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 Functional Bowel Syndrome
Intermittent cramping abdominal pain, associated with episodes of
constipation or diarrhea, with or without mucous stools.
Patients with this problem give a history of periodically recurring
symptoms, often provoked by stress. X-ray evaluation of the abdomen will show no
abnormality and all lab studies will be normal. The pain will move from place to place in
the abdomen.
Treatment is generally supportive with reduction of stress when that is
possible. Avoiding (or treating) constipation or diarrhea is helpful. Non-narcotic
analgesics can be given if the pain is quite significant. Antispasmodics are sometimes
helpful. Psychoactive drugs are inadvisable unless a specific psychological disorder is
present which would be expected to respond to the psychoactive drug.
Gastroenteritis
Acute inflammation of the stomach and intestines, resulting in cramping
abdominal pain, distention, nausea, vomiting, diarrhea, fever, and chills. This may be due
to bacterial infection, viral infection, or ingestion of a toxic substance (food
poisoning).
Patients usually complain of diffuse, cramping abdominal pain with
marked GI symptoms. The pain migrates from place to place. Treatment is mostly supportive
(rest and observation in mild cases, IV fluids in severe cases) with specific antibiotic
therapy when the causative organism is known and sensitive to this approach.
Diverticular Disease
Diverticular disease represents a spectrum of abnormalities ranging from
asymptomatic "diverticula" (small outpouchings of the colon) to
"diverticulitis" with peritonitis, abscess formation and sometimes perforation
of the colon.
Diverticular disease is usually focused in the sigmoid colon in the left
lower quadrant, although diverticula can be found in small numbers anywhere along the
course of the large and small intestines.
Cramping lower abdominal pain with diarrhea alternating with
constipation are symptoms common to those with diverticular disease (and also functional
bowel syndrome). If accompanied by fever and elevated white blood count with a mass in the
left lower abdomen, "diverticulitis" is likely to be present.
Mild symptoms require only supportive treatment. Diverticulitis often
requires IV fluids and antibiotics.
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Appendicitis
This condition is characterized by progressive right lower quadrant
pain. Nausea and anorexia occur early. Vague pain begins in the periumbilical area and
migrates over several hours to McBurney's Point in the right lower quadrant. The patient
lies supine with the right hip flexed.
On examination, marked tenderness at McBurney's Point, voluntary
guarding, rigidity and rebound tenderness are found. Fever is not common unless appendix
is ruptured. Bowel sounds are quiet and no bowel movement will have occurred since the
onset of the pain. Motion of the uterus or right adnexa causes marked pain.
X-ray of the abdomen may show an oval, calcified fecalith up to 1-2 cm
in diameter in the right lower quadrant of the abdomen. A sentinel loop of gas-filled
small bowel next to the appendix may be seen. Ultrasound may show a
fluid-filled appendiceal lumen. CT scan can show appendicitis.
The treatment is essentially surgical. Antibiotics may be helpful but
are not an ideal substitute for surgery in other than unusual
circumstances.
- Unasyn 3.0 grams IV every 6 hours PLUS
- Flagyl 500mg IV every 6 hours, OR
- Mefoxin 2 gm IV every 6 hours, PLUS
- Gentamicin 80 mg IV every 8 hours, OR
- Gentamicin 80 mg IV every 8 hours, PLUS
- Flagyl (Metronidazole)
500mg IV every 6 hours
Gentamicin loading dose: 15 mg /kg infused IV over 1 hour (1 gm or 1,000 mg for a
70 kg adult)
Gentamicin maintenance dose: 7.5 mg/kg infused IV over 1 hour, every 6 hours (500 mg for a 70 kg
adult)
Bowel Obstruction
A condition in which a portion of the large or small intestine becomes
obstructed.
Patients with bowel obstruction complain of pain, which may be cramping
or constant. Abdominal dissension is prominent and patients are constipated. Nausea and
vomiting usually accompany this problem. Plain x-rays of the abdomen show a distended,
gas-filled loop of intestine proximal to the obstruction. If the problem is not resolved,
gangrene and peritonitis develop.
Initial treatment consists of decompression from above
with NG suction and support with IV fluids. Partial obstructions are
usually relieved with these simple measures. Complete bowel obstruction
requires surgery and bowel resection. Without surgery, a complete bowel
obstruction would be expected to be fatal.
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