- restless or irritable behavior <br><br />
- decreased skin turgor <br><br />
- sunken [[eyes]] <br><br />
- and a sunken fontanelle <br><br />
(in infants)|C03='''Severe [[Dehydration]]'''<br><ref name="Parker Unaka p=775">{{cite journal | last=Parker | first=Michelle W. | last2=Unaka | first2=Ndidi | title=Diagnosis and Management of Infectious Diarrhea | journal=JAMA pediatrics | publisher=American Medical Association (AMA) | volume=172 | issue=8 | date=2018-08-01 | issn=2168-6203 | pmid=29889925 | doi=10.1001/jamapediatrics.2018.1172 | page=775}}</ref><br />
these effects become more pronounced and the patient may develop evidence of [[hypovolaemic shock]] including: <br><br />
- Diminished [[consciousness]] <br><br />
- lack of urine output <br><br />
- cool moist extremities <br><br />
- a rapid and feeble [[pulse]]<br />
(the radial pulse maybe undetectable)<br><br />
- low or undetectable [[blood pressure]] <br><br />
- peripheral [[cyanosis]]. <br><br />
Death follows soon if rehydration is not started quickly <br> }}<br />
{{familytree/end}}<br />
<br />
==Treatment==<br />
Shown below is an algorithm summarizing the treatment of acute diarrhea in pediatric patients according the the WHO guidelines.<ref name="WHO 2011">{{cite web | title=The treatment of diarrhoea | website=WHO | date=2011-12-15 | url=https://www.who.int/maternal_child_adolescent/documents/9241593180/en/ | access-date=2020-12-15}}</ref><br />
{{familytree/start |summary=PE diagnosis Algorithm.}}<br />
{{familytree | | | | | | | | | | | A01 | | | A01=Patient presents with acute diarrhea in Emergency}}<br />
{{familytree | | | | |,|-|-|-|-|-|-|+|-|-|-|-|.| }}<br />
{{familytree | | | | C01 | | | | | | C02 | | | C03 |C01='''Mild [[Dehydration]]'''|C02='''Moderate [[Dehydration]]'''|C03='''Severe [[Dehydration]]'''}}<br />
{{familytree | | | | |!| | | | | | | |!| | | |!| |}}<br />
{{familytree | | | | C01 | | | | | | C02 | | C03 | |C01= Children with no signs of [[dehydration]] are given extra fluids and salts to replace losses due to [[diarrhea]].<ref name="Vega Avva 2020">{{cite web | last=Vega | first=Roy M. | last2=Avva | first2=Usha | title=Pediatric Dehydration | website=NCBI Bookshelf | date=2020-08-08 | pmid=28613793 | url=https://www.ncbi.nlm.nih.gov/books/NBK436022/ | access-date=2020-12-15}}</ref><br />
Following Fluids can be given in such cases <br />
* [[ORS]] <br><br />
* Salted drinks eg. salted rice water or salted [[yogurt]] drink <br><br />
* [[Vegetable]] or chicken soup with salt <br><br />
* Home-based ORS: 3 gm of table salt and 18 gm of common sugar in one liter of water. <br><br />
* Plain water should also be given.<br />
* Commercial carbonated beverages, fruit juices, sweetened tea, coffee, medicinal tea should be avoided.<br />
|C02=Oral rehydration therapy for children with moderate dehydration:<br />
* [[ORS]] + [[Zinc]] supplementation should be started <br><br />
* After 4 hours, reassess the child and decide what treatment to be given next as per the Grade of [[dehydration]].<br><br />
*Children who continue to have dehydration even after 4 hours should receive ORS by nasogastric tube or RL intravenously (75 ml/kg in 4 hours).<br><br />
*If abdominal distension then oral rehydration should be withheld and only IV rehydration should be given <br>|C03=<br />
*Start IV fluids immediately.<br><br />
*If the patient can drink, give ORS by mouth until the drip is set up. <br><br />
* Give 100 ml/kg [[Ringer's Lactate]] Solutions divided as follows<br />
*First, give 30 ml/kg in: Then give 70 ml/kg in Infants (under 12 months) in 1 hour <br />
*Reassess the patient every 1-2 hours.<br />
* If [[hydration]] is not improving, give the IV drip more rapidly as follows. <br />
*After six hours (infants) or three hours (older patients), evaluate the patient using the assessment chart. <br />
Then choose the appropriate Treatment Plan (A, B or C) to continue treatment. }}<br />
{{familytree/end}}<br />
<br />
==Do's==<br />
<br />
*[[Hydrate]] the child well. [[Hydration]] plays a vital role in early recovery and reversal of symptoms of [[diarrhea]].<ref name="Whinpark Medical Centre – Medical Doctors in Edinburgh">{{cite web | title=Diarrhoea and Vomiting – Dos and Don’ts – Whinpark Medical Centre | website=Whinpark Medical Centre – Medical Doctors in Edinburgh | url=https://www.whinpark.org/your-care/health-wellbeing-2/general-health-advice/diarrhoea-and-vomiting-dos-and-donts/ | access-date=2020-12-15}}</ref><br />
*Eating properly: Make the child eat properly such as eating a diet consisting of [[bananas]], rice, applesauce, and toast.<br />
*The use of [[probiotics]] can help shorten the duration of illness.<br />
*Use [[antibiotics]] only when indicated in the case of pediatric diarrheal illness.<br />
<br />
==Don'ts==<br />
<br />
*Don't try to make special salt and fluid combinations at home unless your pediatrician instructs you and you have the proper instruments.<ref name="GI Associates 2019">{{cite web | title=The Dos and Don'ts of Treating Diarrhea for Quick Relief | website=GI Associates | date=2019-09-04 | url=https://gi.md/resources/articles/the-dos-and-donts-of-treating-diarrhea | access-date=2020-12-15}}</ref><br />
*Don't prevent the child from eating if she is hungry. <ref name="Positive Parenting 2016">{{cite web | title=Dos and Don’ts of Diarrhoea | website=Positive Parenting | date=2016-03-28 | url=https://mypositiveparenting.org/2016/03/28/dos-and-donts-of-diarrhoea/ | access-date=2020-12-15}}</ref><br />
*Don't use [[antibiotics]] unless prescribed by your pediatrician.<br />
*Don't ignore the [[Symptoms and Signs|symptoms]] and record [[temperature]] and [[hydration]] status.<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
[[Category:Projects]]<br />
[[Category:Resident survival guide]]<br />
[[Category:Pediatrics]]</div>
Usmanaliakbar
https://www.wikidoc.org/index.php?title=Diarrhea_resident_survival_guide_(pediatrics)&diff=1679046
Diarrhea resident survival guide (pediatrics)
2020-12-15T19:50:15Z
<p>Usmanaliakbar: /* Causes */</p>
<hr />
<div>__NOTOC__<br />
<br />
{{CMG}} {{AE}} {{Usman Ali Akbar}}<br />
<br />
{{SK}}<br />
<br />
{| class="infobox" style="margin: 0 0 0 0; border: 0; float: right; width: 100px; background: #A8A8A8; position: fixed; top: 250px; right: 21px; border-radius: 0 0 10px 10px;" cellpadding="0" cellspacing="0" ;<br />
|-<br />
! style="padding: 0 5px; font-size: 85%; background: #A8A8A8" align="center" |{{fontcolor|#2B3B44|Diarrhea resident survival guide (pediatrics) Microchapters}}<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Diarrhea resident survival guide (pediatrics)#Overview|Overview]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Diarrhea resident survival guide (pediatrics)#Causes|Causes]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Diarrhea resident survival guide (pediatrics)#FIRE: Focused Initial Rapid Evaluation|FIRE]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Diarrhea resident survival guide (pediatrics)#Complete Diagnostic Approach|Diagnosis]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Diarrhea resident survival guide (pediatrics)#Treatment|Treatment]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Diarrhea resident survival guide (pediatrics)#Do's|Do's]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Diarrhea resident survival guide (pediatrics)#Don'ts|Don'ts]]<br />
|}<br />
<br />
==Overview==<br />
[[Diarrhea]] remains one of the leading causes of preventable death in developing countries, especially among children under 5 years of age. [[Diarrhea]] is defined as an increase in the number of stools or the presence of looser stools than is normal, like more than three bowel movements each day. [[Acute diarrhea]] is when [[diarrhea]] occurs for less than 3 weeks in total. When [[diarrhea]] lasts longer than three weeks, it is considered to be [[chronic]]. [[Hydration]] status plays an important role in the management of pediatric diarrheal illness. The younger the child, the greater the risk that fluid and [[Electrolyte imbalance|electrolyte losses]] will lead to dehydration. The type of [[dehydration]] whether it is [[isotonic]], [[hypotonic]], or [[hypertonic]] is usually independent of the responsible agent. Fluid losses resulting from diarrhea and vomiting can be as high as three times the circulating blood volume (80–125–250 mL per kg body weight per day) and can be life-threatening. To keep the blood volume constant, the body usually extracts fluid from the [[intracellular]] space which can predispose it to [[dehydration]]. Complications and hospitalization due to dehydration can usually be prevented by the early and adequate oral administration of a [[rehydration]] solution (glucose-electrolyte solution) and normal food for the child’s age.<br />
<br />
==Causes==<br />
The causes of diarrhea can range from life-threatening to mild and self resolving causes. <ref name="WHO">{{cite web | title=Diarrhoeal disease | website=WHO | url=https://www.who.int/news-room/fact-sheets/detail/diarrhoeal-disease#:~:text=There%20are%20three%20clinical%20types,lasts%2014%20days%20or%20longer. | language=af | access-date=2020-12-15}}</ref><br />
{| class="wikitable"<br />
|+<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Life Threatening Causes<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Common Causes<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Misc<br />
|-<br />
|<br />
*[[Cholera]]<br />
*''[[Entamoeba histolytica]]''<br />
*[[Enterohemorrhagic Escherichia coli (EHEC)|Enterohemorrhagic ''Escherichia coli'' (EHEC)]]<br />
*[[Enteroinvasive Escherichia coli (EIEC)|Enteroinvasive ''Escherichia coli'' (EIEC)]]<br />
*[[Campylobacter]] spp.<br />
*[[Salmonella enterica|Nontyphoidal ''Salmonella enterica'']]<br />
|<br />
*[[Rotavirus]]<br />
*[[Enterotoxigenic Escherichia coli]] (ETEC)<br />
*[[Cryptosporidium]]<br />
*[[Shigella|Shigella spp.]]<br />
|<br />
*Parenteral causes including infections elsewhere in the body : [[UTI]],[[Acute otitis media]], [[Sepsis]].<br />
*[[Inflammatory ]] including [[IBD]],Allergy to cow's milk , [[whipples disease]].<br />
*[[Malabsorption]] including [[celiac disease]] ,[[lactase deficiency]]<br />
*[[Endocrine]] :[[Hypothyroidism]],[[Addison's disease]] ,[[Hyperparathyroidism]]'<br />
*[[Neoplastic causes]]<br />
*[[psychosocial]]<br />
|}<br />
<br />
==FIRE: Focused Initial Rapid Evaluation==<br />
<br />
*A Focused Initial Rapid Evaluation (FIRE) should be performed to identify the [[patients]] in need of immediate [[intervention]]].<ref name="Koletzko Osterrieder 2009 p.">{{cite journal | last=Koletzko | first=Sibylle | last2=Osterrieder | first2=Stephanie | title=Acute Infectious Diarrhea in Children | journal=Deutsches Ärzteblatt International | volume=106 | issue=33 | date=2009-09-25 | pmid=19738921 | doi=10.3238/arztebl.2009.0539 | url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2737434/ | access-date=2020-12-15 | page=}}</ref><br />
{{familytree/start |summary=PE diagnosis Algorithm.}}<br />
{{familytree | | | | | | | | | | | A01 | | | A01=Patient presents with acute [[diarrhea]] in Emergency}}<br />
{{familytree | | | | |,|-|-|-|-|-|-|+|-|-|-|-|.| }}<br />
{{familytree | | | | C01 | | | | | | C02 | | | C03 |C01= '''Mild [[Dehydration]]'''|C02='''Moderate [[Dehydration]]'''|C03=<div style=" background: #FA8072; text-align: center; width:15em; padding:0.7em"> {{fontcolor|#F8F8FF|'''Severe [[Dehydration]]'''}}</div> }}<br />
{{familytree | | | | |!| | | | | | | |!| | | |!| |}}<br />
{{familytree | | | | C01 | | | | | | C02 | | C03 | |C01= Home treatment with [[ORS]], patient prescription, and dietary recommendations |C02=Is there any evidence of dehydration or > 8 watery stools in 24 hours or > 4 episodes of vomiting in 24 hours or < 6 months old|C03=<div style=" background: #FA8072; text-align: center; width:15em; padding:0.7em"> {{fontcolor|#F8F8FF|'''> Dehydration > 9 % Shock, Impaired consciousness''}}</div>}}<br />
{{familytree | | | | | | | | | | | |!| | | | | |!| |}}<br />
{{familytree | | | | | | | | | |C01 | | | | |C02 | | | | | |C01= Give [[ORS]] by spoon or syringe according to age and weight <br><br />
* Infants 5—9 kg: 2.0 mL every minute (120 mL/hr) <br><br />
* Infants 9—12 kg: 2.5 mL every minute (150 mL/hr) <br><br />
* Toddlers 12-15 kg: 3.0 mL every minute (180 mL/hr)<br><br />
* If there is no vomiting, then larger volumes at longer intervals: 10-15 mL every 5 or 20-30 mL every 10 minutes Racecadotril in 5 mL of water)<br><br />
* < 9 kg: 10 mg, 10-15 kg: 20 mg, 16-29 kg: 30 mg <br>|C02=<div style=" background: #FA8072; text-align: center; width:15em; padding:0.7em"> {{fontcolor|#F8F8FF|'''Intensive Care'''}}</div> }}<br />
<br />
<br />
{{familytree/end}}<br />
<br />
==Complete Diagnostic Approach==<br />
Shown below is an algorithm summarizing the diagnosis of acute diarrhea in children&lt;/nowiki&gt; according the the WHO guidelines.<ref name="WHO 2011">{{cite web | title=The treatment of diarrhoea | website=WHO | date=2011-12-15 | url=https://www.who.int/maternal_child_adolescent/documents/9241593180/en/ | access-date=2020-12-15}}</ref> <ref name="Radlovic Lekovic Vuletic Radlovic 2015 pp. 755–762">{{cite journal | last=Radlovic | first=Nedeljko | last2=Lekovic | first2=Zoran | last3=Vuletic | first3=Biljana | last4=Radlovic | first4=Vladimir | last5=Simic | first5=Dusica | title=Acute diarrhea in children | journal=Srpski arhiv za celokupno lekarstvo | publisher=National Library of Serbia | volume=143 | issue=11-12 | year=2015 | issn=0370-8179 | doi=10.2298/sarh1512755r | pages=755–762}}</ref><br />
{{familytree/start |summary=PE diagnosis Algorithm.}}<br />
{{familytree | | | | | | | | | A01 | | | A01= Patient with history of [[diarrhea]] }}<br />
{{familytree | | | | | | | | | |!| | | | }}<br />
{{familytree | | | | | | | | | B01 | | | B01= '''[[Assessment]]''' <br><br />
*A child with diarrhea should be assessed for [[dehydration]] <br><br />
*bloody diarrhea, persistent [[diarrhea]] <br><br />
*Malnutrition and serious non-intestinal infections so that an appropriate treatment plan can be implemented.<br><br />
}}<br />
{{familytree | | | | | | | | | |!| | | | }}<br />
{{familytree | | | | | | | | | B01 | | | B01= '''History''' <br><br />
*Duration and severity of [[diarrhea]];<br />
*Presence of blood in the stool;<br />
*Number of watery stools per day;<br />
*Number of episodes of vomiting; swollen; diaper rash<br />
*Presence of fever, cough, or other important problems (eq. convulsions, recent measles);<br />
*Pre-illness feeding practices; type and amount of [[fluids]] (including breast milk) and food taken during the illness;<br />
*History of Medications<br />
*History of [[immunization]]}}<br />
{{familytree | | | | | | | | | |!| | | | }}<br />
{{familytree | | | | | | | | | B01 | | | B01= '''Physical Examination''' <br><br />
*Look for the signs and symptoms of [[dehydration]] <br><br />
*Is the child alert, restless or [[irritable]] ?<br><br />
*Look for the eyes, are they normal or sunken?<br><br />
*Look for skin [[turgor]]?<br><br />
*Does the stool contain red blood?<br><br />
*Is the child [[malnourished]]?<br><br />
*Look for growth char, weight for length or measure the mid-arm circumference<br><br />
*Measure the temperature of child <br><br />
}}<br />
{{familytree | | | | | | | | | |!| | | | }}<br />
{{familytree | | | | | |,|-|-|-|+|-|-|-|-|.| }}<br />
{{familytree | | | | |C01| | |C02| |C03| |C01='''Mild [[Dehydration]]'''<br><br />
There are no specific signs and symptoms <br>|C02='''Moderate [[Dehydration]]''' <br><br />
<br />
Initially, the signs and symptoms that develop include:<br><br />
- [[Thirst]] <br><br />
- restless or irritable behavior <br><br />
- decreased skin turgor <br><br />
- sunken [[eyes]] <br><br />
- and a sunken fontanelle <br><br />
(in infants)|C03='''Severe [[Dehydration]]'''<br><ref name="Parker Unaka p=775">{{cite journal | last=Parker | first=Michelle W. | last2=Unaka | first2=Ndidi | title=Diagnosis and Management of Infectious Diarrhea | journal=JAMA pediatrics | publisher=American Medical Association (AMA) | volume=172 | issue=8 | date=2018-08-01 | issn=2168-6203 | pmid=29889925 | doi=10.1001/jamapediatrics.2018.1172 | page=775}}</ref><br />
these effects become more pronounced and the patient may develop evidence of [[hypovolaemic shock]] including: <br><br />
- Diminished [[consciousness]] <br><br />
- lack of urine output <br><br />
- cool moist extremities <br><br />
- a rapid and feeble [[pulse]]<br />
(the radial pulse maybe undetectable)<br><br />
- low or undetectable [[blood pressure]] <br><br />
- peripheral [[cyanosis]]. <br><br />
Death follows soon if rehydration is not started quickly <br> }}<br />
{{familytree/end}}<br />
<br />
==Treatment==<br />
Shown below is an algorithm summarizing the treatment of acute diarrhea in pediatric patients according the the WHO guidelines.<ref name="WHO 2011">{{cite web | title=The treatment of diarrhoea | website=WHO | date=2011-12-15 | url=https://www.who.int/maternal_child_adolescent/documents/9241593180/en/ | access-date=2020-12-15}}</ref><br />
{{familytree/start |summary=PE diagnosis Algorithm.}}<br />
{{familytree | | | | | | | | | | | A01 | | | A01=Patient presents with acute diarrhea in Emergency}}<br />
{{familytree | | | | |,|-|-|-|-|-|-|+|-|-|-|-|.| }}<br />
{{familytree | | | | C01 | | | | | | C02 | | | C03 |C01='''Mild [[Dehydration]]'''|C02='''Moderate [[Dehydration]]'''|C03='''Severe [[Dehydration]]'''}}<br />
{{familytree | | | | |!| | | | | | | |!| | | |!| |}}<br />
{{familytree | | | | C01 | | | | | | C02 | | C03 | |C01= Children with no signs of [[dehydration]] are given extra fluids and salts to replace losses due to [[diarrhea]].<ref name="Vega Avva 2020">{{cite web | last=Vega | first=Roy M. | last2=Avva | first2=Usha | title=Pediatric Dehydration | website=NCBI Bookshelf | date=2020-08-08 | pmid=28613793 | url=https://www.ncbi.nlm.nih.gov/books/NBK436022/ | access-date=2020-12-15}}</ref><br />
Following Fluids can be given in such cases <br />
* [[ORS]] <br><br />
* Salted drinks eg. salted rice water or salted [[yogurt]] drink <br><br />
* [[Vegetable]] or chicken soup with salt <br><br />
* Home-based ORS: 3 gm of table salt and 18 gm of common sugar in one liter of water. <br><br />
* Plain water should also be given.<br />
* Commercial carbonated beverages, fruit juices, sweetened tea, coffee, medicinal tea should be avoided.<br />
|C02=Oral rehydration therapy for children with moderate dehydration:<br />
* [[ORS]] + [[Zinc]] supplementation should be started <br><br />
* After 4 hours, reassess the child and decide what treatment to be given next as per the Grade of [[dehydration]].<br><br />
*Children who continue to have dehydration even after 4 hours should receive ORS by nasogastric tube or RL intravenously (75 ml/kg in 4 hours).<br><br />
*If abdominal distension then oral rehydration should be withheld and only IV rehydration should be given <br>|C03=<br />
*Start IV fluids immediately.<br><br />
*If the patient can drink, give ORS by mouth until the drip is set up. <br><br />
* Give 100 ml/kg [[Ringer's Lactate]] Solutions divided as follows<br />
*First, give 30 ml/kg in: Then give 70 ml/kg in Infants (under 12 months) in 1 hour <br />
*Reassess the patient every 1-2 hours.<br />
* If [[hydration]] is not improving, give the IV drip more rapidly as follows. <br />
*After six hours (infants) or three hours (older patients), evaluate the patient using the assessment chart. <br />
Then choose the appropriate Treatment Plan (A, B or C) to continue treatment. }}<br />
{{familytree/end}}<br />
<br />
==Do's==<br />
<br />
*[[Hydrate]] the child well. [[Hydration]] plays a vital role in early recovery and reversal of symptoms of [[diarrhea]].<ref name="Whinpark Medical Centre – Medical Doctors in Edinburgh">{{cite web | title=Diarrhoea and Vomiting – Dos and Don’ts – Whinpark Medical Centre | website=Whinpark Medical Centre – Medical Doctors in Edinburgh | url=https://www.whinpark.org/your-care/health-wellbeing-2/general-health-advice/diarrhoea-and-vomiting-dos-and-donts/ | access-date=2020-12-15}}</ref><br />
*Eating properly: Make the child eat properly such as eating a diet consisting of [[bananas]], rice, applesauce, and toast.<br />
*The use of [[probiotics]] can help shorten the duration of illness.<br />
*Use [[antibiotics]] only when indicated in the case of pediatric diarrheal illness.<br />
<br />
==Don'ts==<br />
<br />
*Don't try to make special salt and fluid combinations at home unless your pediatrician instructs you and you have the proper instruments.<ref name="GI Associates 2019">{{cite web | title=The Dos and Don'ts of Treating Diarrhea for Quick Relief | website=GI Associates | date=2019-09-04 | url=https://gi.md/resources/articles/the-dos-and-donts-of-treating-diarrhea | access-date=2020-12-15}}</ref><br />
*Don't prevent the child from eating if she is hungry. <ref name="Positive Parenting 2016">{{cite web | title=Dos and Don’ts of Diarrhoea | website=Positive Parenting | date=2016-03-28 | url=https://mypositiveparenting.org/2016/03/28/dos-and-donts-of-diarrhoea/ | access-date=2020-12-15}}</ref><br />
*Don't use [[antibiotics]] unless prescribed by your pediatrician.<br />
*Don't ignore the [[Symptoms and Signs|symptoms]] and record [[temperature]] and [[hydration]] status.<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
[[Category:Projects]]<br />
[[Category:Resident survival guide]]<br />
[[Category:Pediatrics]]</div>
Usmanaliakbar
https://www.wikidoc.org/index.php?title=Diarrhea_resident_survival_guide_(pediatrics)&diff=1679045
Diarrhea resident survival guide (pediatrics)
2020-12-15T19:49:45Z
<p>Usmanaliakbar: /* Causes */</p>
<hr />
<div>__NOTOC__<br />
<br />
{{CMG}} {{AE}} {{Usman Ali Akbar}}<br />
<br />
{{SK}}<br />
<br />
{| class="infobox" style="margin: 0 0 0 0; border: 0; float: right; width: 100px; background: #A8A8A8; position: fixed; top: 250px; right: 21px; border-radius: 0 0 10px 10px;" cellpadding="0" cellspacing="0" ;<br />
|-<br />
! style="padding: 0 5px; font-size: 85%; background: #A8A8A8" align="center" |{{fontcolor|#2B3B44|Diarrhea resident survival guide (pediatrics) Microchapters}}<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Diarrhea resident survival guide (pediatrics)#Overview|Overview]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Diarrhea resident survival guide (pediatrics)#Causes|Causes]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Diarrhea resident survival guide (pediatrics)#FIRE: Focused Initial Rapid Evaluation|FIRE]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Diarrhea resident survival guide (pediatrics)#Complete Diagnostic Approach|Diagnosis]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Diarrhea resident survival guide (pediatrics)#Treatment|Treatment]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Diarrhea resident survival guide (pediatrics)#Do's|Do's]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Diarrhea resident survival guide (pediatrics)#Don'ts|Don'ts]]<br />
|}<br />
<br />
==Overview==<br />
[[Diarrhea]] remains one of the leading causes of preventable death in developing countries, especially among children under 5 years of age. [[Diarrhea]] is defined as an increase in the number of stools or the presence of looser stools than is normal, like more than three bowel movements each day. [[Acute diarrhea]] is when [[diarrhea]] occurs for less than 3 weeks in total. When [[diarrhea]] lasts longer than three weeks, it is considered to be [[chronic]]. [[Hydration]] status plays an important role in the management of pediatric diarrheal illness. The younger the child, the greater the risk that fluid and [[Electrolyte imbalance|electrolyte losses]] will lead to dehydration. The type of [[dehydration]] whether it is [[isotonic]], [[hypotonic]], or [[hypertonic]] is usually independent of the responsible agent. Fluid losses resulting from diarrhea and vomiting can be as high as three times the circulating blood volume (80–125–250 mL per kg body weight per day) and can be life-threatening. To keep the blood volume constant, the body usually extracts fluid from the [[intracellular]] space which can predispose it to [[dehydration]]. Complications and hospitalization due to dehydration can usually be prevented by the early and adequate oral administration of a [[rehydration]] solution (glucose-electrolyte solution) and normal food for the child’s age.<br />
<br />
==Causes==<br />
The causes of diarrhea can range from life-threatening to mild and self resolving causes. <br />
{| class="wikitable"<br />
|+<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Life Threatening Causes<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Common Causes<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Misc<br />
|-<br />
|<br />
*[[Cholera]]<br />
*''[[Entamoeba histolytica]]''<br />
*[[Enterohemorrhagic Escherichia coli (EHEC)|Enterohemorrhagic ''Escherichia coli'' (EHEC)]]<br />
*[[Enteroinvasive Escherichia coli (EIEC)|Enteroinvasive ''Escherichia coli'' (EIEC)]]<br />
*[[Campylobacter]] spp.<br />
*[[Salmonella enterica|Nontyphoidal ''Salmonella enterica'']]<br />
|<br />
*[[Rotavirus]]<br />
*[[Enterotoxigenic Escherichia coli]] (ETEC)<br />
*[[Cryptosporidium]]<br />
*[[Shigella|Shigella spp.]]<br />
|<br />
*Parenteral causes including infections elsewhere in the body : [[UTI]],[[Acute otitis media]], [[Sepsis]].<br />
*[[Inflammatory ]] including [[IBD]],Allergy to cow's milk , [[whipples disease]].<br />
*[[Malabsorption]] including [[celiac disease]] ,[[lactase deficiency]]<br />
*[[Endocrine]] :[[Hypothyroidism]],[[Addison's disease]] ,[[Hyperparathyroidism]]'<br />
*[[Neoplastic causes]]<br />
*[[psychosocial]]<br />
|}<br />
<br />
==FIRE: Focused Initial Rapid Evaluation==<br />
<br />
*A Focused Initial Rapid Evaluation (FIRE) should be performed to identify the [[patients]] in need of immediate [[intervention]]].<ref name="Koletzko Osterrieder 2009 p.">{{cite journal | last=Koletzko | first=Sibylle | last2=Osterrieder | first2=Stephanie | title=Acute Infectious Diarrhea in Children | journal=Deutsches Ärzteblatt International | volume=106 | issue=33 | date=2009-09-25 | pmid=19738921 | doi=10.3238/arztebl.2009.0539 | url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2737434/ | access-date=2020-12-15 | page=}}</ref><br />
{{familytree/start |summary=PE diagnosis Algorithm.}}<br />
{{familytree | | | | | | | | | | | A01 | | | A01=Patient presents with acute [[diarrhea]] in Emergency}}<br />
{{familytree | | | | |,|-|-|-|-|-|-|+|-|-|-|-|.| }}<br />
{{familytree | | | | C01 | | | | | | C02 | | | C03 |C01= '''Mild [[Dehydration]]'''|C02='''Moderate [[Dehydration]]'''|C03=<div style=" background: #FA8072; text-align: center; width:15em; padding:0.7em"> {{fontcolor|#F8F8FF|'''Severe [[Dehydration]]'''}}</div> }}<br />
{{familytree | | | | |!| | | | | | | |!| | | |!| |}}<br />
{{familytree | | | | C01 | | | | | | C02 | | C03 | |C01= Home treatment with [[ORS]], patient prescription, and dietary recommendations |C02=Is there any evidence of dehydration or > 8 watery stools in 24 hours or > 4 episodes of vomiting in 24 hours or < 6 months old|C03=<div style=" background: #FA8072; text-align: center; width:15em; padding:0.7em"> {{fontcolor|#F8F8FF|'''> Dehydration > 9 % Shock, Impaired consciousness''}}</div>}}<br />
{{familytree | | | | | | | | | | | |!| | | | | |!| |}}<br />
{{familytree | | | | | | | | | |C01 | | | | |C02 | | | | | |C01= Give [[ORS]] by spoon or syringe according to age and weight <br><br />
* Infants 5—9 kg: 2.0 mL every minute (120 mL/hr) <br><br />
* Infants 9—12 kg: 2.5 mL every minute (150 mL/hr) <br><br />
* Toddlers 12-15 kg: 3.0 mL every minute (180 mL/hr)<br><br />
* If there is no vomiting, then larger volumes at longer intervals: 10-15 mL every 5 or 20-30 mL every 10 minutes Racecadotril in 5 mL of water)<br><br />
* < 9 kg: 10 mg, 10-15 kg: 20 mg, 16-29 kg: 30 mg <br>|C02=<div style=" background: #FA8072; text-align: center; width:15em; padding:0.7em"> {{fontcolor|#F8F8FF|'''Intensive Care'''}}</div> }}<br />
<br />
<br />
{{familytree/end}}<br />
<br />
==Complete Diagnostic Approach==<br />
Shown below is an algorithm summarizing the diagnosis of acute diarrhea in children&lt;/nowiki&gt; according the the WHO guidelines.<ref name="WHO 2011">{{cite web | title=The treatment of diarrhoea | website=WHO | date=2011-12-15 | url=https://www.who.int/maternal_child_adolescent/documents/9241593180/en/ | access-date=2020-12-15}}</ref> <ref name="Radlovic Lekovic Vuletic Radlovic 2015 pp. 755–762">{{cite journal | last=Radlovic | first=Nedeljko | last2=Lekovic | first2=Zoran | last3=Vuletic | first3=Biljana | last4=Radlovic | first4=Vladimir | last5=Simic | first5=Dusica | title=Acute diarrhea in children | journal=Srpski arhiv za celokupno lekarstvo | publisher=National Library of Serbia | volume=143 | issue=11-12 | year=2015 | issn=0370-8179 | doi=10.2298/sarh1512755r | pages=755–762}}</ref><br />
{{familytree/start |summary=PE diagnosis Algorithm.}}<br />
{{familytree | | | | | | | | | A01 | | | A01= Patient with history of [[diarrhea]] }}<br />
{{familytree | | | | | | | | | |!| | | | }}<br />
{{familytree | | | | | | | | | B01 | | | B01= '''[[Assessment]]''' <br><br />
*A child with diarrhea should be assessed for [[dehydration]] <br><br />
*bloody diarrhea, persistent [[diarrhea]] <br><br />
*Malnutrition and serious non-intestinal infections so that an appropriate treatment plan can be implemented.<br><br />
}}<br />
{{familytree | | | | | | | | | |!| | | | }}<br />
{{familytree | | | | | | | | | B01 | | | B01= '''History''' <br><br />
*Duration and severity of [[diarrhea]];<br />
*Presence of blood in the stool;<br />
*Number of watery stools per day;<br />
*Number of episodes of vomiting; swollen; diaper rash<br />
*Presence of fever, cough, or other important problems (eq. convulsions, recent measles);<br />
*Pre-illness feeding practices; type and amount of [[fluids]] (including breast milk) and food taken during the illness;<br />
*History of Medications<br />
*History of [[immunization]]}}<br />
{{familytree | | | | | | | | | |!| | | | }}<br />
{{familytree | | | | | | | | | B01 | | | B01= '''Physical Examination''' <br><br />
*Look for the signs and symptoms of [[dehydration]] <br><br />
*Is the child alert, restless or [[irritable]] ?<br><br />
*Look for the eyes, are they normal or sunken?<br><br />
*Look for skin [[turgor]]?<br><br />
*Does the stool contain red blood?<br><br />
*Is the child [[malnourished]]?<br><br />
*Look for growth char, weight for length or measure the mid-arm circumference<br><br />
*Measure the temperature of child <br><br />
}}<br />
{{familytree | | | | | | | | | |!| | | | }}<br />
{{familytree | | | | | |,|-|-|-|+|-|-|-|-|.| }}<br />
{{familytree | | | | |C01| | |C02| |C03| |C01='''Mild [[Dehydration]]'''<br><br />
There are no specific signs and symptoms <br>|C02='''Moderate [[Dehydration]]''' <br><br />
<br />
Initially, the signs and symptoms that develop include:<br><br />
- [[Thirst]] <br><br />
- restless or irritable behavior <br><br />
- decreased skin turgor <br><br />
- sunken [[eyes]] <br><br />
- and a sunken fontanelle <br><br />
(in infants)|C03='''Severe [[Dehydration]]'''<br><ref name="Parker Unaka p=775">{{cite journal | last=Parker | first=Michelle W. | last2=Unaka | first2=Ndidi | title=Diagnosis and Management of Infectious Diarrhea | journal=JAMA pediatrics | publisher=American Medical Association (AMA) | volume=172 | issue=8 | date=2018-08-01 | issn=2168-6203 | pmid=29889925 | doi=10.1001/jamapediatrics.2018.1172 | page=775}}</ref><br />
these effects become more pronounced and the patient may develop evidence of [[hypovolaemic shock]] including: <br><br />
- Diminished [[consciousness]] <br><br />
- lack of urine output <br><br />
- cool moist extremities <br><br />
- a rapid and feeble [[pulse]]<br />
(the radial pulse maybe undetectable)<br><br />
- low or undetectable [[blood pressure]] <br><br />
- peripheral [[cyanosis]]. <br><br />
Death follows soon if rehydration is not started quickly <br> }}<br />
{{familytree/end}}<br />
<br />
==Treatment==<br />
Shown below is an algorithm summarizing the treatment of acute diarrhea in pediatric patients according the the WHO guidelines.<ref name="WHO 2011">{{cite web | title=The treatment of diarrhoea | website=WHO | date=2011-12-15 | url=https://www.who.int/maternal_child_adolescent/documents/9241593180/en/ | access-date=2020-12-15}}</ref><br />
{{familytree/start |summary=PE diagnosis Algorithm.}}<br />
{{familytree | | | | | | | | | | | A01 | | | A01=Patient presents with acute diarrhea in Emergency}}<br />
{{familytree | | | | |,|-|-|-|-|-|-|+|-|-|-|-|.| }}<br />
{{familytree | | | | C01 | | | | | | C02 | | | C03 |C01='''Mild [[Dehydration]]'''|C02='''Moderate [[Dehydration]]'''|C03='''Severe [[Dehydration]]'''}}<br />
{{familytree | | | | |!| | | | | | | |!| | | |!| |}}<br />
{{familytree | | | | C01 | | | | | | C02 | | C03 | |C01= Children with no signs of [[dehydration]] are given extra fluids and salts to replace losses due to [[diarrhea]].<ref name="Vega Avva 2020">{{cite web | last=Vega | first=Roy M. | last2=Avva | first2=Usha | title=Pediatric Dehydration | website=NCBI Bookshelf | date=2020-08-08 | pmid=28613793 | url=https://www.ncbi.nlm.nih.gov/books/NBK436022/ | access-date=2020-12-15}}</ref><br />
Following Fluids can be given in such cases <br />
* [[ORS]] <br><br />
* Salted drinks eg. salted rice water or salted [[yogurt]] drink <br><br />
* [[Vegetable]] or chicken soup with salt <br><br />
* Home-based ORS: 3 gm of table salt and 18 gm of common sugar in one liter of water. <br><br />
* Plain water should also be given.<br />
* Commercial carbonated beverages, fruit juices, sweetened tea, coffee, medicinal tea should be avoided.<br />
|C02=Oral rehydration therapy for children with moderate dehydration:<br />
* [[ORS]] + [[Zinc]] supplementation should be started <br><br />
* After 4 hours, reassess the child and decide what treatment to be given next as per the Grade of [[dehydration]].<br><br />
*Children who continue to have dehydration even after 4 hours should receive ORS by nasogastric tube or RL intravenously (75 ml/kg in 4 hours).<br><br />
*If abdominal distension then oral rehydration should be withheld and only IV rehydration should be given <br>|C03=<br />
*Start IV fluids immediately.<br><br />
*If the patient can drink, give ORS by mouth until the drip is set up. <br><br />
* Give 100 ml/kg [[Ringer's Lactate]] Solutions divided as follows<br />
*First, give 30 ml/kg in: Then give 70 ml/kg in Infants (under 12 months) in 1 hour <br />
*Reassess the patient every 1-2 hours.<br />
* If [[hydration]] is not improving, give the IV drip more rapidly as follows. <br />
*After six hours (infants) or three hours (older patients), evaluate the patient using the assessment chart. <br />
Then choose the appropriate Treatment Plan (A, B or C) to continue treatment. }}<br />
{{familytree/end}}<br />
<br />
==Do's==<br />
<br />
*[[Hydrate]] the child well. [[Hydration]] plays a vital role in early recovery and reversal of symptoms of [[diarrhea]].<ref name="Whinpark Medical Centre – Medical Doctors in Edinburgh">{{cite web | title=Diarrhoea and Vomiting – Dos and Don’ts – Whinpark Medical Centre | website=Whinpark Medical Centre – Medical Doctors in Edinburgh | url=https://www.whinpark.org/your-care/health-wellbeing-2/general-health-advice/diarrhoea-and-vomiting-dos-and-donts/ | access-date=2020-12-15}}</ref><br />
*Eating properly: Make the child eat properly such as eating a diet consisting of [[bananas]], rice, applesauce, and toast.<br />
*The use of [[probiotics]] can help shorten the duration of illness.<br />
*Use [[antibiotics]] only when indicated in the case of pediatric diarrheal illness.<br />
<br />
==Don'ts==<br />
<br />
*Don't try to make special salt and fluid combinations at home unless your pediatrician instructs you and you have the proper instruments.<ref name="GI Associates 2019">{{cite web | title=The Dos and Don'ts of Treating Diarrhea for Quick Relief | website=GI Associates | date=2019-09-04 | url=https://gi.md/resources/articles/the-dos-and-donts-of-treating-diarrhea | access-date=2020-12-15}}</ref><br />
*Don't prevent the child from eating if she is hungry. <ref name="Positive Parenting 2016">{{cite web | title=Dos and Don’ts of Diarrhoea | website=Positive Parenting | date=2016-03-28 | url=https://mypositiveparenting.org/2016/03/28/dos-and-donts-of-diarrhoea/ | access-date=2020-12-15}}</ref><br />
*Don't use [[antibiotics]] unless prescribed by your pediatrician.<br />
*Don't ignore the [[Symptoms and Signs|symptoms]] and record [[temperature]] and [[hydration]] status.<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
[[Category:Projects]]<br />
[[Category:Resident survival guide]]<br />
[[Category:Pediatrics]]</div>
Usmanaliakbar
https://www.wikidoc.org/index.php?title=Diarrhea_resident_survival_guide_(pediatrics)&diff=1679044
Diarrhea resident survival guide (pediatrics)
2020-12-15T19:48:00Z
<p>Usmanaliakbar: /* Causes */</p>
<hr />
<div>__NOTOC__<br />
<br />
{{CMG}} {{AE}} {{Usman Ali Akbar}}<br />
<br />
{{SK}}<br />
<br />
{| class="infobox" style="margin: 0 0 0 0; border: 0; float: right; width: 100px; background: #A8A8A8; position: fixed; top: 250px; right: 21px; border-radius: 0 0 10px 10px;" cellpadding="0" cellspacing="0" ;<br />
|-<br />
! style="padding: 0 5px; font-size: 85%; background: #A8A8A8" align="center" |{{fontcolor|#2B3B44|Diarrhea resident survival guide (pediatrics) Microchapters}}<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Diarrhea resident survival guide (pediatrics)#Overview|Overview]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Diarrhea resident survival guide (pediatrics)#Causes|Causes]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Diarrhea resident survival guide (pediatrics)#FIRE: Focused Initial Rapid Evaluation|FIRE]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Diarrhea resident survival guide (pediatrics)#Complete Diagnostic Approach|Diagnosis]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Diarrhea resident survival guide (pediatrics)#Treatment|Treatment]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Diarrhea resident survival guide (pediatrics)#Do's|Do's]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Diarrhea resident survival guide (pediatrics)#Don'ts|Don'ts]]<br />
|}<br />
<br />
==Overview==<br />
[[Diarrhea]] remains one of the leading causes of preventable death in developing countries, especially among children under 5 years of age. [[Diarrhea]] is defined as an increase in the number of stools or the presence of looser stools than is normal, like more than three bowel movements each day. [[Acute diarrhea]] is when [[diarrhea]] occurs for less than 3 weeks in total. When [[diarrhea]] lasts longer than three weeks, it is considered to be [[chronic]]. [[Hydration]] status plays an important role in the management of pediatric diarrheal illness. The younger the child, the greater the risk that fluid and [[Electrolyte imbalance|electrolyte losses]] will lead to dehydration. The type of [[dehydration]] whether it is [[isotonic]], [[hypotonic]], or [[hypertonic]] is usually independent of the responsible agent. Fluid losses resulting from diarrhea and vomiting can be as high as three times the circulating blood volume (80–125–250 mL per kg body weight per day) and can be life-threatening. To keep the blood volume constant, the body usually extracts fluid from the [[intracellular]] space which can predispose it to [[dehydration]]. Complications and hospitalization due to dehydration can usually be prevented by the early and adequate oral administration of a [[rehydration]] solution (glucose-electrolyte solution) and normal food for the child’s age.<br />
<br />
==Causes==<br />
{| class="wikitable"<br />
|+<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Life Threatening Causes<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Common Causes<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Misc<br />
|-<br />
|<br />
*[[Cholera]]<br />
*''[[Entamoeba histolytica]]''<br />
*[[Enterohemorrhagic Escherichia coli (EHEC)|Enterohemorrhagic ''Escherichia coli'' (EHEC)]]<br />
*[[Enteroinvasive Escherichia coli (EIEC)|Enteroinvasive ''Escherichia coli'' (EIEC)]]<br />
*[[Campylobacter]] spp.<br />
*[[Salmonella enterica|Nontyphoidal ''Salmonella enterica'']]<br />
|<br />
*[[Rotavirus]]<br />
*[[Enterotoxigenic Escherichia coli]] (ETEC)<br />
*[[Cryptosporidium]]<br />
*[[Shigella|Shigella spp.]]<br />
|<br />
*Parenteral causes including infections elsewhere in the body : [[UTI]],[[Acute otitis media]], [[Sepsis]].<br />
*[[Inflammatory ]] including [[IBD]],Allergy to cow's milk , [[whipples disease]].<br />
*[[Malabsorption]] including [[celiac disease]] ,[[lactase deficiency]]<br />
*[[Endocrine]] :[[Hypothyroidism]],[[Addison's disease]] ,[[Hyperparathyroidism]]'<br />
*[[Neoplastic causes]]<br />
*[[psychosocial]]<br />
|}<br />
<br />
==FIRE: Focused Initial Rapid Evaluation==<br />
<br />
*A Focused Initial Rapid Evaluation (FIRE) should be performed to identify the [[patients]] in need of immediate [[intervention]]].<ref name="Koletzko Osterrieder 2009 p.">{{cite journal | last=Koletzko | first=Sibylle | last2=Osterrieder | first2=Stephanie | title=Acute Infectious Diarrhea in Children | journal=Deutsches Ärzteblatt International | volume=106 | issue=33 | date=2009-09-25 | pmid=19738921 | doi=10.3238/arztebl.2009.0539 | url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2737434/ | access-date=2020-12-15 | page=}}</ref><br />
{{familytree/start |summary=PE diagnosis Algorithm.}}<br />
{{familytree | | | | | | | | | | | A01 | | | A01=Patient presents with acute [[diarrhea]] in Emergency}}<br />
{{familytree | | | | |,|-|-|-|-|-|-|+|-|-|-|-|.| }}<br />
{{familytree | | | | C01 | | | | | | C02 | | | C03 |C01= '''Mild [[Dehydration]]'''|C02='''Moderate [[Dehydration]]'''|C03=<div style=" background: #FA8072; text-align: center; width:15em; padding:0.7em"> {{fontcolor|#F8F8FF|'''Severe [[Dehydration]]'''}}</div> }}<br />
{{familytree | | | | |!| | | | | | | |!| | | |!| |}}<br />
{{familytree | | | | C01 | | | | | | C02 | | C03 | |C01= Home treatment with [[ORS]], patient prescription, and dietary recommendations |C02=Is there any evidence of dehydration or > 8 watery stools in 24 hours or > 4 episodes of vomiting in 24 hours or < 6 months old|C03=<div style=" background: #FA8072; text-align: center; width:15em; padding:0.7em"> {{fontcolor|#F8F8FF|'''> Dehydration > 9 % Shock, Impaired consciousness''}}</div>}}<br />
{{familytree | | | | | | | | | | | |!| | | | | |!| |}}<br />
{{familytree | | | | | | | | | |C01 | | | | |C02 | | | | | |C01= Give [[ORS]] by spoon or syringe according to age and weight <br><br />
* Infants 5—9 kg: 2.0 mL every minute (120 mL/hr) <br><br />
* Infants 9—12 kg: 2.5 mL every minute (150 mL/hr) <br><br />
* Toddlers 12-15 kg: 3.0 mL every minute (180 mL/hr)<br><br />
* If there is no vomiting, then larger volumes at longer intervals: 10-15 mL every 5 or 20-30 mL every 10 minutes Racecadotril in 5 mL of water)<br><br />
* < 9 kg: 10 mg, 10-15 kg: 20 mg, 16-29 kg: 30 mg <br>|C02=<div style=" background: #FA8072; text-align: center; width:15em; padding:0.7em"> {{fontcolor|#F8F8FF|'''Intensive Care'''}}</div> }}<br />
<br />
<br />
{{familytree/end}}<br />
<br />
==Complete Diagnostic Approach==<br />
Shown below is an algorithm summarizing the diagnosis of acute diarrhea in children&lt;/nowiki&gt; according the the WHO guidelines.<ref name="WHO 2011">{{cite web | title=The treatment of diarrhoea | website=WHO | date=2011-12-15 | url=https://www.who.int/maternal_child_adolescent/documents/9241593180/en/ | access-date=2020-12-15}}</ref> <ref name="Radlovic Lekovic Vuletic Radlovic 2015 pp. 755–762">{{cite journal | last=Radlovic | first=Nedeljko | last2=Lekovic | first2=Zoran | last3=Vuletic | first3=Biljana | last4=Radlovic | first4=Vladimir | last5=Simic | first5=Dusica | title=Acute diarrhea in children | journal=Srpski arhiv za celokupno lekarstvo | publisher=National Library of Serbia | volume=143 | issue=11-12 | year=2015 | issn=0370-8179 | doi=10.2298/sarh1512755r | pages=755–762}}</ref><br />
{{familytree/start |summary=PE diagnosis Algorithm.}}<br />
{{familytree | | | | | | | | | A01 | | | A01= Patient with history of [[diarrhea]] }}<br />
{{familytree | | | | | | | | | |!| | | | }}<br />
{{familytree | | | | | | | | | B01 | | | B01= '''[[Assessment]]''' <br><br />
*A child with diarrhea should be assessed for [[dehydration]] <br><br />
*bloody diarrhea, persistent [[diarrhea]] <br><br />
*Malnutrition and serious non-intestinal infections so that an appropriate treatment plan can be implemented.<br><br />
}}<br />
{{familytree | | | | | | | | | |!| | | | }}<br />
{{familytree | | | | | | | | | B01 | | | B01= '''History''' <br><br />
*Duration and severity of [[diarrhea]];<br />
*Presence of blood in the stool;<br />
*Number of watery stools per day;<br />
*Number of episodes of vomiting; swollen; diaper rash<br />
*Presence of fever, cough, or other important problems (eq. convulsions, recent measles);<br />
*Pre-illness feeding practices; type and amount of [[fluids]] (including breast milk) and food taken during the illness;<br />
*History of Medications<br />
*History of [[immunization]]}}<br />
{{familytree | | | | | | | | | |!| | | | }}<br />
{{familytree | | | | | | | | | B01 | | | B01= '''Physical Examination''' <br><br />
*Look for the signs and symptoms of [[dehydration]] <br><br />
*Is the child alert, restless or [[irritable]] ?<br><br />
*Look for the eyes, are they normal or sunken?<br><br />
*Look for skin [[turgor]]?<br><br />
*Does the stool contain red blood?<br><br />
*Is the child [[malnourished]]?<br><br />
*Look for growth char, weight for length or measure the mid-arm circumference<br><br />
*Measure the temperature of child <br><br />
}}<br />
{{familytree | | | | | | | | | |!| | | | }}<br />
{{familytree | | | | | |,|-|-|-|+|-|-|-|-|.| }}<br />
{{familytree | | | | |C01| | |C02| |C03| |C01='''Mild [[Dehydration]]'''<br><br />
There are no specific signs and symptoms <br>|C02='''Moderate [[Dehydration]]''' <br><br />
<br />
Initially, the signs and symptoms that develop include:<br><br />
- [[Thirst]] <br><br />
- restless or irritable behavior <br><br />
- decreased skin turgor <br><br />
- sunken [[eyes]] <br><br />
- and a sunken fontanelle <br><br />
(in infants)|C03='''Severe [[Dehydration]]'''<br><ref name="Parker Unaka p=775">{{cite journal | last=Parker | first=Michelle W. | last2=Unaka | first2=Ndidi | title=Diagnosis and Management of Infectious Diarrhea | journal=JAMA pediatrics | publisher=American Medical Association (AMA) | volume=172 | issue=8 | date=2018-08-01 | issn=2168-6203 | pmid=29889925 | doi=10.1001/jamapediatrics.2018.1172 | page=775}}</ref><br />
these effects become more pronounced and the patient may develop evidence of [[hypovolaemic shock]] including: <br><br />
- Diminished [[consciousness]] <br><br />
- lack of urine output <br><br />
- cool moist extremities <br><br />
- a rapid and feeble [[pulse]]<br />
(the radial pulse maybe undetectable)<br><br />
- low or undetectable [[blood pressure]] <br><br />
- peripheral [[cyanosis]]. <br><br />
Death follows soon if rehydration is not started quickly <br> }}<br />
{{familytree/end}}<br />
<br />
==Treatment==<br />
Shown below is an algorithm summarizing the treatment of acute diarrhea in pediatric patients according the the WHO guidelines.<ref name="WHO 2011">{{cite web | title=The treatment of diarrhoea | website=WHO | date=2011-12-15 | url=https://www.who.int/maternal_child_adolescent/documents/9241593180/en/ | access-date=2020-12-15}}</ref><br />
{{familytree/start |summary=PE diagnosis Algorithm.}}<br />
{{familytree | | | | | | | | | | | A01 | | | A01=Patient presents with acute diarrhea in Emergency}}<br />
{{familytree | | | | |,|-|-|-|-|-|-|+|-|-|-|-|.| }}<br />
{{familytree | | | | C01 | | | | | | C02 | | | C03 |C01='''Mild [[Dehydration]]'''|C02='''Moderate [[Dehydration]]'''|C03='''Severe [[Dehydration]]'''}}<br />
{{familytree | | | | |!| | | | | | | |!| | | |!| |}}<br />
{{familytree | | | | C01 | | | | | | C02 | | C03 | |C01= Children with no signs of [[dehydration]] are given extra fluids and salts to replace losses due to [[diarrhea]].<ref name="Vega Avva 2020">{{cite web | last=Vega | first=Roy M. | last2=Avva | first2=Usha | title=Pediatric Dehydration | website=NCBI Bookshelf | date=2020-08-08 | pmid=28613793 | url=https://www.ncbi.nlm.nih.gov/books/NBK436022/ | access-date=2020-12-15}}</ref><br />
Following Fluids can be given in such cases <br />
* [[ORS]] <br><br />
* Salted drinks eg. salted rice water or salted [[yogurt]] drink <br><br />
* [[Vegetable]] or chicken soup with salt <br><br />
* Home-based ORS: 3 gm of table salt and 18 gm of common sugar in one liter of water. <br><br />
* Plain water should also be given.<br />
* Commercial carbonated beverages, fruit juices, sweetened tea, coffee, medicinal tea should be avoided.<br />
|C02=Oral rehydration therapy for children with moderate dehydration:<br />
* [[ORS]] + [[Zinc]] supplementation should be started <br><br />
* After 4 hours, reassess the child and decide what treatment to be given next as per the Grade of [[dehydration]].<br><br />
*Children who continue to have dehydration even after 4 hours should receive ORS by nasogastric tube or RL intravenously (75 ml/kg in 4 hours).<br><br />
*If abdominal distension then oral rehydration should be withheld and only IV rehydration should be given <br>|C03=<br />
*Start IV fluids immediately.<br><br />
*If the patient can drink, give ORS by mouth until the drip is set up. <br><br />
* Give 100 ml/kg [[Ringer's Lactate]] Solutions divided as follows<br />
*First, give 30 ml/kg in: Then give 70 ml/kg in Infants (under 12 months) in 1 hour <br />
*Reassess the patient every 1-2 hours.<br />
* If [[hydration]] is not improving, give the IV drip more rapidly as follows. <br />
*After six hours (infants) or three hours (older patients), evaluate the patient using the assessment chart. <br />
Then choose the appropriate Treatment Plan (A, B or C) to continue treatment. }}<br />
{{familytree/end}}<br />
<br />
==Do's==<br />
<br />
*[[Hydrate]] the child well. [[Hydration]] plays a vital role in early recovery and reversal of symptoms of [[diarrhea]].<ref name="Whinpark Medical Centre – Medical Doctors in Edinburgh">{{cite web | title=Diarrhoea and Vomiting – Dos and Don’ts – Whinpark Medical Centre | website=Whinpark Medical Centre – Medical Doctors in Edinburgh | url=https://www.whinpark.org/your-care/health-wellbeing-2/general-health-advice/diarrhoea-and-vomiting-dos-and-donts/ | access-date=2020-12-15}}</ref><br />
*Eating properly: Make the child eat properly such as eating a diet consisting of [[bananas]], rice, applesauce, and toast.<br />
*The use of [[probiotics]] can help shorten the duration of illness.<br />
*Use [[antibiotics]] only when indicated in the case of pediatric diarrheal illness.<br />
<br />
==Don'ts==<br />
<br />
*Don't try to make special salt and fluid combinations at home unless your pediatrician instructs you and you have the proper instruments.<ref name="GI Associates 2019">{{cite web | title=The Dos and Don'ts of Treating Diarrhea for Quick Relief | website=GI Associates | date=2019-09-04 | url=https://gi.md/resources/articles/the-dos-and-donts-of-treating-diarrhea | access-date=2020-12-15}}</ref><br />
*Don't prevent the child from eating if she is hungry. <ref name="Positive Parenting 2016">{{cite web | title=Dos and Don’ts of Diarrhoea | website=Positive Parenting | date=2016-03-28 | url=https://mypositiveparenting.org/2016/03/28/dos-and-donts-of-diarrhoea/ | access-date=2020-12-15}}</ref><br />
*Don't use [[antibiotics]] unless prescribed by your pediatrician.<br />
*Don't ignore the [[Symptoms and Signs|symptoms]] and record [[temperature]] and [[hydration]] status.<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
[[Category:Projects]]<br />
[[Category:Resident survival guide]]<br />
[[Category:Pediatrics]]</div>
Usmanaliakbar
https://www.wikidoc.org/index.php?title=Diarrhea_resident_survival_guide_(pediatrics)&diff=1679043
Diarrhea resident survival guide (pediatrics)
2020-12-15T19:47:25Z
<p>Usmanaliakbar: </p>
<hr />
<div>__NOTOC__<br />
<br />
{{CMG}} {{AE}} {{Usman Ali Akbar}}<br />
<br />
{{SK}}<br />
<br />
{| class="infobox" style="margin: 0 0 0 0; border: 0; float: right; width: 100px; background: #A8A8A8; position: fixed; top: 250px; right: 21px; border-radius: 0 0 10px 10px;" cellpadding="0" cellspacing="0" ;<br />
|-<br />
! style="padding: 0 5px; font-size: 85%; background: #A8A8A8" align="center" |{{fontcolor|#2B3B44|Diarrhea resident survival guide (pediatrics) Microchapters}}<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Diarrhea resident survival guide (pediatrics)#Overview|Overview]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Diarrhea resident survival guide (pediatrics)#Causes|Causes]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Diarrhea resident survival guide (pediatrics)#FIRE: Focused Initial Rapid Evaluation|FIRE]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Diarrhea resident survival guide (pediatrics)#Complete Diagnostic Approach|Diagnosis]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Diarrhea resident survival guide (pediatrics)#Treatment|Treatment]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Diarrhea resident survival guide (pediatrics)#Do's|Do's]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Diarrhea resident survival guide (pediatrics)#Don'ts|Don'ts]]<br />
|}<br />
<br />
==Overview==<br />
[[Diarrhea]] remains one of the leading causes of preventable death in developing countries, especially among children under 5 years of age. [[Diarrhea]] is defined as an increase in the number of stools or the presence of looser stools than is normal, like more than three bowel movements each day. [[Acute diarrhea]] is when [[diarrhea]] occurs for less than 3 weeks in total. When [[diarrhea]] lasts longer than three weeks, it is considered to be [[chronic]]. [[Hydration]] status plays an important role in the management of pediatric diarrheal illness. The younger the child, the greater the risk that fluid and [[Electrolyte imbalance|electrolyte losses]] will lead to dehydration. The type of [[dehydration]] whether it is [[isotonic]], [[hypotonic]], or [[hypertonic]] is usually independent of the responsible agent. Fluid losses resulting from diarrhea and vomiting can be as high as three times the circulating blood volume (80–125–250 mL per kg body weight per day) and can be life-threatening. To keep the blood volume constant, the body usually extracts fluid from the [[intracellular]] space which can predispose it to [[dehydration]]. Complications and hospitalization due to dehydration can usually be prevented by the early and adequate oral administration of a [[rehydration]] solution (glucose-electrolyte solution) and normal food for the child’s age.<br />
<br />
==Causes==<br />
{| class="wikitable"<br />
|+<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Life Threatening Causes<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Common Causes<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Misc<br />
|-<br />
|<br />
*[[Cholera]]<br />
*''[[Entamoeba histolytica]]''<br />
*[[Enterohemorrhagic Escherichia coli (EHEC)|Enterohemorrhagic ''Escherichia coli'' (EHEC)]]<br />
*[[Enteroinvasive Escherichia coli (EIEC)|Enteroinvasive ''Escherichia coli'' (EIEC)]]<br />
*[[Campylobacter]] spp.<br />
*[[Salmonella enterica|Nontyphoidal ''Salmonella enterica'']]<br />
|<br />
*[[Rotavirus]]<br />
*[[Enterotoxigenic Escherichia coli]] (ETEC)<br />
*[[Cryptosporidium]]<br />
*[[Shigella|Shigella spp.]]<br />
|<br />
*Parenteral causes including infections elsewhere in the body : [[UTI]],[[Acute otitis media]], [[Sepsis]].<br />
*[[Inflammatory ]] including [[IBD]],Allergy to cow's milk , [[whipples disease]].<br />
*[[Malabsorption]] including [[celiac disease]] ,[[lactase deficiency]]<br />
*Feed related<br />
*[[Endocrine]] :[[Hypothyroidism]],[[Addison's disease]] ,[[Hyperparathyroidism]]'<br />
*[[Neoplastic causes]]<br />
*[[psychosocial]]<br />
|}<br />
<br />
==FIRE: Focused Initial Rapid Evaluation==<br />
<br />
*A Focused Initial Rapid Evaluation (FIRE) should be performed to identify the [[patients]] in need of immediate [[intervention]]].<ref name="Koletzko Osterrieder 2009 p.">{{cite journal | last=Koletzko | first=Sibylle | last2=Osterrieder | first2=Stephanie | title=Acute Infectious Diarrhea in Children | journal=Deutsches Ärzteblatt International | volume=106 | issue=33 | date=2009-09-25 | pmid=19738921 | doi=10.3238/arztebl.2009.0539 | url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2737434/ | access-date=2020-12-15 | page=}}</ref><br />
{{familytree/start |summary=PE diagnosis Algorithm.}}<br />
{{familytree | | | | | | | | | | | A01 | | | A01=Patient presents with acute [[diarrhea]] in Emergency}}<br />
{{familytree | | | | |,|-|-|-|-|-|-|+|-|-|-|-|.| }}<br />
{{familytree | | | | C01 | | | | | | C02 | | | C03 |C01= '''Mild [[Dehydration]]'''|C02='''Moderate [[Dehydration]]'''|C03=<div style=" background: #FA8072; text-align: center; width:15em; padding:0.7em"> {{fontcolor|#F8F8FF|'''Severe [[Dehydration]]'''}}</div> }}<br />
{{familytree | | | | |!| | | | | | | |!| | | |!| |}}<br />
{{familytree | | | | C01 | | | | | | C02 | | C03 | |C01= Home treatment with [[ORS]], patient prescription, and dietary recommendations |C02=Is there any evidence of dehydration or > 8 watery stools in 24 hours or > 4 episodes of vomiting in 24 hours or < 6 months old|C03=<div style=" background: #FA8072; text-align: center; width:15em; padding:0.7em"> {{fontcolor|#F8F8FF|'''> Dehydration > 9 % Shock, Impaired consciousness''}}</div>}}<br />
{{familytree | | | | | | | | | | | |!| | | | | |!| |}}<br />
{{familytree | | | | | | | | | |C01 | | | | |C02 | | | | | |C01= Give [[ORS]] by spoon or syringe according to age and weight <br><br />
* Infants 5—9 kg: 2.0 mL every minute (120 mL/hr) <br><br />
* Infants 9—12 kg: 2.5 mL every minute (150 mL/hr) <br><br />
* Toddlers 12-15 kg: 3.0 mL every minute (180 mL/hr)<br><br />
* If there is no vomiting, then larger volumes at longer intervals: 10-15 mL every 5 or 20-30 mL every 10 minutes Racecadotril in 5 mL of water)<br><br />
* < 9 kg: 10 mg, 10-15 kg: 20 mg, 16-29 kg: 30 mg <br>|C02=<div style=" background: #FA8072; text-align: center; width:15em; padding:0.7em"> {{fontcolor|#F8F8FF|'''Intensive Care'''}}</div> }}<br />
<br />
<br />
{{familytree/end}}<br />
<br />
==Complete Diagnostic Approach==<br />
Shown below is an algorithm summarizing the diagnosis of acute diarrhea in children&lt;/nowiki&gt; according the the WHO guidelines.<ref name="WHO 2011">{{cite web | title=The treatment of diarrhoea | website=WHO | date=2011-12-15 | url=https://www.who.int/maternal_child_adolescent/documents/9241593180/en/ | access-date=2020-12-15}}</ref> <ref name="Radlovic Lekovic Vuletic Radlovic 2015 pp. 755–762">{{cite journal | last=Radlovic | first=Nedeljko | last2=Lekovic | first2=Zoran | last3=Vuletic | first3=Biljana | last4=Radlovic | first4=Vladimir | last5=Simic | first5=Dusica | title=Acute diarrhea in children | journal=Srpski arhiv za celokupno lekarstvo | publisher=National Library of Serbia | volume=143 | issue=11-12 | year=2015 | issn=0370-8179 | doi=10.2298/sarh1512755r | pages=755–762}}</ref><br />
{{familytree/start |summary=PE diagnosis Algorithm.}}<br />
{{familytree | | | | | | | | | A01 | | | A01= Patient with history of [[diarrhea]] }}<br />
{{familytree | | | | | | | | | |!| | | | }}<br />
{{familytree | | | | | | | | | B01 | | | B01= '''[[Assessment]]''' <br><br />
*A child with diarrhea should be assessed for [[dehydration]] <br><br />
*bloody diarrhea, persistent [[diarrhea]] <br><br />
*Malnutrition and serious non-intestinal infections so that an appropriate treatment plan can be implemented.<br><br />
}}<br />
{{familytree | | | | | | | | | |!| | | | }}<br />
{{familytree | | | | | | | | | B01 | | | B01= '''History''' <br><br />
*Duration and severity of [[diarrhea]];<br />
*Presence of blood in the stool;<br />
*Number of watery stools per day;<br />
*Number of episodes of vomiting; swollen; diaper rash<br />
*Presence of fever, cough, or other important problems (eq. convulsions, recent measles);<br />
*Pre-illness feeding practices; type and amount of [[fluids]] (including breast milk) and food taken during the illness;<br />
*History of Medications<br />
*History of [[immunization]]}}<br />
{{familytree | | | | | | | | | |!| | | | }}<br />
{{familytree | | | | | | | | | B01 | | | B01= '''Physical Examination''' <br><br />
*Look for the signs and symptoms of [[dehydration]] <br><br />
*Is the child alert, restless or [[irritable]] ?<br><br />
*Look for the eyes, are they normal or sunken?<br><br />
*Look for skin [[turgor]]?<br><br />
*Does the stool contain red blood?<br><br />
*Is the child [[malnourished]]?<br><br />
*Look for growth char, weight for length or measure the mid-arm circumference<br><br />
*Measure the temperature of child <br><br />
}}<br />
{{familytree | | | | | | | | | |!| | | | }}<br />
{{familytree | | | | | |,|-|-|-|+|-|-|-|-|.| }}<br />
{{familytree | | | | |C01| | |C02| |C03| |C01='''Mild [[Dehydration]]'''<br><br />
There are no specific signs and symptoms <br>|C02='''Moderate [[Dehydration]]''' <br><br />
<br />
Initially, the signs and symptoms that develop include:<br><br />
- [[Thirst]] <br><br />
- restless or irritable behavior <br><br />
- decreased skin turgor <br><br />
- sunken [[eyes]] <br><br />
- and a sunken fontanelle <br><br />
(in infants)|C03='''Severe [[Dehydration]]'''<br><ref name="Parker Unaka p=775">{{cite journal | last=Parker | first=Michelle W. | last2=Unaka | first2=Ndidi | title=Diagnosis and Management of Infectious Diarrhea | journal=JAMA pediatrics | publisher=American Medical Association (AMA) | volume=172 | issue=8 | date=2018-08-01 | issn=2168-6203 | pmid=29889925 | doi=10.1001/jamapediatrics.2018.1172 | page=775}}</ref><br />
these effects become more pronounced and the patient may develop evidence of [[hypovolaemic shock]] including: <br><br />
- Diminished [[consciousness]] <br><br />
- lack of urine output <br><br />
- cool moist extremities <br><br />
- a rapid and feeble [[pulse]]<br />
(the radial pulse maybe undetectable)<br><br />
- low or undetectable [[blood pressure]] <br><br />
- peripheral [[cyanosis]]. <br><br />
Death follows soon if rehydration is not started quickly <br> }}<br />
{{familytree/end}}<br />
<br />
==Treatment==<br />
Shown below is an algorithm summarizing the treatment of acute diarrhea in pediatric patients according the the WHO guidelines.<ref name="WHO 2011">{{cite web | title=The treatment of diarrhoea | website=WHO | date=2011-12-15 | url=https://www.who.int/maternal_child_adolescent/documents/9241593180/en/ | access-date=2020-12-15}}</ref><br />
{{familytree/start |summary=PE diagnosis Algorithm.}}<br />
{{familytree | | | | | | | | | | | A01 | | | A01=Patient presents with acute diarrhea in Emergency}}<br />
{{familytree | | | | |,|-|-|-|-|-|-|+|-|-|-|-|.| }}<br />
{{familytree | | | | C01 | | | | | | C02 | | | C03 |C01='''Mild [[Dehydration]]'''|C02='''Moderate [[Dehydration]]'''|C03='''Severe [[Dehydration]]'''}}<br />
{{familytree | | | | |!| | | | | | | |!| | | |!| |}}<br />
{{familytree | | | | C01 | | | | | | C02 | | C03 | |C01= Children with no signs of [[dehydration]] are given extra fluids and salts to replace losses due to [[diarrhea]].<ref name="Vega Avva 2020">{{cite web | last=Vega | first=Roy M. | last2=Avva | first2=Usha | title=Pediatric Dehydration | website=NCBI Bookshelf | date=2020-08-08 | pmid=28613793 | url=https://www.ncbi.nlm.nih.gov/books/NBK436022/ | access-date=2020-12-15}}</ref><br />
Following Fluids can be given in such cases <br />
* [[ORS]] <br><br />
* Salted drinks eg. salted rice water or salted [[yogurt]] drink <br><br />
* [[Vegetable]] or chicken soup with salt <br><br />
* Home-based ORS: 3 gm of table salt and 18 gm of common sugar in one liter of water. <br><br />
* Plain water should also be given.<br />
* Commercial carbonated beverages, fruit juices, sweetened tea, coffee, medicinal tea should be avoided.<br />
|C02=Oral rehydration therapy for children with moderate dehydration:<br />
* [[ORS]] + [[Zinc]] supplementation should be started <br><br />
* After 4 hours, reassess the child and decide what treatment to be given next as per the Grade of [[dehydration]].<br><br />
*Children who continue to have dehydration even after 4 hours should receive ORS by nasogastric tube or RL intravenously (75 ml/kg in 4 hours).<br><br />
*If abdominal distension then oral rehydration should be withheld and only IV rehydration should be given <br>|C03=<br />
*Start IV fluids immediately.<br><br />
*If the patient can drink, give ORS by mouth until the drip is set up. <br><br />
* Give 100 ml/kg [[Ringer's Lactate]] Solutions divided as follows<br />
*First, give 30 ml/kg in: Then give 70 ml/kg in Infants (under 12 months) in 1 hour <br />
*Reassess the patient every 1-2 hours.<br />
* If [[hydration]] is not improving, give the IV drip more rapidly as follows. <br />
*After six hours (infants) or three hours (older patients), evaluate the patient using the assessment chart. <br />
Then choose the appropriate Treatment Plan (A, B or C) to continue treatment. }}<br />
{{familytree/end}}<br />
<br />
==Do's==<br />
<br />
*[[Hydrate]] the child well. [[Hydration]] plays a vital role in early recovery and reversal of symptoms of [[diarrhea]].<ref name="Whinpark Medical Centre – Medical Doctors in Edinburgh">{{cite web | title=Diarrhoea and Vomiting – Dos and Don’ts – Whinpark Medical Centre | website=Whinpark Medical Centre – Medical Doctors in Edinburgh | url=https://www.whinpark.org/your-care/health-wellbeing-2/general-health-advice/diarrhoea-and-vomiting-dos-and-donts/ | access-date=2020-12-15}}</ref><br />
*Eating properly: Make the child eat properly such as eating a diet consisting of [[bananas]], rice, applesauce, and toast.<br />
*The use of [[probiotics]] can help shorten the duration of illness.<br />
*Use [[antibiotics]] only when indicated in the case of pediatric diarrheal illness.<br />
<br />
==Don'ts==<br />
<br />
*Don't try to make special salt and fluid combinations at home unless your pediatrician instructs you and you have the proper instruments.<ref name="GI Associates 2019">{{cite web | title=The Dos and Don'ts of Treating Diarrhea for Quick Relief | website=GI Associates | date=2019-09-04 | url=https://gi.md/resources/articles/the-dos-and-donts-of-treating-diarrhea | access-date=2020-12-15}}</ref><br />
*Don't prevent the child from eating if she is hungry. <ref name="Positive Parenting 2016">{{cite web | title=Dos and Don’ts of Diarrhoea | website=Positive Parenting | date=2016-03-28 | url=https://mypositiveparenting.org/2016/03/28/dos-and-donts-of-diarrhoea/ | access-date=2020-12-15}}</ref><br />
*Don't use [[antibiotics]] unless prescribed by your pediatrician.<br />
*Don't ignore the [[Symptoms and Signs|symptoms]] and record [[temperature]] and [[hydration]] status.<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
[[Category:Projects]]<br />
[[Category:Resident survival guide]]<br />
[[Category:Pediatrics]]</div>
Usmanaliakbar
https://www.wikidoc.org/index.php?title=Diarrhea_resident_survival_guide_(pediatrics)&diff=1679042
Diarrhea resident survival guide (pediatrics)
2020-12-15T19:46:03Z
<p>Usmanaliakbar: /* Overview */</p>
<hr />
<div>__NOTOC__<br />
<br />
{{CMG}} {{AE}} {{Usman Ali Akbar}}<br />
<br />
{{SK}}<br />
<br />
{| class="infobox" style="margin: 0 0 0 0; border: 0; float: right; width: 100px; background: #A8A8A8; position: fixed; top: 250px; right: 21px; border-radius: 0 0 10px 10px;" cellpadding="0" cellspacing="0" ;<br />
|-<br />
! style="padding: 0 5px; font-size: 85%; background: #A8A8A8" align="center" |{{fontcolor|#2B3B44|Diarrhea resident survival guide (pediatrics) Microchapters}}<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Diarrhea resident survival guide (pediatrics)#Overview|Overview]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Diarrhea resident survival guide (pediatrics)#Causes|Causes]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Diarrhea resident survival guide (pediatrics)#FIRE: Focused Initial Rapid Evaluation|FIRE]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Diarrhea resident survival guide (pediatrics)#Complete Diagnostic Approach|Diagnosis]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Diarrhea resident survival guide (pediatrics)#Treatment|Treatment]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Diarrhea resident survival guide (pediatrics)#Do's|Do's]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Diarrhea resident survival guide (pediatrics)#Don'ts|Don'ts]]<br />
|}<br />
<br />
==Overview==<br />
[[Diarrhea]] remains one of the leading causes of preventable death in developing countries, especially among children under 5 years of age. [[Diarrhea]] is defined as an increase in the number of stools or the presence of looser stools than is normal, like more than three bowel movements each day. [[Acute diarrhea]] is when [[diarrhea]] occurs for less than 3 weeks in total. When [[diarrhea]] lasts longer than three weeks, it is considered to be [[chronic]]. [[Hydration]] status plays an important role in the management of pediatric diarrheal illness. The younger the child, the greater the risk that fluid and [[Electrolyte imbalance|electrolyte losses]] will lead to dehydration. The type of [[dehydration]] whether it is [[isotonic]], [[hypotonic]], or [[hypertonic]] is usually independent of the responsible agent. Fluid losses resulting from diarrhea and vomiting can be as high as three times the circulating blood volume (80–125–250 mL per kg body weight per day) and can be life-threatening. In order to keep the blood volume constant, the body usually extracts fluid from the [[intracellular]] space which can predispose it to [[dehydration]]. Complications and hospitalization due to dehydration can usually be prevented by the early and adequate oral administration of a [[rehydration]] solution (glucose-electrolyte solution) and normal food for the child’s age.<br />
<br />
==Causes==<br />
{| class="wikitable"<br />
|+<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Life Threatening Causes<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Common Causes<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Misc<br />
|-<br />
|<br />
*[[Cholera]]<br />
*''[[Entamoeba histolytica]]''<br />
*[[Enterohemorrhagic Escherichia coli (EHEC)|Enterohemorrhagic ''Escherichia coli'' (EHEC)]]<br />
*[[Enteroinvasive Escherichia coli (EIEC)|Enteroinvasive ''Escherichia coli'' (EIEC)]]<br />
*[[Campylobacter]] spp.<br />
*[[Salmonella enterica|Nontyphoidal ''Salmonella enterica'']]<br />
|<br />
*[[Rotavirus]]<br />
*[[Enterotoxigenic Escherichia coli]] (ETEC)<br />
*[[Cryptosporidium]]<br />
*[[Shigella|Shigella spp.]]<br />
|<br />
*Parenteral causes including infections elsewhere in the body : [[UTI]],[[Acute otitis media]], [[Sepsis]].<br />
*[[Inflammatory ]] including [[IBD]],Allergy to cow's milk , [[whipples disease]].<br />
*[[Malabsorption]] including [[celiac disease]] ,[[lactase deficiency]]<br />
*Feed related<br />
*[[Endocrine]] :[[Hypothyroidism]],[[Addison's disease]] ,[[Hyperparathyroidism]]'<br />
*[[Neoplastic causes]]<br />
*[[psychosocial]]<br />
|}<br />
<br />
==FIRE: Focused Initial Rapid Evaluation==<br />
<br />
*A Focused Initial Rapid Evaluation (FIRE) should be performed to identify the [[patients]] in need of immediate [[intervention]]].<ref name="Koletzko Osterrieder 2009 p.">{{cite journal | last=Koletzko | first=Sibylle | last2=Osterrieder | first2=Stephanie | title=Acute Infectious Diarrhea in Children | journal=Deutsches Ärzteblatt International | volume=106 | issue=33 | date=2009-09-25 | pmid=19738921 | doi=10.3238/arztebl.2009.0539 | url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2737434/ | access-date=2020-12-15 | page=}}</ref><br />
{{familytree/start |summary=PE diagnosis Algorithm.}}<br />
{{familytree | | | | | | | | | | | A01 | | | A01=Patient presents with acute [[diarrhea]] in Emergency}}<br />
{{familytree | | | | |,|-|-|-|-|-|-|+|-|-|-|-|.| }}<br />
{{familytree | | | | C01 | | | | | | C02 | | | C03 |C01= '''Mild [[Dehydration]]'''|C02='''Moderate [[Dehydration]]'''|C03=<div style=" background: #FA8072; text-align: center; width:15em; padding:0.7em"> {{fontcolor|#F8F8FF|'''Severe [[Dehydration]]'''}}</div> }}<br />
{{familytree | | | | |!| | | | | | | |!| | | |!| |}}<br />
{{familytree | | | | C01 | | | | | | C02 | | C03 | |C01= Home treatment with [[ORS]], patient prescription, and dietary recommendations |C02=Is there any evidence of dehydration or > 8 watery stools in 24 hours or > 4 episodes of vomiting in 24 hours or < 6 months old|C03=<div style=" background: #FA8072; text-align: center; width:15em; padding:0.7em"> {{fontcolor|#F8F8FF|'''> Dehydration > 9 % Shock, Impaired consciousness''}}</div>}}<br />
{{familytree | | | | | | | | | | | |!| | | | | |!| |}}<br />
{{familytree | | | | | | | | | |C01 | | | | |C02 | | | | | |C01= Give [[ORS]] by spoon or syringe according to age and weight <br><br />
* Infants 5—9 kg: 2.0 mL every minute (120 mL/hr) <br><br />
* Infants 9—12 kg: 2.5 mL every minute (150 mL/hr) <br><br />
* Toddlers 12-15 kg: 3.0 mL every minute (180 mL/hr)<br><br />
* If there is no vomiting, then larger volumes at longer intervals: 10-15 mL every 5 or 20-30 mL every 10 minutes Racecadotril in 5 mL of water)<br><br />
* < 9 kg: 10 mg, 10-15 kg: 20 mg, 16-29 kg: 30 mg <br>|C02=<div style=" background: #FA8072; text-align: center; width:15em; padding:0.7em"> {{fontcolor|#F8F8FF|'''Intensive Care'''}}</div> }}<br />
<br />
<br />
{{familytree/end}}<br />
<br />
==Complete Diagnostic Approach==<br />
Shown below is an algorithm summarizing the diagnosis of acute diarrhea in children&lt;/nowiki&gt; according the the WHO guidelines.<ref name="WHO 2011">{{cite web | title=The treatment of diarrhoea | website=WHO | date=2011-12-15 | url=https://www.who.int/maternal_child_adolescent/documents/9241593180/en/ | access-date=2020-12-15}}</ref> <ref name="Radlovic Lekovic Vuletic Radlovic 2015 pp. 755–762">{{cite journal | last=Radlovic | first=Nedeljko | last2=Lekovic | first2=Zoran | last3=Vuletic | first3=Biljana | last4=Radlovic | first4=Vladimir | last5=Simic | first5=Dusica | title=Acute diarrhea in children | journal=Srpski arhiv za celokupno lekarstvo | publisher=National Library of Serbia | volume=143 | issue=11-12 | year=2015 | issn=0370-8179 | doi=10.2298/sarh1512755r | pages=755–762}}</ref><br />
{{familytree/start |summary=PE diagnosis Algorithm.}}<br />
{{familytree | | | | | | | | | A01 | | | A01= Patient with history of [[diarrhea]] }}<br />
{{familytree | | | | | | | | | |!| | | | }}<br />
{{familytree | | | | | | | | | B01 | | | B01= '''[[Assessment]]''' <br><br />
*A child with diarrhea should be assessed for [[dehydration]] <br><br />
*bloody diarrhea, persistent [[diarrhea]] <br><br />
*Malnutrition and serious non-intestinal infections so that an appropriate treatment plan can be implemented.<br><br />
}}<br />
{{familytree | | | | | | | | | |!| | | | }}<br />
{{familytree | | | | | | | | | B01 | | | B01= '''History''' <br><br />
*Duration and severity of [[diarrhea]];<br />
*Presence of blood in the stool;<br />
*Number of watery stools per day;<br />
*Number of episodes of vomiting; swollen; diaper rash<br />
*Presence of fever, cough, or other important problems (eq. convulsions, recent measles);<br />
*Pre-illness feeding practices; type and amount of [[fluids]] (including breast milk) and food taken during the illness;<br />
*History of Medications<br />
*History of [[immunization]]}}<br />
{{familytree | | | | | | | | | |!| | | | }}<br />
{{familytree | | | | | | | | | B01 | | | B01= '''Physical Examination''' <br><br />
*Look for the signs and symptoms of [[dehydration]] <br><br />
*Is the child alert, restless or [[irritable]] ?<br><br />
*Look for the eyes, are they normal or sunken?<br><br />
*Look for skin [[turgor]]?<br><br />
*Does the stool contain red blood?<br><br />
*Is the child [[malnourished]]?<br><br />
*Look for growth char, weight for length or measure the mid-arm circumference<br><br />
*Measure the temperature of child <br><br />
}}<br />
{{familytree | | | | | | | | | |!| | | | }}<br />
{{familytree | | | | | |,|-|-|-|+|-|-|-|-|.| }}<br />
{{familytree | | | | |C01| | |C02| |C03| |C01='''Mild [[Dehydration]]'''<br><br />
There are no specific signs and symptoms <br>|C02='''Moderate [[Dehydration]]''' <br><br />
<br />
Initially, the signs and symptoms that develop include:<br><br />
- [[Thirst]] <br><br />
- restless or irritable behavior <br><br />
- decreased skin turgor <br><br />
- sunken [[eyes]] <br><br />
- and a sunken fontanelle <br><br />
(in infants)|C03='''Severe [[Dehydration]]'''<br><ref name="Parker Unaka p=775">{{cite journal | last=Parker | first=Michelle W. | last2=Unaka | first2=Ndidi | title=Diagnosis and Management of Infectious Diarrhea | journal=JAMA pediatrics | publisher=American Medical Association (AMA) | volume=172 | issue=8 | date=2018-08-01 | issn=2168-6203 | pmid=29889925 | doi=10.1001/jamapediatrics.2018.1172 | page=775}}</ref><br />
these effects become more pronounced and the patient may develop evidence of [[hypovolaemic shock]] including: <br><br />
- Diminished [[consciousness]] <br><br />
- lack of urine output <br><br />
- cool moist extremities <br><br />
- a rapid and feeble [[pulse]]<br />
(the radial pulse maybe undetectable)<br><br />
- low or undetectable [[blood pressure]] <br><br />
- peripheral [[cyanosis]]. <br><br />
Death follows soon if rehydration is not started quickly <br> }}<br />
{{familytree/end}}<br />
<br />
==Treatment==<br />
Shown below is an algorithm summarizing the treatment of acute diarrhea in pediatric patients according the the WHO guidelines.<ref name="WHO 2011">{{cite web | title=The treatment of diarrhoea | website=WHO | date=2011-12-15 | url=https://www.who.int/maternal_child_adolescent/documents/9241593180/en/ | access-date=2020-12-15}}</ref><br />
{{familytree/start |summary=PE diagnosis Algorithm.}}<br />
{{familytree | | | | | | | | | | | A01 | | | A01=Patient presents with acute diarrhea in Emergency}}<br />
{{familytree | | | | |,|-|-|-|-|-|-|+|-|-|-|-|.| }}<br />
{{familytree | | | | C01 | | | | | | C02 | | | C03 |C01='''Mild [[Dehydration]]'''|C02='''Moderate [[Dehydration]]'''|C03='''Severe [[Dehydration]]'''}}<br />
{{familytree | | | | |!| | | | | | | |!| | | |!| |}}<br />
{{familytree | | | | C01 | | | | | | C02 | | C03 | |C01= Children with no signs of [[dehydration]] are given extra fluids and salts to replace losses due to [[diarrhea]].<ref name="Vega Avva 2020">{{cite web | last=Vega | first=Roy M. | last2=Avva | first2=Usha | title=Pediatric Dehydration | website=NCBI Bookshelf | date=2020-08-08 | pmid=28613793 | url=https://www.ncbi.nlm.nih.gov/books/NBK436022/ | access-date=2020-12-15}}</ref><br />
Following Fluids can be given in such cases <br />
* [[ORS]] <br><br />
* Salted drinks eg. salted rice water or salted [[yogurt]] drink <br><br />
* [[Vegetable]] or chicken soup with salt <br><br />
* Home-based ORS: 3 gm of table salt and 18 gm of common sugar in one liter of water. <br><br />
* Plain water should also be given.<br />
* Commercial carbonated beverages, fruit juices, sweetened tea, coffee, medicinal tea should be avoided.<br />
|C02=Oral rehydration therapy for children with moderate dehydration:<br />
* [[ORS]] + [[Zinc]] supplementation should be started <br><br />
* After 4 hours, reassess the child and decide what treatment to be given next as per the Grade of [[dehydration]].<br><br />
*Children who continue to have dehydration even after 4 hours should receive ORS by nasogastric tube or RL intravenously (75 ml/kg in 4 hours).<br><br />
*If abdominal distension then oral rehydration should be withheld and only IV rehydration should be given <br>|C03=<br />
*Start IV fluids immediately.<br><br />
*If the patient can drink, give ORS by mouth until the drip is set up. <br><br />
* Give 100 ml/kg [[Ringer's Lactate]] Solutions divided as follows<br />
*First, give 30 ml/kg in: Then give 70 ml/kg in Infants (under 12 months) in 1 hour <br />
*Reassess the patient every 1-2 hours.<br />
* If [[hydration]] is not improving, give the IV drip more rapidly as follows. <br />
*After six hours (infants) or three hours (older patients), evaluate the patient using the assessment chart. <br />
Then choose the appropriate Treatment Plan (A, B or C) to continue treatment. }}<br />
{{familytree/end}}<br />
<br />
==Do's==<br />
<br />
*[[Hydrate]] the child well. [[Hydration]] plays a vital role in early recovery and reversal of symptoms of [[diarrhea]].<ref name="Whinpark Medical Centre – Medical Doctors in Edinburgh">{{cite web | title=Diarrhoea and Vomiting – Dos and Don’ts – Whinpark Medical Centre | website=Whinpark Medical Centre – Medical Doctors in Edinburgh | url=https://www.whinpark.org/your-care/health-wellbeing-2/general-health-advice/diarrhoea-and-vomiting-dos-and-donts/ | access-date=2020-12-15}}</ref><br />
*Eating properly: Make the child eat properly such as eating a diet consisting of [[bananas]], rice, applesauce, and toast.<br />
*The use of [[probiotics]] can help shorten the duration of illness.<br />
*Use [[antibiotics]] only when indicated in case of pediatric diarrheal illness.<br />
<br />
==Don'ts==<br />
<br />
*Don't try to make special salt and fluid combinations at home unless your pediatrician instructs you and you have the proper instruments.<ref name="GI Associates 2019">{{cite web | title=The Dos and Don'ts of Treating Diarrhea for Quick Relief | website=GI Associates | date=2019-09-04 | url=https://gi.md/resources/articles/the-dos-and-donts-of-treating-diarrhea | access-date=2020-12-15}}</ref><br />
*Don't prevent the child from eating if she is hungry. <ref name="Positive Parenting 2016">{{cite web | title=Dos and Don’ts of Diarrhoea | website=Positive Parenting | date=2016-03-28 | url=https://mypositiveparenting.org/2016/03/28/dos-and-donts-of-diarrhoea/ | access-date=2020-12-15}}</ref><br />
*Don't use [[antibiotics]] unless prescribed by your pediatrician.<br />
*Don't ignore the [[Symptoms and Signs|symptoms]] and record [[temperature]] and [[hydration]] status.<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
[[Category:Projects]]<br />
[[Category:Resident survival guide]]<br />
[[Category:Pediatrics]]</div>
Usmanaliakbar
https://www.wikidoc.org/index.php?title=Diarrhea_resident_survival_guide_(pediatrics)&diff=1679041
Diarrhea resident survival guide (pediatrics)
2020-12-15T19:43:31Z
<p>Usmanaliakbar: /* Overview */</p>
<hr />
<div>__NOTOC__<br />
<br />
{{CMG}} {{AE}} {{Usman Ali Akbar}}<br />
<br />
{{SK}}<br />
<br />
{| class="infobox" style="margin: 0 0 0 0; border: 0; float: right; width: 100px; background: #A8A8A8; position: fixed; top: 250px; right: 21px; border-radius: 0 0 10px 10px;" cellpadding="0" cellspacing="0" ;<br />
|-<br />
! style="padding: 0 5px; font-size: 85%; background: #A8A8A8" align="center" |{{fontcolor|#2B3B44|Diarrhea resident survival guide (pediatrics) Microchapters}}<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Diarrhea resident survival guide (pediatrics)#Overview|Overview]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Diarrhea resident survival guide (pediatrics)#Causes|Causes]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Diarrhea resident survival guide (pediatrics)#FIRE: Focused Initial Rapid Evaluation|FIRE]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Diarrhea resident survival guide (pediatrics)#Complete Diagnostic Approach|Diagnosis]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Diarrhea resident survival guide (pediatrics)#Treatment|Treatment]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Diarrhea resident survival guide (pediatrics)#Do's|Do's]]<br />
|-<br />
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Diarrhea resident survival guide (pediatrics)#Don'ts|Don'ts]]<br />
|}<br />
<br />
==Overview==<br />
[[Diarrhea]] remains one of the leading causes of preventable death in developing countries, especially among children under 5 years of age. [[Diarrhea]] is defined as an increase in the number of stools or the presence of looser stools than is normal, like more than three bowel movements each day. [[Acute diarrhea]] is when [[diarrhea]] occurs for less than 3 weeks in total. When [[diarrhea]] lasts longer than three weeks, it is considered to be [[chronic]]. Hydration status plays an important role in the management of pediatric diarrheal illness. The younger the child, the greater the risk that fluid and electrolyte losses will lead to dehydration. The type of dehydration—isotonic, hypotonic, or hypertonic—is usually independent of the responsible agent. Fluid losses resulting from diarrhea and vomiting can be as high as three times the circulating blood volume (80–125–250 mL per kg body weight per day) and can be life-threatening. In order to keep the blood volume constant, the body usually extracts fluid from the intracellular space which can predispose it to dehydration. Complications and hospitalization due to dehydration can usually be prevented by the early and adequate oral administration of a rehydration solution (glucose-electrolyte solution) and normal food for the child’s age.<br />
<br />
==Causes==<br />
{| class="wikitable"<br />
|+<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Life Threatening Causes<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Common Causes<br />
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Misc<br />
|-<br />
|<br />
*[[Cholera]]<br />
*''[[Entamoeba histolytica]]''<br />
*[[Enterohemorrhagic Escherichia coli (EHEC)|Enterohemorrhagic ''Escherichia coli'' (EHEC)]]<br />
*[[Enteroinvasive Escherichia coli (EIEC)|Enteroinvasive ''Escherichia coli'' (EIEC)]]<br />
*[[Campylobacter]] spp.<br />
*[[Salmonella enterica|Nontyphoidal ''Salmonella enterica'']]<br />
|<br />
*[[Rotavirus]]<br />
*[[Enterotoxigenic Escherichia coli]] (ETEC)<br />
*[[Cryptosporidium]]<br />
*[[Shigella|Shigella spp.]]<br />
|<br />
*Parenteral causes including infections elsewhere in the body : [[UTI]],[[Acute otitis media]], [[Sepsis]].<br />
*[[Inflammatory ]] including [[IBD]],Allergy to cow's milk , [[whipples disease]].<br />
*[[Malabsorption]] including [[celiac disease]] ,[[lactase deficiency]]<br />
*Feed related<br />
*[[Endocrine]] :[[Hypothyroidism]],[[Addison's disease]] ,[[Hyperparathyroidism]]'<br />
*[[Neoplastic causes]]<br />
*[[psychosocial]]<br />
|}<br />
<br />
==FIRE: Focused Initial Rapid Evaluation==<br />
<br />
*A Focused Initial Rapid Evaluation (FIRE) should be performed to identify the [[patients]] in need of immediate [[intervention]]].<ref name="Koletzko Osterrieder 2009 p.">{{cite journal | last=Koletzko | first=Sibylle | last2=Osterrieder | first2=Stephanie | title=Acute Infectious Diarrhea in Children | journal=Deutsches Ärzteblatt International | volume=106 | issue=33 | date=2009-09-25 | pmid=19738921 | doi=10.3238/arztebl.2009.0539 | url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2737434/ | access-date=2020-12-15 | page=}}</ref><br />
{{familytree/start |summary=PE diagnosis Algorithm.}}<br />
{{familytree | | | | | | | | | | | A01 | | | A01=Patient presents with acute [[diarrhea]] in Emergency}}<br />
{{familytree | | | | |,|-|-|-|-|-|-|+|-|-|-|-|.| }}<br />
{{familytree | | | | C01 | | | | | | C02 | | | C03 |C01= '''Mild [[Dehydration]]'''|C02='''Moderate [[Dehydration]]'''|C03=<div style=" background: #FA8072; text-align: center; width:15em; padding:0.7em"> {{fontcolor|#F8F8FF|'''Severe [[Dehydration]]'''}}</div> }}<br />
{{familytree | | | | |!| | | | | | | |!| | | |!| |}}<br />
{{familytree | | | | C01 | | | | | | C02 | | C03 | |C01= Home treatment with [[ORS]], patient prescription, and dietary recommendations |C02=Is there any evidence of dehydration or > 8 watery stools in 24 hours or > 4 episodes of vomiting in 24 hours or < 6 months old|C03=<div style=" background: #FA8072; text-align: center; width:15em; padding:0.7em"> {{fontcolor|#F8F8FF|'''> Dehydration > 9 % Shock, Impaired consciousness''}}</div>}}<br />
{{familytree | | | | | | | | | | | |!| | | | | |!| |}}<br />
{{familytree | | | | | | | | | |C01 | | | | |C02 | | | | | |C01= Give [[ORS]] by spoon or syringe according to age and weight <br><br />
* Infants 5—9 kg: 2.0 mL every minute (120 mL/hr) <br><br />
* Infants 9—12 kg: 2.5 mL every minute (150 mL/hr) <br><br />
* Toddlers 12-15 kg: 3.0 mL every minute (180 mL/hr)<br><br />
* If there is no vomiting, then larger volumes at longer intervals: 10-15 mL every 5 or 20-30 mL every 10 minutes Racecadotril in 5 mL of water)<br><br />
* < 9 kg: 10 mg, 10-15 kg: 20 mg, 16-29 kg: 30 mg <br>|C02=<div style=" background: #FA8072; text-align: center; width:15em; padding:0.7em"> {{fontcolor|#F8F8FF|'''Intensive Care'''}}</div> }}<br />
<br />
<br />
{{familytree/end}}<br />
<br />
==Complete Diagnostic Approach==<br />
Shown below is an algorithm summarizing the diagnosis of acute diarrhea in children&lt;/nowiki&gt; according the the WHO guidelines.<ref name="WHO 2011">{{cite web | title=The treatment of diarrhoea | website=WHO | date=2011-12-15 | url=https://www.who.int/maternal_child_adolescent/documents/9241593180/en/ | access-date=2020-12-15}}</ref> <ref name="Radlovic Lekovic Vuletic Radlovic 2015 pp. 755–762">{{cite journal | last=Radlovic | first=Nedeljko | last2=Lekovic | first2=Zoran | last3=Vuletic | first3=Biljana | last4=Radlovic | first4=Vladimir | last5=Simic | first5=Dusica | title=Acute diarrhea in children | journal=Srpski arhiv za celokupno lekarstvo | publisher=National Library of Serbia | volume=143 | issue=11-12 | year=2015 | issn=0370-8179 | doi=10.2298/sarh1512755r | pages=755–762}}</ref><br />
{{familytree/start |summary=PE diagnosis Algorithm.}}<br />
{{familytree | | | | | | | | | A01 | | | A01= Patient with history of [[diarrhea]] }}<br />
{{familytree | | | | | | | | | |!| | | | }}<br />
{{familytree | | | | | | | | | B01 | | | B01= '''[[Assessment]]''' <br><br />
*A child with diarrhea should be assessed for [[dehydration]] <br><br />
*bloody diarrhea, persistent [[diarrhea]] <br><br />
*Malnutrition and serious non-intestinal infections so that an appropriate treatment plan can be implemented.<br><br />
}}<br />
{{familytree | | | | | | | | | |!| | | | }}<br />
{{familytree | | | | | | | | | B01 | | | B01= '''History''' <br><br />
*Duration and severity of [[diarrhea]];<br />
*Presence of blood in the stool;<br />
*Number of watery stools per day;<br />
*Number of episodes of vomiting; swollen; diaper rash<br />
*Presence of fever, cough, or other important problems (eq. convulsions, recent measles);<br />
*Pre-illness feeding practices; type and amount of [[fluids]] (including breast milk) and food taken during the illness;<br />
*History of Medications<br />
*History of [[immunization]]}}<br />
{{familytree | | | | | | | | | |!| | | | }}<br />
{{familytree | | | | | | | | | B01 | | | B01= '''Physical Examination''' <br><br />
*Look for the signs and symptoms of [[dehydration]] <br><br />
*Is the child alert, restless or [[irritable]] ?<br><br />
*Look for the eyes, are they normal or sunken?<br><br />
*Look for skin [[turgor]]?<br><br />
*Does the stool contain red blood?<br><br />
*Is the child [[malnourished]]?<br><br />
*Look for growth char, weight for length or measure the mid-arm circumference<br><br />
*Measure the temperature of child <br><br />
}}<br />
{{familytree | | | | | | | | | |!| | | | }}<br />
{{familytree | | | | | |,|-|-|-|+|-|-|-|-|.| }}<br />
{{familytree | | | | |C01| | |C02| |C03| |C01='''Mild [[Dehydration]]'''<br><br />
There are no specific signs and symptoms <br>|C02='''Moderate [[Dehydration]]''' <br><br />
<br />
Initially, the signs and symptoms that develop include:<br><br />
- [[Thirst]] <br><br />
- restless or irritable behavior <br><br />
- decreased skin turgor <br><br />
- sunken [[eyes]] <br><br />
- and a sunken fontanelle <br><br />
(in infants)|C03='''Severe [[Dehydration]]'''<br><ref name="Parker Unaka p=775">{{cite journal | last=Parker | first=Michelle W. | last2=Unaka | first2=Ndidi | title=Diagnosis and Management of Infectious Diarrhea | journal=JAMA pediatrics | publisher=American Medical Association (AMA) | volume=172 | issue=8 | date=2018-08-01 | issn=2168-6203 | pmid=29889925 | doi=10.1001/jamapediatrics.2018.1172 | page=775}}</ref><br />
these effects become more pronounced and the patient may develop evidence of [[hypovolaemic shock]] including: <br><br />
- Diminished [[consciousness]] <br><br />
- lack of urine output <br><br />
- cool moist extremities <br><br />
- a rapid and feeble [[pulse]]<br />
(the radial pulse maybe undetectable)<br><br />
- low or undetectable [[blood pressure]] <br><br />
- peripheral [[cyanosis]]. <br><br />
Death follows soon if rehydration is not started quickly <br> }}<br />
{{familytree/end}}<br />
<br />
==Treatment==<br />
Shown below is an algorithm summarizing the treatment of acute diarrhea in pediatric patients according the the WHO guidelines.<ref name="WHO 2011">{{cite web | title=The treatment of diarrhoea | website=WHO | date=2011-12-15 | url=https://www.who.int/maternal_child_adolescent/documents/9241593180/en/ | access-date=2020-12-15}}</ref><br />
{{familytree/start |summary=PE diagnosis Algorithm.}}<br />
{{familytree | | | | | | | | | | | A01 | | | A01=Patient presents with acute diarrhea in Emergency}}<br />
{{familytree | | | | |,|-|-|-|-|-|-|+|-|-|-|-|.| }}<br />
{{familytree | | | | C01 | | | | | | C02 | | | C03 |C01='''Mild [[Dehydration]]'''|C02='''Moderate [[Dehydration]]'''|C03='''Severe [[Dehydration]]'''}}<br />
{{familytree | | | | |!| | | | | | | |!| | | |!| |}}<br />
{{familytree | | | | C01 | | | | | | C02 | | C03 | |C01= Children with no signs of [[dehydration]] are given extra fluids and salts to replace losses due to [[diarrhea]].<ref name="Vega Avva 2020">{{cite web | last=Vega | first=Roy M. | last2=Avva | first2=Usha | title=Pediatric Dehydration | website=NCBI Bookshelf | date=2020-08-08 | pmid=28613793 | url=https://www.ncbi.nlm.nih.gov/books/NBK436022/ | access-date=2020-12-15}}</ref><br />
Following Fluids can be given in such cases <br />
* [[ORS]] <br><br />
* Salted drinks eg. salted rice water or salted [[yogurt]] drink <br><br />
* [[Vegetable]] or chicken soup with salt <br><br />
* Home-based ORS: 3 gm of table salt and 18 gm of common sugar in one liter of water. <br><br />
* Plain water should also be given.<br />
* Commercial carbonated beverages, fruit juices, sweetened tea, coffee, medicinal tea should be avoided.<br />
|C02=Oral rehydration therapy for children with moderate dehydration:<br />
* [[ORS]] + [[Zinc]] supplementation should be started <br><br />
* After 4 hours, reassess the child and decide what treatment to be given next as per the Grade of [[dehydration]].<br><br />
*Children who continue to have dehydration even after 4 hours should receive ORS by nasogastric tube or RL intravenously (75 ml/kg in 4 hours).<br><br />
*If abdominal distension then oral rehydration should be withheld and only IV rehydration should be given <br>|C03=<br />
*Start IV fluids immediately.<br><br />
*If the patient can drink, give ORS by mouth until the drip is set up. <br><br />
* Give 100 ml/kg [[Ringer's Lactate]] Solutions divided as follows<br />
*First, give 30 ml/kg in: Then give 70 ml/kg in Infants (under 12 months) in 1 hour <br />
*Reassess the patient every 1-2 hours.<br />
* If [[hydration]] is not improving, give the IV drip more rapidly as follows. <br />
*After six hours (infants) or three hours (older patients), evaluate the patient using the assessment chart. <br />
Then choose the appropriate Treatment Plan (A, B or C) to continue treatment. }}<br />
{{familytree/end}}<br />
<br />
==Do's==<br />
<br />
*[[Hydrate]] the child well. [[Hydration]] plays a vital role in early recovery and reversal of symptoms of [[diarrhea]].<ref name="Whinpark Medical Centre – Medical Doctors in Edinburgh">{{cite web | title=Diarrhoea and Vomiting – Dos and Don’ts – Whinpark Medical Centre | website=Whinpark Medical Centre – Medical Doctors in Edinburgh | url=https://www.whinpark.org/your-care/health-wellbeing-2/general-health-advice/diarrhoea-and-vomiting-dos-and-donts/ | access-date=2020-12-15}}</ref><br />
*Eating properly: Make the child eat properly such as eating a diet consisting of [[bananas]], rice, applesauce, and toast.<br />
*The use of [[probiotics]] can help shorten the duration of illness.<br />
*Use [[antibiotics]] only when indicated in case of pediatric diarrheal illness.<br />
<br />
==Don'ts==<br />
<br />
*Don't try to make special salt and fluid combinations at home unless your pediatrician instructs you and you have the proper instruments.<ref name="GI Associates 2019">{{cite web | title=The Dos and Don'ts of Treating Diarrhea for Quick Relief | website=GI Associates | date=2019-09-04 | url=https://gi.md/resources/articles/the-dos-and-donts-of-treating-diarrhea | access-date=2020-12-15}}</ref><br />
*Don't prevent the child from eating if she is hungry. <ref name="Positive Parenting 2016">{{cite web | title=Dos and Don’ts of Diarrhoea | website=Positive Parenting | date=2016-03-28 | url=https://mypositiveparenting.org/2016/03/28/dos-and-donts-of-diarrhoea/ | access-date=2020-12-15}}</ref><br />
*Don't use [[antibiotics]] unless prescribed by your pediatrician.<br />
*Don't ignore the [[Symptoms and Signs|symptoms]] and record [[temperature]] and [[hydration]] status.<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
[[Category:Projects]]<br />
[[Category:Resident survival guide]]<br />
[[Category:Pediatrics]]</div>
Usmanaliakbar