Constipation clinical presentation

Autonomic neuropathy is also a common complication as DM progresses. Clinical presentation of autonomic neuropathy may include gastroparesis, resting tachycardia, orthostatic hypotension, impotence, constipation, and hypoglycemic autonomic failure. Therapy for each individual autonomic complication is addressed separately. 

Table 36-7 shows the general clinical presentation of constipation. 

A 36-year-old woman who has been in good health presents to your clinic complaining of constipation and abdominal pain. She explains to you that she has been feeling stressed lately because her 40-year-old sister is undergoing chemotherapy for breast cancer, and they just lost there mother to ovarian cancer a few years ago. 

The clinical effects of overdosage with atropine-like drugs, as recorded in a series of 119 patients, are presented in Table 2 (5). Infrequent manifestations (less than 10% of cases) included seizures, convulsions, vomiting, rash, urinary retention, abdominal distress, paralytic ileus, and constipation. Death, when it occurs, is due primarily to the effects on the central nervous system a stage of excitement is followed by drowsiness, stupor, and coma, with generalized central depression. 

Typhoid fever is an illness caused by infection with Salmonella typhi. Typhoid is spread via the fecal-oral route. Clinical illness in its severe form is characterized by gradually rising fever that reaches 39 to 41°C (102.2 to 105.8°F) and persists for up to 2 weeks. Headaches, abdominal discomfort, malaise, myalgia, and anorexia usually are present. Older children and adults usually have constipation, whereas diarrhea is common in infants. Complications include intestinal perforation and hemorrhage. Between 2% and 5% of patients become chronic gallbladder carriers of S. typhi. 

A 38-year-old female presents to the clinic with complaints of alternating diarrhea and constipation. She reports some abdominal discomfort and bloating that are relieved with her bowel movement. She states that her episodes are worse in times of stress. She denies any blood in her diarrhea. She denies any weight loss or anorexia. Her physical exam is all within normal limits. She has been prescribed a cellulose-containing dietary supplement, which her doctor says will increase the bulk of her stools. 

A 65-year-old female presents to the clinic feeling tired and fatigued all the time. She has also noticed an increasing problem with constipation despite adequate fiber intake. She is frequently cold when others are hot. Her skin has become dry, and she has noticed a swelling sensation in her neck area. On examination she is afebrile with a pulse of 60 beats per minute. She is in no acute distress and appears in good health. She has an enlarged, nontender thyroid noted on her neck. Her reflexes are diminished, and her skin is dry to the touch. 

The German pediatric literature early in the present century has many references to a condition referred to as Milchnahrschaden (milk injury) occurring when infants were fed on cow s milk without added carbohydrate. The clinical picture was an indefinite one—failure to thrive, with pale, constipated stools. It was probably due to presentation of the protein in considerable part in a form which yielded indigestible curds and to a consequent decrease in available calories. Recent observations on formulas without added carbohydrate, but with the milk processed in such a way as to avoid difficulty with curd assimilation, have failed to produce Milchnahrschaden. 

Clinical Features Several symptoms and signs of hypothyroidism may be mistaken with those presented by a euthyroid pregnant woman (asthenia, weight increase, drowsiness, constipation, etc.), although others may make the diagnosis doubtful (bradycardia, sensitivity to cold, dry skin) (Abalovich et al., 2006). In contrast, 70-80% of women with OH, and almost all SGH carriers, may remain asymptomatic. Thus, particular attention... 

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